The Supermarket of Private Primary Healthcare

The phrase “Healthcare is changing” is often heard within the NHS and today it is more relevant than ever in terms of diversity and patient choice. Nevertheless, within the NHS, change is often laborious, bound by bureaucracy and characterised by limited patient choice. Conversely, private healthcare is emerging as a paradigm of choice, speed and convenience.

THIS ARTICLE concentrates on primary private healthcare (PPH) rather than secondary healthcare, as this ‘new kid’ is becoming increasingly important to the healthcare consumer. The NHS has the back-up of a myriad of departments and community services when compared with the options offered by PPH; however, PPH offers contemporary up-todate screening and health checks which are not routinely offered by the NHS. PPH differs from general private healthcare, as its use may be ad hoc, although membership schemes are available. It offers similar functions to the community GP, as well as ‘optional extras’. In addition, we can also see the rise of the ‘health boutique’, which offers one-off treatments such as laser eye correction, alternative therapies or a temporary botox face-lift.

Any simple sociological analysis will reveal the reasons why PPH has slotted so neatly into the lives of professionals. Professionals today tend to have more disposable income compared with professionals 20 years ago and, in addition, the number of professionals has been rising since the demise of heavy industry and, paradoxically, leisure time is becoming increasingly busier. All this impacts on the viability of PPH, and consumers, faced with copious choices, are increasingly looking outside the traditional arenas of health provision to meet their needs. The concept is simple, provide busy workers with convenient on-demand PPH and cosmetic services at well-situated venues, and it is sure to attract customers. It is about providing a shop-window for health needs, enticing the consumer in to browse and buy.

Healthcare provision outside the NHS has taken on evolutionary characteristics. The PPH boom suggests that if there is a niche, where there is no competition for resources, an adaptable organism can exploit those resources if the organism’s survival mechanisms are suited to that environment. This is the basic principle behind the emergence of PPH. The niche here is not providers of healthcare who focus on surgery, treatments and consultations which fill the gap left by long NHS waiting lists and relative inconvenience, but the providers who are more specialised, recognising that even when NHS treatment is available, they can provide ‘better’ treatments at a perceived higher standard. That is the sales pitch. The attributes which a private provider can offer are noticeably different from the NHS. These are convenience, speed of delivery and access, and pleasant, contemporary surroundings. The NHS cannot, at present, compete in this market. It remains to be seen whether they will in the future, with the Conservatives’ market forces being slipped in through the back door by the Labour Party, in the guise of autonomy and better access to care.

Fundamentally, the NHS remains an integral aspect of health provision, providing care ‘from the cradle to the grave’ despite our own provisions, simply because the NHS cannot be matched on the scale and sophistication of healthcare which it provides. However, in the day-today management of lifestyles, people are segmenting their choice of health provider, and moving away from the ideological to the consumer- based. People who can afford it and who are not ideologically opposed to private health provision are increasingly becoming adaptable to the concept that we can control our own health provision. Today PPH is becoming an integral part of many of our lives in an increasingly choice-driven society.

The government can dismiss the notion that a health hierarchy exists, and perhaps it does not within the NHS. However, it is obvious that healthcare in the UK can be divided into a hierarchy between those who can and those who cannot afford private health insurance or those who can access PPH on an ad hoc basis. It does not take a great deal of investigation to reveal how this translates into access and delivery of healthcare throughout the UK. To complicate the picture further, there is a general rule that people from low-income groups may tend towards a higher incidence of illnesses, involving more frequent visits to a GP’s surgery or another primary healthcare provider. Therefore, for these patients to have access to private care would translate into a higher outlay of finances. High disposable incomes are not common among the lowpaid earner group, and this will serve to increase health inequalities.

The Office for National Statistics General Household Survey explains that almost one-quarter of professionals and/or managers are likely to be covered by medical insurance; however, only 4% of those in manual groups have medical insurance. The survey also illustrates that people with a long-standing illness are less likely to have private medical insurance (about 5%). A person’s socio-economic group also influences this figure. In addition, the Social Trends Report shows that since the early 1970s, the uptake of private medical insurance has increased by over 30%. Professionals, however, may have private insurance provided by their company, but this figure does not take into account the occasional purchasing of PPH outside their existing plan. Although these figures do not show who is most likely to use primary private medical care, such as private dentists, private walk-in centres, or highstreet health boutiques, it can be assumed that there is a correlation between income and private health access. This is because the influences pushing consumers to buy private medical insurance will be the same factors influencing primary private care choice.

One question which arises is, ‘what does private primary healthcare offer that the NHS doesn’t?’ The answer is simple – convenience, convenience, convenience! According to the DoH, around 70% of patients are satisfied with their GP services, although this figure falls to around 55% of patients who are happy with GP appointment systems. This indicates one area where boutique healthcare is ‘filling the niche’. If professionals and managers are more likely to have private medical insurance, this is because their life-style, or rather work-style, is suited to it. Boutique healthcare has capitalised on the necessity for quick, accessible healthcare for people who prefer not to wait for a GP’s appointment. As a professional, whether covered by company insurance or not, a good disposable income means that £45 for a private GP consultation may not hurt as much as a two-week wait for a GP appointment. Alternatively, private primary care offers people who can pay the option of central locations, convenient consultation times (for example, some private centres have late-night opening), and some companies have not only slotted themselves into the quick, convenient, healthcare provision market, they have also physically placed themselves in places of high professional, busy work environments, for example, mainline train stations.

The emphasis is on convenience and health promotion/illness prevention, although not exclusively. They are well placed, due to their facilities, equipment and attractive advertising, to attract people in for tests who may not normally ask for a test. It is the supermarket of healthcare. At a supermarket, the consumer is faced with options which they may not normally consider. In the same way, PPH places options in front of the consumer, using both media and emotional promotion. The advertising of some companies shows a happy family as something which is to be achieved or maintained. The subliminal message is that this is not the case when there is ill health. The promotion of actual and perceived good health is an underlying message used in the promotion of this commodity.

The placement of PPH and boutique healthcare is a growing phenomenon in the high streets of the UK and they are not likely to disappear. They fill a gap left vacant by the NHS, to provide certain people with additional healthcare notoriously ignored by the NHS. Although this is not a criticism of the NHS, it does point to the fact that there are growing numbers of people who are happy to pay for their own healthcare if this means quicker access and convenience to maintaining their health. Access to private healthcare also includes the boutique aspect of ‘cosmetic’ treatment, again open only to those with an adequate income, highlighting the fact that access to healthcare is divided between social groups. For the promoters of PPH it is therefore necessary to target an audience which will have the ‘ability to access’ this type of healthcare. Marketing and emotional concepts used to tempt the ad hoc patient into these facilities should reflect the social aspects, that is, maintaining the concept that optimum health is attainable and maintainable. The ad hoc nature of this type of provision means that customers may switch suppliers. Prevention of this is ensured by professional customer service, incentives and, again, convenience, maintaining loyalty among those people who are not subscribers to one company. In the supermarket of health provision, loyalty is key to maintaining and expanding on a customer base. Company profiles and placement should be carefully managed to ensure visibility and healthcare excellence, emphasising convenience, quality care, and health maintenance, which is necessary in a society where health is increasingly seen as a precarious commodity.