Mind the Gap: A Qualitative Study of Patients’ Experiences of Acute Elective Care Across the NHS and the Private Sector in England

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INTRODUCTION: Whilst the use of the private sector to deliver acute elective care in the United Kingdom is increasing, there is limited understanding of the patient experience when moving between NHS and private organisations to receive treatment. This study aims to explore how patients make choices and navigate care pathways across NHS and private sector organisations. METHODS: A qualitative semi-structured interview study was conducted with 27 patients and 73 clinical and non-clinical senior leaders across NHS and private organisations between September 2023 and April 2025. Analysis was conducted using a reflexive thematic approach and abductive analysis to position themes against wider knowledge. RESULTS: Three key themes structured around the patient journey were identified through analysis. First, the ability of patients to make informed decisions on receiving treatment in private sector organisations was constrained by long waiting times and challenges accessing NHS care. Second, there was a lack of consistency in the timely and thorough transfer of patient information between NHS and private sector organisations, which undermined patient trust in the safe provision of care when delivered across the interface. Third, the provision of aftercare across the interface was fragmented, and its effects compounded by ambiguity for patients, and at times, providers, for who was responsible for the ongoing management of patient care once they had received treatment in a private hospital. CONCLUSION: Patients receiving elective care across the NHS and the private sector faced some barriers in decision-making, transfer of information and aftercare. In order to address these challenges, there is a need for stronger collaboration between the sectors to improve information sharing, continuity of care and patient safety across the interface. PATIENT OR PUBLIC CONTRIBUTION: Patients and carers were involved in our study from inception to dissemination. Our Patient and Public Involvement (PPI) forum was involved throughout project design and planning and gave us feedback and guidance on research materials and outputs (e.g., interview schedules, participant recruitment material, theme development). Our PPI group co-produced our patient interview schedule and were involved in analysis of patient interviews. Our PPI co-applicant was involved in the preparation of this manuscript.

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