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Competition will keep NHS on its toes

The plans in the health bill to increase competition won't lead to 'privatisation', but will unlock innovation and help GPs offer their patients better care, says Dr Paul Charlson

The BMA has said that the NHS should not be run like a ‘privatised industry' and that competition is potentially damaging to providing comprehensive, high-quality healthcare. But as Alan Milburn, a former Labour health secretary, wrote in the Health Service Journal recently: ‘Monopolies in any walk of life rarely deliver either operational efficiency or customer responsiveness. That's why there should be no preferred providers.'

The debate about competition has exploded as the Health and Social Care Bill makes its way through Parliament, but the discussion has polarised opinion and generated more heat than light.

Competition and privatisation are often linked, and the words are used interchangeably – yet the two concepts are quite different. There is a difference between private medicine where the patient pays directly and private providing services free at the point of use funded by the taxpayer.

GPs are private, profit-making businesses offering a mix of taxation and non-taxation funded services, but many GPs who are against ‘privatisation' seem to have conveniently forgotten this. Many alternative providers run successful, high-quality services using the same clinicians who work in the local hospital trust or surgery.

Similarly, hospital trusts compete for patients just like a private company. The fact is that the NHS is already a hotch-potch of providers all competing for a bigger slice of the £110bn in tax that you and I stump up each year.

Patients are not concerned about who provides their care so long as it is free, of good quality and offers continuity of care, short wait-times, easy parking and ideally convenient opening hours.

Nobody, least of all this Government, is suggesting that patients should pay for services that have previously been free. The NHS is not being privatised – the new bill is seeking to extend the concept of competing providers started in the 1990s and developed significantly under the last government.

Evidence-based charge

Healthcare is complicated and there is no simple answer as to whether competition is a good thing, but logically we all know that competition makes people up their game and that's often true in the NHS.

If you have two local services – one opening at weekends with high-quality clinicians operating from modern premises and another that has chaotic, weekday-only appointments, with stressed clinicians working from a scruffy building where you get lost and can't park – which would you choose?

Either the second service changes or it will close. The first service sounds like many new community services, and the second like some hospital outpatients departments. This is competition in action.

There is evidence that competition on price generally reduces standards, but fixed-price competition raises them.

The London School of Economics concluded in its 2010 report Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms: ‘Our results suggest that hospital competition in markets with fixed prices can lead to improvements in clinical quality.'

Professor Chris Ham, chief executive of the King's Fund, recently stated that competition is much more likely to benefit primary care, elective and planned care than emergency, unplanned and complex care, where collaboration and integration is far more important.

We also know that the system of pricing of services has to prevent cherry picking by reflecting the complexity of care. A proper competition framework focused in the right areas will unlock innovation, raise quality and ultimately provide better care. This is what the health bill seeks to achieve and the NHS is about.

A pause is sensible to ensure that everything is right – but it would be a grave mistake to dump the competition element completely.

Dr Paul Charlson is a chair of Conservative Health and a GP in east Yorkshire

Dr Paul Charlson