Intended for healthcare professionals

Rapid response to:


A third of NHS contracts awarded since health act have gone to private sector, BMJ investigation shows

BMJ 2014; 349 doi: (Published 10 December 2014) Cite this as: BMJ 2014;349:g7606

Rapid Response:

We read with interest and concern your investigation into awarding of contracts by CCGs, revealing that only 55% go to the NHS.

The news today that Nottingham University Hospitals Trust - once one of the biggest teaching trusts in England - has been forced to axe its once renowned acute dermatology service due to an exodus of staff following the transfer of their contract to a private provider, is just one example of the impact of poor commissioning decisions.

Dermatology is a prime example of how political meddling is decimating the NHS, despite 54% of the population each year suffering from skin diseases. This specialty has suffered disproportionately, because it has been perceived as being easy to shift ‘into the community’ using private providers, due to the mistaken view that skin diseases are easy to diagnose and treat locally. However, the shift to the community has led to decommissioning of dermatology hospital services, and has not achieved its intended aim of improving patient care. Where implemented, NHS community services were associated with a 67% increase in referrals to local secondary care and private community services use similar care models. The cost usually remains the same per head of patients as in the acute hospital service so the net effect of the increased referrals is greater expense for the local health economy. Plurality of services under Any Qualified Provider has not provided integrated care despite being a requirement of the Service Specification and contract. Instead, there are increased referrals to both community and hospital services with increasing waiting times to see dermatologists.

‘Cherry-picking’ by private healthcare providers, who take on profitable high volume, routine dermatology surgery work, leaves local NHS hospitals with more difficult and expensive cases, aggravating hospital financial pressures and destabilising secondary care services.

Loss of staff threatens provision of specialised services. Loss of high quality hospital training programmes will reduce the sustainability of health care in the UK. Closure of high quality research will stifle innovation. What is happening in dermatology today will affect other specialties now and in the future.

Our secondary and tertiary services in every specialty have been built up over many years to provide sustainable care, training and research for serious diseases. Change is essential to maintain the affordability of health care in the UK. However political healthcare experiments should be piloted in localised areas and evaluated to determine efficiency in an objective way.

Competing interests: No competing interests

16 December 2014
David J Eedy
Nick Levell, Clinical Vice President, British Association of Dermatologists
British Association of Dermatologists
4 Fitzroy Square, London, W1T 5HQ