The British Medical Association’s cause to reign in the spreading commercialisation of the National Health Service was given a boost this week after two Dutch doctors warned against increasing private sector involvement in the health service.

Writing in the British Medical Journal, the doctors point to the situation in The Netherlands where the introduction of competition through independent sector treatment centres has given rise to a climate in which private clinics are effectively cherry picking the easiest cases to deal with in order to ensure maximum profits.

“Unsurprisingly, such providers’ clinical outcomes and turnaround times can be excellent; they are likely to be heralded triumphantly for all to see how good healthcare can be in the private sector,” they write in, adding: “Meanwhile, poor old sate funded hospitals, with no ability (or desire) to refuse patients, have far higher delays and complication rates, and the blame is attributed (usually for political purposes) to unclean hospitals and poor nursing and medical care”.

The doctors have also questioned the “generous terms” awarded in ISTC contracts, which have come under fire before. Under the scheme, many private clinics awarded contracts under the first year of the programme in the UK have been paid even though they failed complete the contracted workload, and even enjoyed a 15% premium on tariffs awarded to the NHS, they note.

The cost-effectiveness of these centres needs “rigorous ongoing scrutiny”, particularly as discussions are currently underway for the second phase of the ISTC programme in the UK, the doctors stressed.

More contracts won
Their warning comes as a survey by Pulse magazine found a sharp rise in the percentage of contracts for GP-led health centres awarded to the independent sector over the last year.

Pulse looked at 55 equitable-access contracts and found that 40% were handed to private companies, compared to 24% in the prior batch it investigated, suggesting that GPs bidding for contracts are finding it hard to compete with independent groups.

“Many GP bidders are unwilling to undercut in a way that may risk quality,” Chaand Nagpaul, GPC negotiator and a GP in Stanmore, Middlesex, told the publication, and warned that too often contracts are being awarded “on the basis of lowest cost and not on quality”.