The involvement of private companies in the National Health Service always generates controversy. Some people believe that only commercial interests can bring innovation and efficiency to modernise the NHS. Others assume that the profit motive is incompatible with the pursuit of excellence in health care.

This debate has been reignited by the announcement that United Health Europe, a subsidiary of a large American health company, has won a contract to run three NHS general practices in London. This is the latest in a series of similar acquisitions by commercial companies throughout England. The government is also investing £250m (€335m; $487m) in establishing at least 150 new health centres, many of which will probably be run by private companies.1

These developments are meant to increase access to primary health care in areas where existing contractual arrangements have not provided adequate services.2 The establishment of new health centres is linked to the aim of developing large polyclinics that offer extended services and wide opening hours.3 However, these changes are also part of the broad …