Two-tiered medicine: the increasing disparity in medical care in the UK

Howard Freeman

doi:10.3399/bjgp21X715385

Independent healthcare providers have long been a core part of the UK health system and both patients and GPs should be reassured by the safety and quality of the services delivered in the independent sector to NHS and privately funded patients.

Currently over 84% of independent acute hospitals are rated good or outstanding by the Care Quality Commission, which compares favourably with the NHS average, with independent providers scoring highly in both the NHS Family and Friends Test, as well as Patient Reported Outcome Measures (PROMs). Indeed, the latest figures available show that 9 of the top 10 providers under PROMs scores for primary hip and knee replacements are from the independent sector.

Dr Dawson is right to acknowledge the importance of transparency in the health service and the need for both NHS and independent providers to work together to provide safe, seamless care for patients¹ — particularly in light of the Paterson case. Indeed, in his report into this last year, the Bishop of Norwich made clear that a ‘whole-systems solution’ will be needed to minimise the chances of any similar cases happening again.² The independent sector, for its part, has already taken important steps to further strengthen and build upon the medical governance systems already in place, notably with the launch of the ‘Medical Practitioners Assurance Framework’ in 2019, led by Sir Bruce Keogh, which set out key principles around expected practice for acute independent providers in a number of areas, including: clinical governance structures; patient safety, clinical quality, and continuous improvement; wholepractice appraisal of clinicians; and raising and responding to concerns from staff and patients.³

NHS and independent-sector partnerships have really stepped up during COVID-19. Over 2.5 million NHS patients have been treated in independent hospitals alone as part of a historic agreement that ensured vital non-COVID treatment, including highly complex urgent cancer care, could continue during the pandemic — hailed as ‘lifesaving’ by the Royal College of Surgeons.⁴ And with waiting times for NHS treatment getting ever longer, it’s vital that these public/private partnerships continue to ensure that patients can access the safe, high-quality treatment they need.