Primary care is one of Europe’s most underdeveloped markets, despite many practices being owned and run as private businesses. Private equity has largely steered clear and the market is yet to find another consolidator. Reform is underway in parts of Europe giving patients more choice in primary care and outpatient settings, however – and this could disrupt the market.

NHS England, in its recently unveiled ‘Long Term Plan’, is pushing patients to take more responsibility for their own health by offering better access to mental health, primary care and chronic disease management through apps and integrated care. Patients will also have the right to see a doctor online within five years.

It’s unlikely that patient choice will create more competition in the delivery of physical primary care but we can see a number of digital health providers could flood the market.

There’s a different story going on in Finland, where patient choice reform could see for-profit providers of primary care in face-to-face settings take up more of the market. In June, the country passed laws that support freedom of choice between public and for-profit providers. Both will be reimbursed from the public purse through either a voucher system or capitation model. The reform is likely to be implemented in 2021.

Terveystalo, Pihlajalinna, Mehilainen and Attendo are already big players in the Finnish acute and outpatient network so it’s likely that they will steal market share from the public sector. In the UK, there are very few for-profit players that might step in in the same way – and the public purse would be much less willing to fund them.

But either way, patient choice might finally be the catalyst to open up the primary care market.