More than two-thirds of doctors are uncomfortable with the use of private providers for NHS services, according to a new report by the British Medical Association.

In a survey for the report, 67 percent of doctors said they were fairly or very uncomfortable with independent sector provision of NHS clinical services, with commonly cited concerns being fragmentation of services and poor value for money. 

Nearly half (49 percent) of respondents also said the current level of spending on private providers was higher/much higher than expected.

According to the trade union, every year for the past five years the amount of money spent by NHS England on healthcare provided by the independent sector has increased, with the current yearly total at nearly £7 billion, around 6.3% of the total NHS budget.

While this remains a relatively small portion of the overall spend, the Association insists that the independent sector should be subject to the same robust standards as NHS providers, and stressed that managers must be wary of the health service becoming fragmented.

“Privatisation remains a major concern for our members because it has seemed to be a thread through the previous three Governments,” noted BMA council chair Mark Porter. 

“There are widespread fears that the private sector will be allowed to cherry-pick the most profitable work, leading to a destabilising effect on the wider NHS,” he said, and warned that in some cases it may could push trusts already facing record deficits to the point of collapse. “This betrays a complete lack of strategic sense as to how an integrated and effective health service should be run.”

The BMA’s first report on privatisation in the NHS makes a series of recommendations aimed at keeping the service on an even keel and ensure that, where independent sector providers are already delivering NHS care, “the priority remains for them to support the NHS to deliver high quality services”. 

Data collection and transparency

For one, NHS England should collect data on levels of independent sector provision of NHS services by sector (community service, mental health, etc), it says, and before any independent sector provider is chosen as a preferred bidder, there should be a thorough impact analysis taken to ensure the decision will not destabilise existing NHS services.

Also key, independent sector providers should be subject to the same requirements as NHS providers in relation to transparent reporting of both patient safety incidents and performance, and the standard NHS contract should be amended to include a clause requiring private providers to contribute towards the education and training of the NHS workforce, in addition to the existing requirement to support the work of Health Education England and local education and training boards, it suggests.

The recommendations follows a series of high profile cases in which private involvement in NHS care has led to failings, including the problems at Hitchingbrooke, which was taken over by private firm Circle Partnership in 2012 “before being handed back to the NHS three years later in special measures and with severe financial pressures,” and in West Sussex, where commissioners gave a £235 million contract for musculoskeletal services to Bupa, before a study revealed the deal would push the local hospital trust into deficit.