The benefits to patients of 'healthy' competition

I once worked with a consultant who had an uncanny ability to extract the truth from his junior staff. When he suspected dubious information (such as “I’m sure the patient had a high erythrocyte sedimentation rate (ESR)”) he’d say, “Is that a guess, rumour, fact or lie?”

Of course, he did it in such an intimidating manner that the answer was clear by the blood draining from the face of the poor, unfortunate wretch who didn’t have all the information to hand.

The current debate about the absolute need to reorganise and improve the NHS often reminds me of that consultant’s 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 claiming that “competition is bad for the NHS and bad for patients”.

Good competition is encouraged in good industries for a reason and health care – and patients – should be allowed to realise these benefits

Such views mainly seem to come from political-posturing and professional associations, which protect the interests of their own members by treating change as heresy. This is not a guess, rumour or fact, it is a lie.

So here is a fact: increased competition in UK GP services gives better clinical outcomes and better patient experience. 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. 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.”

The conclusions are:

• increased competition is associated with better quality of primary care;

• increased competition is associated with reduced taxpayer expenditure;

• the presence of additional rival practices is associated with patients being more satisfied with the efforts made by their GP practice.

Poorly regulated competition is not good, and it is easy to find examples of failed competition in all sectors.

But, good competition is encouraged in good industries for a reason and health care – and patients – should be allowed to realise these benefits. Everyone who truly believes in improving patient care should be arguing for increased and fully regulated competition in primary care. Fact.

Neil Bacon is CEO and Founder of iWantGreatCare. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.