Intended for healthcare professionals

Feature Briefing

Is the great NHS sell-off under way?

BMJ 2014; 348 doi: (Published 29 April 2014) Cite this as: BMJ 2014;348:g2912
  1. Peter Davies, freelance journalist
  1. 1 London, UK
  1. petergdavies{at}

One year on from the health reforms in England, Peter Davies asks whether there has been an increase in private provision of NHS services

Twelve months after a reorganisation widely perceived as a blueprint for increasing private sector participation in the health service, is the great NHS sell-off under way? Given steadfast public resistance to any suggestion of NHS privatisation, such a move would have to be subtle. But is it happening at all?

What do the figures reveal?

Official statistics from the Department of Health detailing NHS spending on independent sector providers in 2013-14 are not due to be published until July. But a study released this week (3 May) by the NHS Support Federation, which opposes a competitive market in the NHS, has tracked NHS commissioners’ invitations to tender for clinical services and contracts awarded during the 12 months to April 2014. These appeared in the Official Journal of the European Union and on the Supply2health website.

Commissioners placed 390 contract notices during the year plus 22 “prior information” notices, while awarding 80 contracts. Among these, clinical commissioning groups (CCGs) were responsible for 274 advertisements, gave notice of 13 more coming up, and awarded 38 contracts. About 40% of CCG contract notices involved multiple partners.

Altogether this represented £13.5bn (€16.4bn; $22.7bn) of NHS funding, albeit spread over several years. The NHS Support Federation estimates this is more than three times the value of contract activity that it detected in the previous year. It found 77 types of clinical care and treatment covered compared with 44 in 2012-13. Diagnostics accounted for 19% of tenders, with mental health and pharmacy representing 7% each.

Of the 80 contracts awarded, 54 (worth a total of £475m) went to non-NHS providers, 25 (worth £88m) went to the NHS, and one was shared. The Department of Health maintains that …

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