New NHS market to come under the microscope

The new NHS market in England will come under the microscope this autumn with a major King's Fund programme examining three critical aspects of the new market - regulation, commissioning and primary care, and incentives.

The series is launched today with an overview paper, NHS Market Futures: Exploring the impact of health service reforms, which examines the health service market as it stands today and considers scenarios about where it might lead. It outline some of the major challenges facing the health service as it seeks to implement the government's reform agenda, while also considering how the introduction of market forces may help or hinder the core aims of the NHS.

This will be followed by three papers on the new NHS market which will seek to prompt debate about the consequences of policy to date, the main challenges outstanding and the best options for future reform. A final report will be published early in 2006. There will also be debates for senior policy-makers, managers, practitioners, parliamentarians and the media (see notes to editor). The three key areas that will be examined are:

Regulation

The role of regulation in a market with a variety of health care providers - including NHS foundation hospitals, privately run diagnostic and treatment centres, and potentially staff-led primary care services - is likely to be quite different to that of the regulatory system we have today. Anticipating the government's own review of health regulation, we will consider if and how the market can best be managed to avoid major organisational failures.

Commissioning and primary care

A quiet revolution in primary care has occurred over recent years with the ending of the monopoly of provision by independently contracted GPs and the introduction of NHS Direct, walk-in centres and other new forms of first contact care. It is now poised for further radical change. Central guidance on reforming the structure and roles of primary care trusts, ending primary care trusts' role in provision and enabling competition between primary care providers was issued this summer and a White Paper on out-of-hospital care is expected at the turn of the year. The King's Fund will look at how commissioners can be made more effective within the market, consider whether or not competition has a useful role within commissioning, and examine how primary and secondary care for patients can be better integrated.

Incentives

Many of the current market-related reforms, if left unchecked, risk inflating demand for NHS care. Under payment by results, providers of NHS care have a clear incentive to maximise activity and income. While incentives to maximise productivity and reduce waiting times may be appropriate for elective care, they may be less useful for emergency care and services for patients with long-term conditions. Here, avoiding unnecessary hospital admissions may be a more appropriate objective yet commissioners, primary care providers and NHS trusts do not have strong incentives to work towards this aim.

The King's Fund chief executive Niall Dickson said:

'The NHS in England has embarked on one of the most radical and far reaching set of reforms in its history. The success or failure of this endeavour will determine the future of the NHS and perhaps even whether it has one. The government is right to pursue a radical agenda and new reforms, such as autonomous foundation trusts, payment by results and more patient choice, are welcome. But we recognise the current experiment with a more market orientated system carries risks and the new reforms could add to financial instability if not well managed.

'The government will need to address potential problems associated with the introduction of stronger market incentives. Our series aims to stimulate debate around the market reforms by setting out some of the challenges to be addressed and identifying some of the uncertainties, tensions and contradictions that are inevitable when bringing about change in such a complex enterprise. We hope it will offer practical solutions to ensure patients are protected as the health service attempts to change the way it delivers care.'

Read the report: NHS Market Futures: Exploring the impact of health service reforms

Notes to editors: 

1. For further information, interviews or a copy of the report, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. For out-of-hours enquiries, please contact 07831 554927 or 07774 2128439. An ISDN line is available for interviews on 020 7637 0185.

2. NHS Market Futures: Exploring the impact of health service reforms, by Richard Lewis and Jennifer Dixon, is free to download from our website.

3. The King's Fund will host the following breakfast debates throughout the Autumn as part of the NHS Market Futures programme:


Breakfast discussion I – Tuesday 18 October 2005
What is the role of regulation in the new NHS market?
The role of regulation in a market with a variety of health care providers is likely to be different from the current system. Anticipating further changes, we will be both asking how best to combine economic and quality regulation, and whether the new market can be managed to avoid major organisational failures, and reviewing the roles of the various organisations involved. Speakers will be: 

  • Nigel Edwards, Director of Policy, NHS Confederation
  • Jennifer Dixon, Director of Policy, King's Fund
  • Final speaker to be confirmed.

Breakfast discussion II – Wednesday 16 November 2005
Can choice transform commissioning and primary care?
Already the subject of a quiet revolution with the ending of the GP monopoly of provision and the introduction of new services such as NHS Direct, primary care is poised for further radical change. Central guidance on reforming the structure and roles of primary care trusts and enabling competition between primary care providers was issued this summer, and the white paper on out-of-hospital care is expected at the turn of the year. But how can commissioning be strengthened, and what role will competition play? Speakers will be:

  • Paul Corrigan, Professor in Public Policy, London Metropolitan University
  • Dr Kambiz Boomla, East London Integrated Care
  • Richard Lewis, Fellow in Health Policy, King's Fund.

Breakfast discussion III – Wednesday 7 December 2005
Incentives and reform in the NHS – does it all add up?
While the current and planned incentives to maximise productivity and reduce waiting times may be appropriate for elective care, they may be less useful or even harmful for emergency care and services involving patients with long-term conditions. Here, avoiding unnecessary hospital admissions may be a more appropriate aim. In this event we will discuss how to design appropriate incentives for different parts of the health care system. Speakers will be:

  • Dr Michael Walsh, Chief Executive of South East London Strategic Health Authority
  • Dr Keith Palmer, Senior Associate, King's Fund and Non-Executive Director of Guy's and St Thomas' NHS Foundation Trust
  • Rebecca Rosen, Fellow in Health Policy, King's Fund.

4. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.