Privatizing primary care


ConservativeHome's Tim Montgomerie reports:

I've now been told by an impeccable Tory source that co-payments have been ruled out for the NHS and that it will remain free at the point of use.

I'm not surprised and, indeed, have heard the same absolute commitment myself. One of David Cameron's earliest acts as leader was to rule out ever moving in the direction of an insurance-based system, and shadow health secretary Andrew Lansley has been going out of his way not to "frighten the horses" ever since.

This is understandable. Despite its failings, the British public remains bizarrely attached to the idea of a nationalized health service, so it would take a brave politician to break with orthodoxy. At the same time, the Conservatives are promising a fully-fledged internal market in the NHS, which is at least a step in the right direction.

However, I don’t believe that a universal, taxpayer-funded, free-at-the-point of use health service is sustainable – especially not in the context of a fiscal crisis. Given that healthcare accounts for about 17 percent of total public spending, no government that is serious about balancing the books can afford to 'ring-fence' it, as the Tories currently propose.

My money-saving suggestion would be a radical one: the complete privatization of NHS primary care (GP surgeries, clinics, dentists, etc), on which the government spent £18.6bn in 2007/8. Clinicians would offer their services in a free, competitive free market. Patients would be free to shop around and would then pay directly for any services. Of course, an NHS entitlement could still be available for those unable to pay their own way.

Britain's high street opticians – Specsavers, Vision Express and the like – provide a good example of how this could work in practice. They also indicate the way in which private ownership and competition could make a dramatic difference to standards, as well as working to keep down prices.
This would certainly be a controversial policy at first. But just as no-one would today advocate returning opticians to government control, privatized primary care would soon be accepted as a completely normal state of affairs. And given that the vast majority of patient interactions with the health service occur at the primary care level, the impact of this would be enormous.