Can market forces makethe NHS more efficient? David Pruce PruceConsulting Yes … but
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
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
Market forces -ve• Market domination by powerful providers• Battling competitors rather than collaborating• Cost cutting affecting quality and safety• Competition centres on profitable services
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
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
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?