(Press-News.org) The analysis of 3,494 contracts awarded by 182 Clinical Commissioning Groups (CCGs) in England between April 2013 and August 2014 - disclosed to the BMJ under the Freedom of Information (FOI) Act - showed that in total, non NHS providers have secured 45% of contracts awarded since April 2013.
A total of 1,149 contracts (33%) were awarded to private sector providers, 335 contracts (10%) were awarded to voluntary and social enterprise sector providers, while 100 contracts (2%) were awarded to other providers, such as joint ventures or local authorities.
A further 1,910 contracts (55%) were awarded to NHS providers, including NHS hospitals, community and mental health providers and general practices.
The analysis examined different types of contract to provide NHS clinical services, including those awarded to a single provider without an open tender, those awarded via a competitive tendering process, and those awarded to multiple providers under Any Qualified Provider (AQP), a government policy that opened up a wide range of community based NHS services to different providers from outside the NHS.
Private sector providers were most successful at winning contracts awarded via competitive tender - 80 (41%), compared to 59 (30%) won by NHS providers. Private firms were also more likely to win smaller contracts on an AQP basis, for services such as diagnostics, audiology, and podiatry in the community.
The BMJ also found concerns among health professionals about fragmentation of care and a lack of transparency over where NHS funds were being spent.
The BMJ requested financial details for all contracts to see where NHS funds are being distributed. In many cases CCGs were unable or unwilling to provide figures.
CCGs did disclose the full value of 1349 contracts worth £10bn in total. Of these, NHS providers were awarded £8.5bn (85%), voluntary and social enterprise providers were awarded £690m (7%), private sector providers were awarded £490m (5%), while other providers were awarded £330m (3%).
The figures reflect the fact that many of the most high value contracts in this sample were awarded to NHS providers to provide acute care.
While NHS leaders said that the proportion of care being provided by private companies remains at the margins, campaigners said the findings provided further evidence that the government's reforms are gradually accelerating the privatisation of the NHS.
Simon Stevens, chief executive of NHS England, recently told The BMJ that the proportion of NHS care being provided by the private sector was "at the margins" and unlikely to increase much in the next few years. But Clive Peedell, a consultant oncologist and co-leader of the National Health Action Party, a political party set up to oppose the health reforms, warned that if the private sector continues to win a third of the contracts awarded long term, "then the NHS gets diluted as you'll get more and more private sector involvement over time."
David Hare, chief executive of the NHS Partners Network, which represents private sector companies that provide NHS services, said The BMJ's analysis suggested that commissioners were increasingly placing trust in the private sector.
Meanwhile, Rachael Addicott of healthcare think tank the King's Fund said political support for integrated care may create further opportunities for the private sector due to its strengths in areas such as IT, informatics and back office efficiencies. But she also suggested that some CCGs were "anxious" about the potential bad publicity of awarding large NHS contracts to private companies.
In the face of these competing pressures, joint ventures and alliances between the NHS, the private sector and others may become more commonplace as CCGs look at new methods of care delivery that retain an NHS ethos.
Steve Kell, GP and co chair of the NHS Clinical Commissioners representative group, said: "CCGs are trying to develop a sense of joint responsibility for populations, so people in the hospital are thinking beyond their hospital walls to look at nursing home quality, and anything that affects our patients. It's about working together."
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WASHINGTON, DC (December 9, 2014)--A study published today in the Journal of the American Medical Association (JAMA) shows that physicians who do residency training in regions of the country with higher health care spending patterns continue to practice in a more costly manner - even when they move to a geographic area where health care spending is lower.
Immediately following residency, physicians whose residencies were in higher-spending regions spent 29 percent more on average than their peers who had trained in lower-spending areas of the country, according to the ...
The cognitive effects of poverty can be mitigated during middle school with a targeted intervention, according to researchers at the Center for BrainHealth at The University of Texas at Dallas.
In a paper published today in the open-access journal Frontiers in Human Neuroscience, researchers for the first time examine the efficacy of cognitive training in a large and diverse group of 7th and 8th grade public middle school students as compared to typically developing students who received no specific training.
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Rules don't reduce death, morbidity or adverse effects
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The restrictions also did not result in any differences in surgical residents' performance on exams.
"Our study suggests that these ...
An examination of the effect of resident duty hour reforms in 2011 finds no significant change in mortality or readmission rates for hospitalized patients, according to a study in the December 10 issue of JAMA, a theme issue on medical education.
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented new duty hour reforms for all ACGME-accredited residency programs. The revisions maintain the weekly limit of 80 hours set forth by the 2003 duty hour reforms but reduced the work hour limit from 30 consecutive hours to 16 hours for firstyear ...
An examination of the effect of resident duty hour reforms in 2011 finds no significant change in outcomes for general surgery patients, according to a study in the December 10 issue of JAMA, a theme issue on medical education.
Ravi Rajaram, M.D., of the American College of Surgeons, Chicago, and colleagues conducted a study to determine if the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance.
The study examined general surgery patient ...
Among primary care physicians, the spending patterns in the regions in which their residency program was located were associated with expenditures for subsequent care they provided as practicing physicians, with those trained in lower-spending regions continuing to practice in a less costly manner, even when they moved to higher-spending regions, and vice versa, according to a study in the December 10 issue of JAMA, a theme issue on medical education.
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An analysis of the non-English-language skills of U.S. medical residency applicants finds that although they are linguistically diverse, most of their languages do not match the languages spoken by the U.S. population with limited English proficiency, according to a study in the December 10 issue of JAMA, a theme issue on medical education.
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Sunny Smith, M.D., of the University of California, San Diego, and colleagues conducted a study to assess whether there has been growth of student-run free clinics (SRFCs) in medical schools and describe the characteristics of these clinics. The first national study of SRFCs conducted in 2005 ...
In a sample of U.S. emergency departments, compared to attending physicians alone, supervised visits (involving both resident and attending physicians) were associated with a greater likelihood of hospital admission and use of advanced imaging and with longer emergency department stays, according to a study in the December 10 issue of JAMA, a theme issue on medical education.
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PHILADELPHIA - In the first year after the Accreditation Council for Graduate Medical Education (ACGME) reduced the number of continuous hours that residents can work, there was no change in the rate of death or readmission among hospitalized Medicare patients, according to a new study published in JAMA. The study was led by researchers at the Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia.
"There has been a lot of speculation about the effect of the 2011 ACGME duty hour reforms on patient outcomes, so we looked ...
