Commercialisation and private business models in English primary care: learning from global health?

Maureen Mackintosh, Pam Smith, Julia Chukwuma

Photo by Natanael Melchor on Unsplash

Debate concerning the role of the private sector within the UK National Health Service has until the 2020s focused mainly on hospital services, but is now turning to primary care. We argue that the extensive global health research literature on the private sector in health systems can offer useful lessons for this emerging debate. We apply definitions and metrics developed to measure the extent and nature of commercialisation in global health systems to documenting trends in the organisation of English primary care. While English primary care is largely provided, for no charge, by private general practitioner-owned partnerships, that business structure has come under increasing financial and institutional pressure. This working paper documents, from secondary literature, changing private business models in English primary care, and ways in which they are driving increases in charging and commercialisation. We argue that UK research and policy debates lag behind the global health field in their lack of attention to the impact of alternative primary care business models in shaping health system commercialisation. Despite clear national commitment to funding healthcare free at the point of use, the English primary care system may now be sleep-walking into normalising primary care charging, with severe potential consequences for access and inequality. Implementing the Labour government’s political commitment to shifting more relative resource and activity towards primary care that is free at the point of use, while sustaining and rebuilding family practices, can reverse the trend but that initiative will require clear policies on business models and the limits to commercialisation. 

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International Development Research Office
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