Diverse health care providers: Behaviour in response to commissioners, patients

English health policy (Liberating the NHS, Any Qualified Provider (AQP) policy) aims to promote competition among existing NHS providers and encourage provision of NHS-funded services by diverse providers (of the types listed below). Their variations in ownership and management raise questions about how they will differ in implementing health policy and NHS commissioners' aims. Some studies suggest that different types of provider vary in the services produced, patient groups served, prices, perceived trustworthiness, and some clinical outcomes and aspects of service quality. Others report different organisational types converging in productivity, managerial practices and production costs. Providers with large market shares tend to set pricing and quality patterns for the whole health system.

Aims in relation to the issue to be addressed

We aim to:

  1. Reduce some gaps and uncertainties in existing research regarding the effects and implications of provider diversification.
  2. Understand better the mechanisms by which provider diversification produces these effects.

Focusing on a range of services heavily used by older people, we will investigate variations in provider behaviour regarding how diverse healthcare providers differ in their:

  • Choices for patients and service users
  • Innovation and operational freedom, specifically providers':
  • Freedom to innovate
  • Responses to potential innovations
  • Service changes in response to innovations

Implications for commissioning and managerial practice which follow from the above, for enabling the NHS to make better use of the plural provision of NHS-funded services.


April 2015 - March 2017


HSMC Leads: Mark Exworthy and Russell Mannion
PI: Rod Sheaff, University of Plymouth
Other researchers involved: Pauline Allen, London School of Tropical Medicine


We will adopt a mixed methods design combining:

  1. Systematic comparison of organisational case studies.
  2. Qualitative study of patient experience and choice, in same sites as (1).

There will be a tripartite empirical focus on CHS, primary care out-of-hours services, and secondary care (in depth study of planned orthopaedics, ophthalmology.

Qualitative studies of patient experience and organisational studies will use a purposive sample of providers (c.12 cases), selected for maximum variety of organisational type.


DH Policy Research Programme