8 Minutes 
Healthcare in the United Kingdom is divided between the public healthcare system: National Health Service (NHS) and a smaller private segment.
The industry is made up of mainly:
- Pharmaceutical manufacturers
- Medical device, supplies, and equipment manufacturers
- Primary healthcare providers
- Secondary healthcare providers
- Tertiary healthcare providers (for services not funded through the NHS such as cosmetic surgery)
- Patients
- Health insurance firms
Healthcare is a complex matter and we strongly advise engaging an insights provider/fieldwork company which specializes in healthcare recruitment and understands the changing landscape.
In England, health policy and healthcare are the responsibility of the central government. In Scotland, Wales, and Northern Ireland, it is the responsibility of the respective local governments. As a result, there is policy and priority divergence between the health systems of the four UK countries. Depending on the therapy area, some projects may only be appropriate to the field in England, given the different systems which are in place.
The National Health Service
Most healthcare in England is provided by the National Health Service (NHS). NHS England’s publicly-funded system for the last 70 years, which oversees the commissioning, planning, and buying of NHS services, and which accounts for most of the Department of Health’s budget, has a budget of over £114 billion for 2018/19. For more information regarding the NHS budget, see the NHS Business Plan 2018/19.
NHS England commissions some services itself but passes most of its funding to 200 or so Clinical Commissioning Groups (CCGs) across England which identify local health needs and plan and buy care for people in their area. CCGs buy services from a wide range of different organizations from hospitals and community services to doctors, charities, and private sector.
Healthcare in the rest of the UK is provided by NHS Wales, NHS Scotland, and Health and Social Care in Northern Ireland.
Financing Challenges
The British Medical Association estimates that health funding in England is more than £7bn a year lower than comparable European countries. The NHS is struggling to cope with record demand and social care services are stretched to the limit. The challenges of an aging population and the rising costs of care and drugs have taken NHS finances to breaking point. In June this year, the government announced a £20bn a year injection of extra cash into the NHS by 2023-24 that will pay for thousands more doctors and nurses, and improve mental health services.
Private Healthcare
The public healthcare sector is added to by a smaller private sector and voluntary care. The private sector offers faster healthcare services to those who can afford to pay directly or through private insurance. Approximately 11% of the UK population has private health insurance. Many employers include complementary private healthcare as an employee benefit. There are some crossover arrangements between public and private provision to increase capacity in either sector. Private sector growth is closely linked to public sector performance, policy, and funding for core services. The private hospital segment is dominated by a handful of large hospital groups.
Healthcare Professionals
The UK healthcare system can be quite complex, but the key starting point is with the General Practitioner (GP), roughly equivalent to what US researchers would call a PCP (primary care physician). Patients will consult with their GP, who will then refer them to a specialist in secondary care. Specialties will vary across countries, and in the UK, different specialists may treat different conditions. For example, diabetes is treated primarily by Endocrinologists and not Diabetologists, which are a very small specialty in the UK. Some clients may want to speak with definitive specialist physicians and it is sometimes the case that they do not have that same specialized title in the UK. For example, Epileptologists do not exist in the UK. For this target, we would recruit a Neurologist with a high epilepsy patient load.
Payers
The UK is, in theory, a single-payer healthcare system in that the government, rather than private insurers, covers all healthcare. Technically, however, the UK is no longer single-payer, as it now consists of a number of autonomous trusts.
Field agencies specializing in healthcare should be able to connect you with payers in a broad range of non-clinical positions. As titles can vary, recruitment success criteria for payer research should include clear detail about respondents’ responsibilities. Payers have responsibility with local, regional, and national levels. Interviews with local and regional payers are regularly conducted. Interviewing national payers is very rare due to the nature of the state system and their roles in government.
Patients
Unlike the US, and like the rest of the EU, prescription medication is not advertised in the UK. Patients prescribed prescription medicine are not particularly brand-aware, as doctors are expected to prescribe the standard drug in most cases. Patients are treated with the medications which are approved and available within their Clinical Commissioning Groups.
Strategic Developments in Co-ordinated Care Models
New models of care are designed to get providers working together to provide joined-up care for people with long-term healthcare conditions, particularly the aging population. Such models lead to care that might normally take place in hospitals (such as chemotherapy) taking place at home, or dementia specialists carrying our clinics in GP surgeries. This is part of a broader shift for healthcare organizations to come together to support patients’ physical and mental health needs and away from a fee-for-service NHS marketplace.
New and evolving approaches are beginning to appear, such as Accountable Care Systems (ACS) which take inspiration from the US where services come together to improve health and coordinate services with a budget and a particular area.
Across England, we are starting to see CCGs merging and hospitals working together in chains, and GPS forming practice partnerships.
Healthcare Trends in UK Healthcare
- A more patient/”customer” centric approach
- ’P4 Medicine’: Predictive, Preventative, Personalised & Participatory • The ‘genetically aware’ patient
- Application of intelligent devices (IoT)
- Use of expert systems – (Big Data)
- Automated dispensing
- Remote consultations
- Self-monitoring of vital signs – assistive technology to address health issues of an aging population
- Use of robotics
- Virtual reality applications for pain relief and motivation
- Gamification – rewarding users for healthy behaviors
- Online patient communities providing sources for crowd-funded data & drug healthcare ratings
- Crowd-funded medical treatments
- Telehealth – for long-term illness
- Personalized health technology
- A shift of dental patients to private sector providers offering more aesthetic and innovative treatments that patients are willing to pay for
The NHS and Brexit
The UK Government has announced that the UK will leave the European Union on March 29, 2019.
In its whitepaper ‘The Future Relationship Between The United Kingdom And The European Union, published on July 12th, 2018, the Government states that the proposal “would end vast annual contributions to the EU budget, releasing funds for domestic priorities – in particular our long-term plan for the NHS.”
The period of uncertainty has impacted the number of migrant healthcare professionals. Since the referendum, the number of nurses from EU countries coming to work in the NHS is down by 89% and the number leaving has risen by 67%. The Company Chemists’ Association, said the number of pharmacists registering with the General Pharmaceutical Council has fallen by 80%. A British Medical Association survey found that 20% of the 12,000 EU doctors in the NHS have made plans to leave the UK because of Brexit, and the medical professions voice grave concerns about research collaboration and supply and certification of drugs.
Medical associations and both pro and anti-Brexit politicians continue to issue stark warnings to the government urging the protection of the healthcare industry in both the cases of a deal and of no deal.
Key areas where exit deals and agreements for governing the UK’s future with the EU will have important implications include:
- Approval of medicines and devices
- Reciprocal healthcare programmes
- Regulation of medical research and healthcare
- Trading agreements
- Collaboration in EU health and science programs
The Brexit Health Alliance brings together the NHS, medical research, industry, public health organizations, and patients to safeguard the interests of patients and the healthcare they count on. It is working to ensure that issues such as healthcare research, access to technologies, and treatment of patients are given prominence during Brexit negotiations.
Additional Resources
The UK Government Brexit Proposal Whitepaper
Healthcare Marketing Research and the UK Law
The British Healthcare Business Intelligence Association (BHBIA) provides legal and ethical guidelines for healthcare marketing research. These were fully revised in July 2018. To incorporate the impact of new data protection requirements introduced via the General Data Protection Regulation (GDPR) and the UK Data Protection Act (DPA) 2018. https://www.bhbia.org.uk/guidelines/legalandethicalguidelines.aspx
Also see our Schlesinger Group Guide to GDPR
