Education And Debate

New providers in UK health care

BMJ 2004; 328 doi: (Published 05 February 2004) Cite this as: BMJ 2004;328:340
  1. Penelope Dash, independent advisor in health care (
  1. 1St Albans, Hertfordshire AL1 4HH
  • Accepted 15 January 2004

What effect will more competition have on the NHS?

Over the past 5-10 years the European airline market has been completely transformed by the introduction of new players. Through a combination of adding capacity and radically changing traditional ways of working, Ryanair and Easyjet have effectively challenged the status quo among the traditional incumbents (British Airways, Alitalia, Air France, etc) and created a whole new approach to air travel across Europe. Can the same transformation happen in health care?

The current UK government hopes so. Since its election to office in 1997, the government has set itself an ambitious strategy to substantially improve health care. The strategy has three key planks—improvement of quality, expansion of capacity, and introduction of new incentives (in particular customer choice1) to drive through radical changes (box). This article explores how the expansion of capacity through opening up health care to new providers, combined with increasing consumer choice, will change the way in which health care is provided and used.

New providers to increase capacity

The NHS Plan focused on increasing capacity and put at its heart key targets for the reduction of waiting lists and waiting times for planned elective care.2 By 2005, no patient will have to wait more than six months for a routine operation, and by 2008, waiting times will be less than three months.

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Changes in health care could bring substantial benefits to patients


Mechanisms for implementing three key components of NHS strategy Improving quality

  • National service frameworks

  • New general practice contract

  • Commission for Healthcare Audit and Inspection,other inspectorates, National Institute for Clinical Excellence

Increasing capacity

  • NHS Plan

  • New providers

Creating incentives for change

  • Choice initiative

  • Star ratings

  • Reforming financial flows

  • New staff contracts

  • Commissioning role for primary care trusts

  • Vouchers?

Increased capacity will be achieved partly by expanding existing NHS services but also by purchasing services from non-NHS organisations—so called plurality of provision.3 The …

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