{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T16:27:56Z","timestamp":1792772876585,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative semi\u2010structured interview study was conducted with 27 patients and 73 clinical and non\u2010clinical 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients receiving elective care across the NHS and the private sector faced some barriers in decision\u2010making, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>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\u2010produced our patient interview schedule and were involved in analysis of patient interviews. Our PPI co\u2010applicant was involved in the preparation of this manuscript.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70867","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:15:43Z","timestamp":1789460143000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mind the Gap: A Qualitative Study of Patients\u2019 Experiences of Acute Elective Care Across the NHS and the Private Sector in England"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3355-9355","authenticated-orcid":false,"given":"Eleanor","family":"Gee","sequence":"first","affiliation":[{"name":"Alliance Manchester Business School The University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9325-3362","authenticated-orcid":false,"given":"Gemma","family":"Stringer","sequence":"additional","affiliation":[{"name":"Division of Population Health, Health Services Research &amp; Primary Care University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8129-8376","authenticated-orcid":false,"given":"Jane","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Alliance Manchester Business School The University of Manchester Manchester UK"},{"name":"Health Services Management Centre University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1473-2189","authenticated-orcid":false,"given":"Michael","family":"Molete","sequence":"additional","affiliation":[{"name":"Alliance Manchester Business School The University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Walshe","sequence":"additional","affiliation":[{"name":"Alliance Manchester Business School The University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-8648","authenticated-orcid":false,"given":"Christos","family":"Grigoroglou","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care The University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2972-7911","authenticated-orcid":false,"given":"Thomas","family":"Allen","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care The University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8454-4640","authenticated-orcid":false,"given":"Michael","family":"Anderson","sequence":"additional","affiliation":[{"name":"Health Organisation, Policy, and Economics (HOPE), Division of Population Health, Health Services Research and Primary Care University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2833-0621","authenticated-orcid":false,"given":"Nils","family":"Gutacker","sequence":"additional","affiliation":[{"name":"Centre for Health Economics University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-9854","authenticated-orcid":false,"given":"Karen","family":"Bloor","sequence":"additional","affiliation":[{"name":"Department of Health Sciences University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"M.Dayan S.Gainsbury andS.Bagri How Has the Role of the Private Sector Changed in UK Health Care?2024 12\/11\/2025 Available From:https:\/\/www.nuffieldtrust.org.uk\/news-item\/how-has-the-role-of-the-private-sector-changed-in-uk-health-care."},{"key":"e_1_2_10_3_1","unstructured":"J.Keith A.Lawless L.Ewbank T.Boshari andT.Gardner Is the Use of Privately Funded Health Care on the Rise? 2024 [cited 2025 12\/11\/2025]; Available from:https:\/\/www.health.org.uk\/reports-and-analysis\/analysis\/is-the-use-of-privately-funded-health-care-on-the-rise."},{"key":"e_1_2_10_4_1","volume-title":"Deal Between NHS and Independent Sector to Cut NHS Waiting Lists","author":"DHSC","year":"2025"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-2953-9"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-025-01767-6"},{"key":"e_1_2_10_7_1","first-page":"41","volume-title":"Navigating Private and Public Healthcare","author":"Blomqvist P.","year":"2019"},{"key":"e_1_2_10_8_1","first-page":"227","volume-title":"Navigating Private and Public Healthcare","author":"Willis K.","year":"2019"},{"key":"e_1_2_10_9_1","volume-title":"How Patients Choose and How Providers Respond","author":"Dixon A.","year":"2010"},{"key":"e_1_2_10_10_1","unstructured":"J.Curtice C.Sivathasan andG.Morton BSA 42| Repairing Britain: Attitudes Towards the Economy Taxation and Public Services.2025."},{"key":"e_1_2_10_11_1","unstructured":"NHS The NHS Constitution for England.2023."},{"key":"e_1_2_10_12_1","unstructured":"NHS. NHS Choice Framework\u2014What Choices Are Available to You in Your NHS Care. 2024 13\/11\/2025; Available from:https:\/\/www.gov.uk\/government\/publications\/the-nhs-choice-framework\/the-nhs-choice-framework-what-choices-are-available-to-me-in-the-nhs#choice-in-the-nhs---an-overview."},{"key":"e_1_2_10_13_1","unstructured":"Department of Health Operational Guidance to the NHS: Extending Patient Choice of Provider.2011."},{"key":"e_1_2_10_14_1","volume-title":"Private Healthcare Market Investigation Order 2014","author":"CMA","year":"2014"},{"key":"e_1_2_10_15_1","volume-title":"Shared Decision Making","author":"NICE","year":"2021"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001203"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-12-53"},{"key":"e_1_2_10_18_1","volume-title":"Independent Investigation of the National Health Service in England","author":"Darzi A.","year":"2024"},{"key":"e_1_2_10_19_1","unstructured":"IHPN Going Private 2024.2024."},{"key":"e_1_2_10_20_1","volume-title":"Patient Priorities: Research Into Patient Confidence and Choice in the UK's Private Healthcare Sector","author":"PHIN","year":"2024"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.1720"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7425.1219"},{"key":"e_1_2_10_23_1","unstructured":"G.FreemanandJ.Hughes Continuity of Care and the Patient Experience.2010 London."},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzr068"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-001215"},{"key":"e_1_2_10_26_1","volume-title":"Patients\u2019 Experience of CHD Choice","author":"Le Maistre N.","year":"2003"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/16094069251342542"},{"issue":"11","key":"e_1_2_10_28_1","first-page":"2469","article-title":"Imposter Participants: Overcoming Methodological Challenges Related to Balancing Participant Privacy With Data Quality When Using Online Recruitment and Data Collection","volume":"27","author":"Roehl J. M.","year":"2022","journal-title":"Qualitative Report"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/1948550617698203"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/10497323251359207"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114523"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_10_33_1","volume-title":"Globalisation, Markets and Healthcare Policy: Redrawing the Patient as Consumer","author":"Dorfman P.","year":"2009"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1188\/12.ONF.E70-E83"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e6572"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/14461242.2016.1170624"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2022-014695"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-088074"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2011.03763.x"}],"container-title":["Health Expectations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70867","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hex.70867","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70867","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T13:53:25Z","timestamp":1792763605000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hex.70867"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/hex.70867"],"URL":"https:\/\/doi.org\/10.1111\/hex.70867","archive":["Portico"],"relation":{},"ISSN":["1369-6513","1369-7625"],"issn-type":[{"value":"1369-6513","type":"print"},{"value":"1369-7625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"assertion":[{"value":"2025-12-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70867"}}