BMJ 2015;350:h2184 doi: 10.1136/bmj.h2184 (Published 24 April 2015)
Page 1 of 1
Research News
RESEARCH NEWS Alternative providers of GP services perform worse than traditional practices Zosia Kmietowicz The BMJ
Researchers have warned that the quality of care in the NHS in England may suffer from the influx of private and voluntary sector providers, after finding that the performance of alternative providers of GP services was worse than that of traditional practices on a range of indicators.
The researchers, from Imperial College London, compared the quality of primary care services provided under new alternative provider contracts with that in traditional models of general practice. In the open cohort study they examined data on how all general practices in England operating between 2008-09 and 2012-13 performed on 17 established quality indicators covering clinical effectiveness, safety, patients’ experience, timeliness and access, efficiency, and equity. They included measures such as total points achieved in the Quality and Outcomes Framework (QOF), the proportions of hypertensive patients whose blood pressure was controlled, of patients with well controlled diabetes, and of women screened for cervical cancer, numbers of admissions for ambulatory care conditions, and practices’ prescribing of statins. Since 2004 private sector and voluntary organisations have been able to provide primary care services in England, and the scope for non-traditional providers to enter the NHS market was boosted by increased competition introduced by the Health and Social Care Act 2012. Reporting in the Journal of the Royal Society of Medicine, the researchers found that 4.1% of practices (347 of 8300) held an alternative provider contract in at least one year in the study period.1
Overall these alternative providers performed worse than traditional general practices on 15 of the 17 indicators, the researchers found after adjusting for the characteristics of the practices and the populations they served. Alternative providers had worse results on all measures of clinical quality and patients’ experience, though they had a higher percentage of patients who were satisfied with opening hours and to whom statins were prescribed. The study also found that performance did not improve when an alternative practice provider took over a traditional practice. The researchers acknowledged some limitations to their study, including the fact that the practices put out to tender as
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alternative provider practices may have had a history of poor performance and that the number of practices switching to alternative provider status may have been too small for the effect of change to be detected. They concluded that their findings “provide little support for the hypothesis that increasing plurality of provision has increased quality of care.” The study’s lead author, Christopher Millett, of the School of Public Health at Imperial College London, said, “This study provides data to 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 added, “So far, alternative providers have not been widely contracted to deliver primary care services. 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 the quality of care.”
1
Greaves F, Laverty A, Pape U, et al. Performance of new alternative providers of primary care services in England: an observational study. J Royal Soc Med 24 Apr 2015, doi:10. 1177/0141076815583303.
Cite this as: BMJ 2015;350:h2184 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS Alternative providers of GP services perform worse than traditional practices Zosia Kmietowicz The BMJ
Researchers have warned that the quality of care in the NHS in England may suffer from the influx of private and voluntary sector providers, after finding that the performance of alternative providers of GP services was worse than that of traditional practices on a range of indicators.
The researchers, from Imperial College London, compared the quality of primary care services provided under new alternative provider contracts with that in traditional models of general practice. In the open cohort study they examined data on how all general practices in England operating between 2008-09 and 2012-13 performed on 17 established quality indicators covering clinical effectiveness, safety, patients’ experience, timeliness and access, efficiency, and equity. They included measures such as total points achieved in the Quality and Outcomes Framework (QOF), the proportions of hypertensive patients whose blood pressure was controlled, of patients with well controlled diabetes, and of women screened for cervical cancer, numbers of admissions for ambulatory care conditions, and practices’ prescribing of statins. Since 2004 private sector and voluntary organisations have been able to provide primary care services in England, and the scope for non-traditional providers to enter the NHS market was boosted by increased competition introduced by the Health and Social Care Act 2012. Reporting in the Journal of the Royal Society of Medicine, the researchers found that 4.1% of practices (347 of 8300) held an alternative provider contract in at least one year in the study period.1
Overall these alternative providers performed worse than traditional general practices on 15 of the 17 indicators, the researchers found after adjusting for the characteristics of the practices and the populations they served. Alternative providers had worse results on all measures of clinical quality and patients’ experience, though they had a higher percentage of patients who were satisfied with opening hours and to whom statins were prescribed. The study also found that performance did not improve when an alternative practice provider took over a traditional practice. The researchers acknowledged some limitations to their study, including the fact that the practices put out to tender as
For personal use only: See rights and reprints http://www.bmj.com/permissions
alternative provider practices may have had a history of poor performance and that the number of practices switching to alternative provider status may have been too small for the effect of change to be detected. They concluded that their findings “provide little support for the hypothesis that increasing plurality of provision has increased quality of care.” The study’s lead author, Christopher Millett, of the School of Public Health at Imperial College London, said, “This study provides data to 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 added, “So far, alternative providers have not been widely contracted to deliver primary care services. 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 the quality of care.”
1
Greaves F, Laverty A, Pape U, et al. Performance of new alternative providers of primary care services in England: an observational study. J Royal Soc Med 24 Apr 2015, doi:10. 1177/0141076815583303.
Cite this as: BMJ 2015;350:h2184 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
