The announcement by the Nuffield Group that it was changing its position in the market and looking to contract more with the NHS has been followed by other providers. Capio, like the Nuffield, has now signed up for a large orthopaedic contract with the NHS at prices which some other providers believe are not sustainable. It is unclear which doctors will actually perform this contract work and even some private groups of consultants are shy of contracting at these rates.

BUPA Insurance has also made a surprise move with an announcement on 11 June 2004 that, not only would it be selling 10 of its hospitals, but would also be looking for new lower priced contract work. Specific details of the type of work and the consultant or sub consultant grades who might be involved are still unclear. It is not known if new style “limited” medical insurance products are envisaged.

Some provider groups, in particular the BMI group with hospitals around the UK and the HCA group (with its mainly London base), are for the moment sticking at the upper end of the market with the traditional fee for service system.