Professional partnerships and non-hierarchical organisations in the NHS

Professor Russell Mannion

HSMC's Professor Russell Mannion is co-author of a new NIHR (National Institute for Health Research) report on Professional Partnerships and non-hierarchical Organisations in the NHS.

The aim of this research was to strengthen the evidence base for decisions about what kinds of partnerships and NHOs the NHS should incorporate or commission.


Organisations such as professional partnerships, co-operatives and similar non-hierarchical organisations (NHOs) play a larger role in health care than is usually recognised. For example, general practices (professional partnerships) handle over 80% of patients' first contacts with the NHS. Co-operatives provide much out-of-hours primary care. The role of such organisations might well increase as more diverse providers enter the NHS. The structure of these organisations is partly or entirely democratic. Unlike corporations and most public sector organisations they are accountable to their working members, or to service users, and allocate leadership roles by election or taking turns. Fewer than one percent of published research studies examine these forms of organisation. The studies that do exist raise two main questions. Are these types of organisation 'efficient', compared to hierarchies? And do they tend to 'degenerate' over time, reverting to hierarchy?

Understanding professional partnerships and non-hierarchical organisations - Executive Summary (PDF)

Understanding professional partnerships and non-hierarchical organisations - Final Report (PDF)