What's the Goss! CSP and OCPPP continue to avoid discussing the real issue in the UK

[physiobob]

What's the Goss! CSP and OCPPP continue to avoid discussing the real issue in the UK - BUPA!

At a time where NHS jobs in the UK are starting to materialise where are the jobs in the private sector? BUPA continues to stick to their policy of not permitting any graduate with less than 5 years post graduate experience from getting BUPA recognition. I have asked them for a policy on why this is so and they have failed to provide one. It is based on a simple number of 5 and has nothing to do with experience. When questioned why someone who has been back packing the world for three years and has done 2 year of locum work would be recognised over someone who has been working under mentorship for 4 years, they had no answer. They said the number was 5, they gave no reason, but the kindly offered to take me off their list if I wished!

It bewilders me that as a private practitioner an insurance company can tell me who I can and cannot employ to treat their patients. This is nothing short of unlawful a it contravenes the Employment Equality (Age) Regulations Act that came into for on October 1st 2006. These regulations clearly state, "Avoid asking for ‘x’ years experience'. The quality and relevance of the experience should be important - not the number of years."

The reality is that as physiotherapists working in an NHS environment, many will work in that structure for 2-3 years after which a good percentage may choose to move into private practice. The key here that no one is mentioning that private practitioners are not hiring anyone with less than 5 years and even then only those already with BUPA recognition. This means physios with less than 5-6 years in the NHS have no jobs to go to and any that do move are more senior.

No one out, means no one in. No matter what the NHS does, this trade restriction by the likes of BUPA will mean this situation will never change. I have written to the CSP and the OCPPP on this issue. I have provided then a copy of the regulations and how they also might have an influence on the tactics of other companies such as PPP. Despite repeated attempts I have had no response. Please offer your comments on the forum...

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[Physiofit]

Hi Physiobob,
You are spot on with highlighting this issue. I have recently opened up my own private practice within a health club, after losing the battle with the NHS to secure myself a place, i did many months of voluntary work for the NHS and when they had a vacancy for one junior rotation post, believe it or not; nearly 1000 applicants went for it and guess what? i was not even short listed! Now i'm doing fine building my reputation within my clinic and regularly pay for a clinical specialist to come twice a month for mentoring & help with some questions, in addition to in-service training weekly between me and my other physio friends ! the clinical specialist has been great and offered 24hr (in theory) email support.
The Good news are; only about 14% of private clients belong to Private Insurance company and not all of the 14% belong to BUPA, but you've got Norwich Union, AXA, ppp and other companies that happy to cover the client as long as the physio able to show appropriate level of qualifications, i personally get most of my clients paying their fees out of their pockets! If you qualified you qualified otherwise they should keep you at university, getting enough training before they release you! and we all know every physio will have different experience and different fields they specialise or do best at! I Think BUPA should tackle this issue reasonably and fairly.
I propose an idea, if some (nice!) clinical specialists or seniour physios offer their mentoring service and email support facility to juniors within private sectors then BUPA or any other insurance company must recognise this scheme and chenge their policy. this might allow Private clinics encouraged to employ juniors and help with the job situation.

Physiofit

[allphysio]

And here's a thought. As a private practitioner I can say (from my experience at least) that it's by no means essential to be BUPA recognised to go into private practice. I started without it, and have decided to stay that way. Plenty of patients without it. The HSA is far more important in my opinion and they have no odd rules...

[physiobob]

And here's a thought. As a private practitioner I can say (from my experience at least) that it's by no means essential to be BUPA recognised to go into private practice. I started without it, and have decided to stay that way. Plenty of patients without it. The HSA is far more important in my opinion and they have no odd rules...

Totally agree with you as a private practitioner but as you and I both know this is preventing our new graduates from enjoying the many career opportunities provided by our profession. My clinic is in an expensive part of London, rent wise, and so to only work alone is almost not financially worth the effort. I need at least one other staff member to be able to pay the rent, the mortgage and then take a wage. BUPA and others are preventing me from expanding my clinic and are preventing me from taking on new staff that are keen and eager to learn.

[allphysio]

Yeah, I see your point. Thinking about it I suppose my post is really for those thinking of starting up for themselves after a few years... I heard a number of recent-ish graduates say "I'd love to start my own clinic... but I've not had the 5 years experience..." so it's for them I say "Why let BUPA dictate when you can start up or not?".


Also, from the confidence aspect, something for youger graduates to think about private practice is that from a sports massage point of view, there are people coming out of 9-month BTEC courses and creating a full-time living. Maybe private treatment along slightly different lines to pure 'physio' is something that could be considered by some...

Interesting to hear what you were told (or not) by BUPA. Who knows, maybe next year they'll re-roll the dice...

[JAW]

Hi All, I dont believe that BUPA will re-roll the dice.
The 5 years limit has been in place for some time amongst various forms of therapy including Hypnotherapy, and I think Osteopathy and Acupuncture. It is their policy. Axa are unlikely to open membership to people for a while, because they have sufficient on their register. With regard to a comment made earlier about coming straight out of college and starting in private practice. A Physiotherapist only completes about 250 tops clinical hours in outpatients. So in comparison to the sports therapist, it may well be that the ST actually does more clinical hours in what they are trained in. Its a very narrow field. Chiropractors and Osteopaths do between 1200 and 2000 really quite specific clinical practice hours in training, with the Chiro doing a year assigned to a private pract at the end of the course, so I understand, Osteopaths on graduation customarily join a private practice as a junior, with mentored suport, and responsibility for building their private lists. I have tried rescruiting on this basis recently and had very poor success.

