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The real privatisation

GMC Arora

This year, the new health bill will usher in yet another reorganisation of the NHS. Critics say it will open the door to the ‘privatisation’ of the NHS. 

The criticism is based – as far as I understand it – on a potential move to ‘accountable care organisations’, which will offer primary and secondary care services in a way that will be attractive to US health firms, which already run this model. 

This seems a bit of a stretch. In fact, I’d say there is evidence the bill is a move away from privatisation, in the sense of private firms taking over NHS contracts. 

The 2012 reforms opened the door to private firms through Section 75, whereby contracts above a certain threshold had to go out to procurement. The latest bill explicitly removes this.   

In fact, the bill is a fairly dull piece of legislation that just codifies changes that have already happened with the move away from CCGs.

There are a few reasons why I can’t see us reaching a stage where NHS contracts are being taken over on a grand scale. Principally, despite the claims of the more rabid free marketeers, the NHS is incredibly efficient. The work NHS bodies – GPs, hospitals and all other providers – get through for the money they receive is astounding. And lots of work for not much profit is hardly an attractive option for shareholders. 

Capita’s primary care support services contract offers an illustration of what happens when the private sector takes over NHS contracts. I don’t imagine too many at Capita are still happy they won it after seeing the scale of the tasks. 

But there’s another reason the private sector won’t be looking to take on existing NHS contracts any time soon: it already has the best of all worlds. 

With waiting lists growing, private providers are benefiting from a growth in the self-pay healthcare market. They can continue with full control of their contracts, knowing there is a new pipeline of patients. They can even charge the NHS to use their services at their own rates for taking on the overdemand. 

And I believe this is even more damaging than traditional concepts of private sector takeover. If we consider the aspects of privatisation many of us fear, the worst ones are already being realised: healthcare no longer being free at the point of use; widening inequality; a two-tier system; people being plunged into financial difficulties due to poor health; and companies profiting from ill health. 

I don’t blame the companies, which could argue that without them even more patients would be waiting for care, and pressure on the NHS would be even greater. 

No, the blame lies with the Government. Austerity has cut healthcare spending in real terms, while cuts to other public services have medicalised more people’s problems. Yet ministers ramp up demand, promising patients all the access they need – notably in general practice.    

We are never going to see HealthCo running A&Es, and, beyond the current handful of APMS contracts, private firms will see no value in the GP contract.  

But don’t think this avoids a privatised health service. Because my fear is that we are already there. 

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash  or email him at


Gerard Bulger 7 January, 2022 9:23 am

GPs are never nationalised, always private with a contract, always “privatised”. Alas most GPs now prefer to be part time and salaried, and the concept of primary care as a business and capital pension pot now gone. The mantra against it is “vested interest” which is never an issue when declared or obvious but now seen as a grave sin (wages are not regarded that way). The result has been that primary care did not seize the initiative and grab the opportunities when the epidemic broke, in fact withdrew so GPs were cut out of the loop. it is not surprising that others are filling the void that the profession created. Vested interest simple mean interested. GPs can hardly rail against priviatisation when they themselves are private contractors.