Intended for healthcare professionals

Head To Head

Is the private sector a good thing for the NHS?

BMJ 2014; 349 doi: (Published 30 September 2014) Cite this as: BMJ 2014;349:g5865
  1. Richard Smith, chair, Patients Know Best, Cambridge, UK,
  2. Clive Peedell, consultant clinical oncologist, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
  1. Correspondence to: R Smith richardswsmith{at}, C Peedell clive.peedell{at}

Richard Smith argues that private sector investment in new products and services is essential to maintain the NHS, but Clive Peedell believes that markets and the use of private providers in healthcare will increase costs and reduce the quality of care

Yes—Richard Smith

The British public wants the NHS to continue to cover everybody, be free at the point of care, and provide equal quality of care for all. Severe financial constraints mean that these fundamental values are threatened, but the private sector can help sustain them. It can do so by continuing its present contribution, helping with the workload, bringing new skills, and contributing to competition.

Most general practices are in the private sector but see only NHS patients. This has been the case since the beginning of the NHS. Nobody doubts that general practice has been a good thing for the NHS, although the inverse care law—which says that those who need care the most get the least—is more true of general than hospital practice.1 General practice has also been highly variable in quality.2 Private companies that expand beyond single practices, often owned and run by GPs, are bringing higher quality care to underserved areas and ensuring more consistent quality across practices.3

To sustain the NHS it will be necessary to provide more services in the community, and larger companies with a greater capacity to invest will be more able to do this than traditional practices. But most importantly the private sector can supply new products and services. For example, it was the private sector that supplied general practitioners with electronic records years ahead of them arriving in hospitals, and now Patients Know Best, a company founded by a doctor and of which I’m the chair, is linking together records from practices, hospitals, and mental health services …

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