Intended for healthcare professionals

Feature Data Briefing

Paid for by the NHS, treated privately

BMJ 2015; 350 doi: (Published 10 June 2015) Cite this as: BMJ 2015;350:h3109
  1. John Appleby, chief economist, King’s Fund, London, UK
  1. j.appleby{at}

John Appleby looks at how much non-NHS providers contribute to NHS care

Central to the 1990 reforms of the NHS was the idea that by separating purchasers of care from providers, with the purchasers holding the money (but no services) and the providers services (but no money), the transactions that would need to take place would drive up quality and efficiency.1 Health authorities would be active purchasers of care on behalf of their resident populations. And in this “internal market” there would be freedom to shop around for the best deals from any organisation willing to supply, whether state owned or independent sector.

There have been several reboots of the original idea since then. Internal market 2.0 from the 2002 Labour administration emphasised patient choice and encouraged more private …

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