title: Provider diversity in the English NHS: a study of recent developments in four local health economies.
abstract: OBJECTIVE
  To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers.
  
  
  METHODS
  Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009.
  
  
  RESULTS
  Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies.
  
  
  CONCLUSIONS
  There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.
authors: London School of Hygiene and Tropical Medicine, London, UK. pauline.allen@lshtm.ac.uk
authors: Pauline
authors: P
authors: Allen
authors: Simon
authors: S
authors: Turner
authors: Will
authors: W
authors: Bartlett
authors: Virginie
authors: V
authors: Perotin
authors: Greenwell
authors: G
authors: Matchaya
authors: Bernarda
authors: B
authors: Zamora
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D004739:England; D006302:Health Services Research; D006788:Hospitals, Voluntary / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008503:Medical Staff; D009936:Organizational Innovation; D017149:Private Sector / Q000458:organization & administration* / Q000592:standards; D017150:Public Sector / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care; D013222:State Medicine / Q000191:economics / Q000458:organization & administration* / Q000592:standards