Reform Scotland

Let’s be honest: the NHS relies on the private sector

This article by Alison Payne first appeared in The Times on 21 November 2019.

Watching the general election campaign, you could be forgiven for thinking the NHS is a wholly publicly owned and operated service. But as with so much in this campaign, that is far from the truth.

The NHS in Scotland is undoubtedly in need of reform. Audit Scotland’s recent report highlighted financial constraints, while our demographic projections of an ageing population with fewer working-age people present serious challenges that need to be addressed. But in order to reform we have to understand how the health service operates at present, and currently our NHS would fall apart without private sector contractors. GP surgeries, pharmacists, opticians, dentists: all private sector contractors providing crucial services.

Most patients’ first and only contact with the NHS in Scotland is via the private sector, at their GP. Although an increasing number of surgeries are being run directly by NHS boards, this still represents a tiny minority. According to ISD Scotland, the NHS information service, at October 1, 2019 there were 935 GP practices. Of these, only 58 were classed as a “2C practice” — a practice run directly by an NHS board. The other 94 per cent were private sector contractors.

Primary care in Scotland, as with the rest of the UK, is heavily reliant on the private sector and to claim otherwise is misleading.

If managed properly, giving public money to contractors to deliver public services can lead to a diverse range of providers, helping to raise standards across the board. However, that doesn’t mean there isn’t room for improvement. For example, there can be a great deal of variation in how GP practices operate. Some allow you to book non-urgent appointments a couple of weeks in advance, others only allow you to book an appointment for that day. Some offer extended hours cover, others offer none. Some allow patients to book appointments online, others do not.

Such differences in provision would be unacceptable in publicly owned and operated services, but this lottery is operated by the private sector because patients have little choice in the practice they are with. Even finding out what, if any, choice you may have is not straightforward. The “find local services” tool on the NHS inform website gives far less information than NHS Choices, which covers England.

Serious discussion is required on the future of our NHS, but that debate must take account of the reality that the health service relies on the private sector.