Having studied law at the University of Warwick, he joined the fast-track NHS Management Training Scheme in 1989, receiving his post-graduate education at Warwick Business School. His early career included various management posts in the NHS, a spell with the Australian health service, a year in the civil service fast stream during which he was sponsored by the Australian College of Health Service Executives to work inMelbourne and Sydney before being seconded to the NHS Executive in 1992. Britnell joined St Mary’s Hospital in London as a General Manager before being appointed as a Director at Central Middlesex Hospital in 1995, when he was named Project Director for an Ambulatory Care and Diagnostic Private Finance Initiative scheme - the first of its kind in the UK. At 34 years of age, he became chief executive at University Hospitals BirminghamNHS Foundation Trust, one of the youngest people to be appointed to a chief executive role in the NHS. He led the organization from 2000 to 2006, taking it through first-wave NHS Foundation Trust status, securing the second-largest PFI hospital build in England to date and establishing the first Royal Centre for Defence Medicine in partnership with the Ministry of Defence. In 2006 he was appointed as chief executive of the NHS South Centralstrategic health authority. He was Director-General for Commissioning and System Management for the National Health Service of England. During this time he oversaw the development of the World Class Commissioning policy, the creation of the Cooperation and Competition Panel and reforms to primary care, patient and public engagement, integrated care and community services. He has twice been tipped as a likely contender for the post of NHS Chief Executive but in both instances declined to apply. In 2009 he joined KPMG as Head of Health for the UK and Europe, becoming Global Chairman for Health in 2010. Since then, he claims to have worked in 60 countries on more than 200 occasions. In October 2015 he published 'In Search of the Perfect Health System' - a commentary on 25 different national health systems around the world. Common subjects he speaks and writes on include health service integration, workforce redesign, patient empowerment and achieving large-scale change in healthcare organizations and systems. He has described his consulting style as "more brown mud, less blue sky".
In 2010, while discussing British health reforms at a healthcare industry conference in the USA, Britnell was quoted as stating: "In future, The NHS will be a state insurance provider not a state deliverer", and that "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years." KPMG issued a press statement on behalf of Britnell on 16 May 2011 stating "The article in The Observer attributes quotes to me that do not properly reflect discussions held at a private conference last October. Nor was I given the opportunity to respond ahead of publication. I worked in the NHS for twenty years and now work alongside it. I have always been a passionate advocate of the NHS and believe that it has a great future. Like many other countries throughout the world, the pressure facing healthcare funding and provision are enormous. If the NHS is to change and modernize the public, private and voluntary sectors will all need to play their part." The Health Service Journal website published a longer statement from Britnell on 17 May, prompted by the article in The Observer. In it Britnell explained his perspective on the reform of the NHS. Among wide-ranging remarks he stated that "f course, the vast majority of care - quite rightly in the UK context - will always be provided by public sector organisations and will be paid out of taxation" and "he issue of competition, which now seems to be conflated with privatisation, is unhelpful and misleading and, at best, only a small part of reform. Competition can exist without privatisation and the NHS can maintain its historic role in funding care while dealing with a richer variety of providers - public sector, social enterprise and private organisations". Commenting on the UK health service in an article for the Guardian Health Network, Britnell said "I'm proud to have worked for the NHS, with its great people, and now feel privileged to be able to work on health systems internationally."
Publications
In Search of the Perfect Health System, Palgrave 2015