Private MSK care: are we in step with the NHS?

There’s not much research into private versus public intervention rates in musculoskeletal (MSK) care; that is, whether private patients anywhere in the world receive different treatment for MSK conditions when compared with patients receiving publicly-funded care. And when we looked, we couldn’t find any analysis on variation in MSK care between the NHS and the UK private sector. 

So we did our own. We asked consultant orthopaedic surgeon David Elliott, who has experience in managing clinical delivery transformation in the NHS, to look at our MSK data and compare it with NHS data.*  

Variation against NHS practice

We noticed that, for some individual procedures such as knee replacement, carpal tunnel decompression or spinal surgery, rates of intervention in private practice mirror NHS practice. 

We did find variation, however. Our members are receiving more knee arthroscopies, joint injections, anterior cruciate ligament (ACL) repairs and rotator cuff repairs than they would if they were NHS patients. 

Some variation might be explained by AXA Health’s member profile: with a higher proportion of working age, active people you might expect a higher rate of ACL repair, for example. 

But we’re left with unexplained variation in some conditions. Do our members really need more treatment than they’d get on the NHS, or are they simply getting more treatment? We have to conclude that some clinicians are offering our members more treatment than they would if the patient came through an NHS clinic.  

Next steps

What should we all do about that? At AXA Health, we passionately believe in healthcare that benefits patients, in terms of experience, outcomes and value. We already look at rates of intervention and engage with our provider population to try to understand variation. We believe we could do more here. 

This is the first, very high level, view we’ve taken on how private work measures up against NHS interventions. We deliberately posed a simple question and we know there are limitations on comparing the two datasets, and that specialist practice is often more complicated than a graph can show. 

So we’re interested in hearing what providers think about the issue, and what we can all do about it, working together in the best interests of patients.  

I’ll be meeting with orthopaedic groups to discuss our findings this year, and my team will be visiting our networked hospitals to meet specialists where they work. I’m pleased that we’re having this discussion – and that the conversation is just beginning.  

Sarah Taylor, Head of Specialist & Practitioner Relations

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^Footnotes

^{AXA Health internal data on intervention rates in MSK conditions was compared with national NHS population details and the Hospital Episode Statistics (HES) data warehouse, April 2019 to March 2020} 

^{Male/female ratio compares well; AXA Health data shows higher percentage of patients of working age.} 

^{Interventions for AXA Health were defined as interactions with a consultant generating a procedure code, which compares to the NHS Finished Consultant Episode (FCE) necessary for entry into the HES database.}