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Alternative primary care providers perform worse than traditional GP practices

Competition has not boosted quality and may have worsened care, say researchers

Caroline White

Friday, 24 April 2015

Alternative providers of primary care services in the NHS—which includes private sector companies— don’t perform as well as traditional GP practices, reveals a study* published today in the Journal of the Royal Society of Medicine.

Competition has not boosted the quality of care, and may have worsened it, say the researchers from Imperial College London.
Alternative providers have been contracted to offer primary care in the NHS in England since 2004 under reforms designed to boost competition.

The researchers looked at a range of 17 performance indicators from the Health and Social Care Information Centre and the national GP Patient Survey in all general practices operating between 2008-9 and 2012-13.

The indicators included access measures, such as how easily patients can get appointments, clinical measures, such as how well they manage patients’ blood pressure, and efficiency measures.

The analysis showed that 347 general practices, equivalent to 4.1% of the total, are now run by alternative providers, including private companies and voluntary sector organisations.

These practices tend to be smaller, and serve younger, more diverse, and more deprived populations than traditional providers.

But alternative providers performed worse than traditional GP practices on 15 indicators even after taking account of the characteristics of the practices and the populations they serve.

They fared worse on diabetes control and hospital admission rates for long-term conditions, and scored lower on overall patient satisfaction.

And switching to a new alternative provider contract did not boost performance either, the analysis showed.

Lead author Dr Christopher Millett, from the School of Public Health at Imperial, said that the study results would inform the debate about the growing role of the private sector in the NHS.

“New providers were allowed into the primary care market to stimulate competition, but our findings suggest that their introduction has not led to improvements in quality and may have resulted in worse care,” he explained.
“The lesson is that increasing diversity does not necessarily lead to better quality. Regulators should ensure that new providers of NHS services are performing to adequate standards and at least as well as traditional providers,” he said.
“So far, alternative providers have not been widely contracted to delivery primary care services,” said Dr Millett. “However, private sector providers have secured a third of contracts to deliver NHS clinical services since the Health and Social Care Act was enacted in 2013. Our findings highlight the need for careful and independent evaluation of how this legislation has impacted quality of care.”

* Felix Greaves, et al. Performance of new alternative providers of primary care services in England: an observational study. J R Soc Med April 23, 2015. doi: 10.1177/0141076815583303

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