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Proven fact: choice and competition is great for patients

June 9, 2011

I once worked with a canny old consultant who could sniff out rubbish, guesses and lies from his junior staff.
When he smelt dubious information (such as “I’m sure the patient had a high ESR”) he’d say, “is that a lie, guess, rumour or fact?”.
Of course he did it in such an intimidating and powerful manner that the answer was quite clear by the blood draining from the face of the poor, unfortunate wretch who hadn’t actually got all the information to hand.

The current debate about the absolute need to reorganise and improve the NHS often reminds me of that consultant and his total focus on truth and how it is fundamental to delivering the best possible care for patients. I am especially reminded of it when I read reports from those claiming categorically that “competition is bad for the NHS and bad for patients”. This is not a guess, rumour or fact, it is a lie – and one that mainly seems to come from political-posturing, dogma and those professional associations formed to protect the interests of their members (because it is indeed true that competition is bad for some parts of the NHS and some GPs – those that give poor quality care!).

Of course, poorly regulated competition is not good, and it is easy to find examples of failed competition – just as it is all too easy to find examples of failed parts of the NHS. Just because some Trusts have failed, it does not mean that all NHS Trusts are bad, and just because some competition is bad, it is untrue to say that all competition is bad for the NHS.

So hear is a fact – it is not a lie, rumour or guess. Increased competition in UK GP services gives better clinical outcomes and better patient experience. The detailed academic research was done by Dr Chris Pike of the Co-operation and Competition Panel and published in 2010. Here is the abstract:

We analyse the relationship between the quality of a GP practice in England and the degree of competition that it faces (as indicated by the number of nearby rival GP practices). We find that those GP practices that are located close to other rival GP practices provide a higher quality of care than that provided by GP practices that lack competitors. This higher level of quality is observed firstly in an indicator of clinical quality (referrals to secondary care for conditions that are treatable within primary care), and secondly in an indicator of patient observed quality (patient satisfaction
scores obtained from the national GP patient survey). The association between increased competition and higher quality is found for GP practices located within 500 metres of each other. However it would appear that the magnitude and geographic scope of the relationship are constrained by restrictions upon patient choice. As a result the findings presented here may only reflect a fraction of the potential benefits to patients from increased choice and competition.

And the conclusions:
Firstly, increased GP competition is associated with a better quality of primary care.
Secondly…this paper suggests that increased GP competition is associated with reduced taxpayer expenditure.
Thirdly, the presence of additional rival GP practices is associated with patients being more satisfied with the efforts made by their GP practice. Improved levels of patient satisfaction reflect important aspects of the quality of service that the NHS provides to its patients.

Everyone who truly believes in improving patient care should be arguing for increased competition in primary care. Fact.

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