Pressure was put on local GPs to refer patients to the centres, rather than to NHS hospitals, because the primary care trusts had to pay for activity whether or not it was used.
[2] According to the NHS Partners Network, which represents private providers working within the health service, GP referral rates were rising in 2009 as patients report positive experiences back to their GPs.
[4] This was based on a Scottish example and does not in fact reflect the experience of the English ISTC program, where referrals have been more in line with the expectations of the original contracts and continue to grow.
A critique of this development is that more difficult and expensive work is left for NHS hospitals to do, increasing their marginal costs and making them appear less 'efficient'.
An article by Angus Wallace in the British Medical Journal (BMJ vol 332 11 March 2006) suggested that treatments may be proportionally less successful in ISTCs due to the employment of inexperienced or less fully trained staff with less backup than the NHS facilities.
In the 2008 Healthcare Commission 2008 NHS Inpatient Survey,[10] ISTCs scored highly on a number of measures, including overall quality of care.