1. Can market forces make
the NHS more efficient?
David Pruce
PruceConsulting
Yes … but
2. Do we have a market in
the NHS?
• Secondary & Tertiary Care
– Not really
• Primary Care
– Pharmacy and Optometry
• Competition, mergers, acquisitions,
market exit
– General Practice
• Limited by relative shortage of GPs
– Dentistry
• Very few dentists with NHS contract
4. Market forces +ve
• Sharpens up organisations
– Threat of business failure, reward
of success
• Forces focus on to the customer
• Encourages innovation
– Doing something better or more
efficiently brings a competitive
advantage
5. Market forces -ve
• Market domination by powerful
providers
• Battling competitors rather
than collaborating
• Cost cutting affecting quality
and safety
• Competition centres on
profitable services
6. Reading the runes
• Choice
– Choice of any willing provider
(willing to provide NHS care to NHS
standards at NHS prices)
• FT, Private hospital, Charity or GP
– Choice of consultant-led team
– Choice of GP practice and
– Choice of treatment
• Choice without information is not
real choice
7. Reading the runes
• Competition
– Any willing provider
– Monitor’s role to “promote competition” and
enforce competition law
– Monitor compared with OFCOM/OFGEM
• All providers of NHS care should be able
to compete on a level playing field
8. The unknowns
• Who really decides
– Commissioner
– Patient
• Practical issues
– Shifting care from one provider to
another
– Speed of development of measures,
information, new pricing tariff,
regulations, etc.
– Will there be sufficient competition?
