How does the private sector interact with the NHS?

Wednesday, 6th February 2019

Guest blog by Charlotte Lewis, Senior Associate at Mills & Reeve and Chair of pro-manchester’s Healthcare sector committee. 

The NHS Long Term Plan (LTP) emphasises the need for NHS organisations to collaborate with local partners to meet the needs of local people, highlighting the fact that those partners can be from the independent, voluntary or social care sectors.

It is a common misconception that our health care service is delivered purely by the public sector. The private sector has always played a key role in the NHS but despite this, there remains a concern that the private sector involvement is evidence of the NHS being privatised and is bad for the NHS.

The pro-manchester healthcare sector group held a roundtable at Mills & Reeve to explore how this fear might be dispelled, allowing the effective collaboration envisaged by the LTP. Several themes cut through the discussion including, quality, value, trust and engagement.

“If you don’t engage with people they will create their own story to fill the gaps”

A key concern of the group was the messaging around private sector investment in the NHS, with many believing it had contributed to the feeling of mistrust. A lack of transparency about involvement of the private sector only damaged the sector’s chances to gain public trust.

The private sector has much to bring to the NHS, often moving more quickly and flexibly compared to its public sector counterparts. In terms of clinical services, private providers have been used to provide additional capacity to an overstretched NHS. The partnership between the University Hospital Plymouth NHS Trust and Care UK, to perform hip and knee operations at Care UK’s Plymouth Treatment Centre using a mixture of NHS and private surgeons has been rated “outstanding” by the healthcare regulator.

Despite these benefits there is often a knee jerk reaction to private sector involvement in the NHS. Fear often lies in “creeping privatisation”. A fear that we will move to a world where patients do not know whether a recommended service or product is really the best option for them or whether the clinician or provider receives a commission for doing so.

“Long term partnerships”

Our group felt strongly that it shouldn’t matter whether a supplier into the NHS is a public or private organisation provided they are delivering quality and value. So what can help to improve public opinion?

Patients Know Best (PKB), whose aim is to put patients in control of their medical records through an online patient portal, discussed how they hoped to make a difference. PKB deliver their software “as a service rather than a product” and see their relationship with the NHS as a “long term partnership”. This means that both sides are more invested in making the relationship a success. PKB also offer an outcomes-based arrangement where customers only pay for the service when the desired outcomes are achieved. In their view, this drives up performance as it incentivises PKB to do well.

Our group agreed that these outcomes-based models of contracting should be adopted more widely to get the best out of all suppliers (be they public, private or third sector) and to help reinforce to the public the fact that private as well as public suppliers are there to deliver real benefits.


No-one at our event thought it would be easy to dispel long-held fears about motivations of the private sector in the NHS. However, there was optimism that an increased transparency; the use of outcomes based contracting models; and the creation of long term partnerships with the NHS could help generate more acceptance and trust.

Maybe the launch of the LTP marks the beginning of a new era in the relationship between public and private suppliers in the NHS.