An experience in my own family has underlined the growing risks in outsourced clinical pathways and the importance of primary care recognising the warning signs.

Please note that the views expressed here are those of the individual author, independent to those of FPM and do not reflect the views or position of FPM Group, Thornfields or Stericycle. 

A recent incident involving my wife has highlighted a concern I have held for some time: outsourcing clinical services without proper safeguards can compromise patient safety.

My wife recently decided she wanted support to stop smoking. In the past, she would have booked in with the practice nurse, had a proper conversation, and agreed a safe treatment plan based on her full medical record.

But that’s no longer how things work. Our local ICB has outsourced smoking cessation services to a private company. Instead of seeing someone at the practice, she received a telephone assessment from an external provider. They asked a few questions and recommended a medication they would ask the GP to prescribe.

A few days later, the GP left a message explaining that he would not prescribe the medication because, when combined with her existing treatment, it could have been dangerous — potentially very dangerous. A telephone consultation was arranged.

During that consultation, the GP explained his concerns in detail. He asked further questions, checked interactions, and confirmed that the outsourced recommendation was clinically unsafe. He also told my wife this was not the first time he had seen similar issues arise from outsourced services.

With her permission, he planned to report it as a Significant Event, raise it at clinical meetings, and escalate it to both the outsourced provider and the ICB. He was clear that the practice had reservations about this model of outsourcing because it can expose patients to unnecessary risk.

He also explained something that surprised me: he cannot override the outsourced service and prescribe the safer alternative himself — he has to go back to the outsourced provider. A highly trained clinician unable to act directly in the best interests of his patient because of a commissioning arrangement is difficult to justify.

His vigilance prevented what could have been a very serious outcome.

My wife understood exactly what he was saying, but someone without knowledge of how these systems work might easily have blamed the surgery or the GP. And that is the heart of the problem.

We are outsourcing services to teams who do not appear to have full access to the patient’s record, may not have the clinical background to identify contraindications, and are not accountable for the consequences. That combination is not simply inefficient — it is unsafe.

Why This Matters — and What the Guidance Says

NHS England’s own Service Conditions and Clinical Governance Framework require that:

• Providers must have timely access to relevant clinical information
• Care must be safe, coordinated, and based on the full medical record
• Outsourced services must have clear clinical governance and risk‑management processes

ICBs, under the Health and Care Act 2022, are also responsible for ensuring that any commissioned service is safe, integrated, and does not fragment patient care.

Yet in this case, the outsourced provider was making clinical recommendations without accessing essential medical information. That is not a technicality — it is a direct contradiction of the standards the NHS is expected to uphold.

This is not a minor oversight. It is a structural weakness that can lead to harm.

GPs Should Continue to Raise Concerns as they occur

This incident reinforces something important: GPs and practices should feel confident in raising concerns when outsourced services create clinical risk.

This is not about confrontation. It is about safeguarding patients.  When outsourced providers make recommendations that are unsafe or incomplete, practices should:

• Report the issue
• Escalate it through clinical governance channels
• Share learning at practice and PCN level
• Provide feedback to the ICB
• Ensure the incident is recorded and reviewed

Practices are often the first to spot these problems, and their feedback is essential if commissioning decisions are to improve.

ICBs, in turn, must take these concerns seriously. Listening to frontline clinicians is not optional — it is central to safe commissioning.

A Final Reflection

In this instance, no harm was done — but only because the GP took the time to question the recommendation and protect the patient. It would have been easy for this to slip through unnoticed, and the consequences could have been serious.

This is not an argument against innovation or partnership working. It is an argument for responsibility, accountability, and safe clinical practice.

Before NHS organisations and ICBs outsource clinical services, they must:

• Assess the clinical risks, not just the financial savings
• Ensure outsourced providers have full access to patient records
• Require appropriate clinical training and oversight
• Put in place safeguards to prevent unsafe recommendations
• Recognise that outsourcing does not remove their duty of care

Outsourcing may appear efficient on paper, but if it compromises patient safety, the cost is far too high.

This incident is a reminder that the NHS must never lose sight of the fundamentals: continuity, safety, and informed clinical decision‑making. Outsourcing has its place — but only when it is done with care, competence, and proper clinical governance.

Perhaps more importantly, it is now nearly four weeks since she made the decision to quit, and yet the help she requested has still not been provided. That delay alone raises further questions about whether this model truly serves patients well.