Competition in the NHS: a provider perspective

ObjectiveTo analyse how competition is experienced and characterized by NHS and independent sector acute care providers in the English National Health Service (NHS).MethodsSemi-structured interviews with 49 senior staff in 15 NHS trusts and independent sector providers between November 2008 and April 2009, in England.ResultsThe market was predominantly defined based on geographical proximity. Competition was mainly on the periphery of catchment areas but markets were differentiated based on the scope and type of services. Niche providers, specialist hospitals and tertiary centres did not directly compete with district general hospital-type providers. Competitors were increasingly primary and community care providers, while there was little perceived threat from the private sector. There were many examples of how different providers (both NHS and independent sector) were co-operating and collaborating. Patients and general practitioners (GPs) appeared to be loyal to local providers.ConclusionThe providers'...