A lot of this is historic. The training NHS Physiotherapists get is an NHS costed course, so the training fees are based on people going into the the NHS. Plus the clinical content is based on people carrying on gaining experience, with up to 2 years of rotations, or about 2000 clinical hours for competency. As I see it a shake up in training is needed. A costed training course specific to outpatient / sports work with built in business studies etc could be designed.... well except that folk could have done Osteopathy and Chiropractic. Isn't the point here that a lot of new grads are very angry and feel tricked into believing they will immediately have jobs unlike other university graduates?

Coming back to the BUPA point, if you are qualifed, you are most certainly qualified...in other words jumped the jumps, to call yourself a Physiotherapist, be HPC registered. BUT clinical hours are what counts. I believe that BUPA etc might benefit from considering setting a number on recorded clinical hours, and role specificity.

The biggest, and most worrying issue here, is actually the lack of inpatient orthopaedics, neuro rehab, early stage care in the NHS. so that new raduates can gain all that HUGE clinical experience, like driving a car on lots of different road conditions, after just passing the test. I'm sorry to say, there are plenty of very academic folk out there, with little hands on capability.
A solution some new grads may consider, is NHS junior job sharing. If every new post was split in half, or even a third, then double or triple the number of new grads would get NHS experience, and weekend work etc would be covered more easily.
Why says NHS jobs have to be full time? Why cant new grad set their sites on say 15 hours NHS and working elsewhere in an established private practice on a fee sharing basis part time, or even part time in Waitrose?

[physiobob]

I see your points and all are valid. However we are not talking about new graduates and I can agree for a year or two before BUPA recognition. This would be fine.

However BUPA oppressive tactics have nothing to do with patient care. They in fact will recruit people for their own BUPA wellness clinics and hospitals who may less than 5 years experience and they will be happy for their members to be treated by those people.

They have no outline based on experience for their 5 year rule and openly admin that it is just 5 years and that is that. What qualification does a corporate insurance company have in relation to deciding who is and who is not qualified to treat the public. Surely this is the job of the CSP and the HPC. Who they have let BUPA begin to dictate/control this is beyond me.

Why would a person who has done 5 years in cardiac rehabilitation or neuro rehab be more 'qualified' than someone with 1 year in the NHS, post grad sports science degree & 3 years in a sports physio clinic under mentorship when faced with treating someone with an acute sports injury?

I have a member of staff who has a sports science degree, two year working in that field, then a physio degree, then 3 years in the NHS dealing with an acute back program, plus a diploma in massage and post grad acupuncture. He also has over one year working with me under mentorship. Yet BUPA say, sorry he is not 5 years as a full registered physio with the HPC and it therefore not up to the standards required. This is clearly a breach of the law as it relates to experience.

Also everyone is missing the point. The fact that you need 5 years minimum, and luck to gain BUPA recognition. This means no one under 5 years is going to leave the NHS. This means no new job openings are going to happen on an annual basis. Once you have done 5-6 years in the NHS, you may never move on to private practice. Not that you should of course, but in countries like Australia this is a necessary part of the system that creats new grad positions every year.

[allphysio]

Very good points :-)

Not sure I had missed the point. I just think people need to realise that they don't *need* BUPA recognition to leave the NHS... sure it might help get a few percent more clients, but with a flexible strategy this really shouldn't be a problem. However, as long as most people THINK they need that recognition in order to leave, then as you say that is a problem (among all the others!)...

Anyhow, off into the sunny weather :-)

[lexi]

I totally agree with allphysio
I am a private practitioner and have been BUPA recognised for over 20 years until recently when I declined to be on the provider list
Some patients I have treated previously I have unfortunately had to say I no longer take BUPA patients
Some patients have still attended for treatment self funding
If all p rivate practitioners decided to boycott BUPA then patients would find the lack of choice unacceptable and vote with their feet in my opinion

[physiobob]

I totally agree with allphysio
I am a private practitioner and have been BUPA recognised for over 20 years until recently when I declined to be on the provider list
Some patients I have treated previously I have unfortunately had to say I no longer take BUPA patients
Some patients have still attended for treatment self funding
If all p rivate practitioners decided to boycott BUPA then patients would find the lack of choice unacceptable and vote with their feet in my opinion

Would you take on a new staff member with under 5 years experience who is not on the BUPA or PPP list? I agree with a boycott. The whole of the OCPPP should ban together in a month of Boycotting and then PR about it.

Unfortunately many practices (not mine) had many PT's on their books without 5 years at the time this came into force. Many of those where looking after a lot of BUPA patients. This is typical of practices in the bigger cities where companies include BUPA in their staff packages. This is the issue: I would say 50% of my patients are BUPA. Many don't bother to claim but if I had 5 staff working for me and my business was based on seeing 50% BUPA I would be out of business overnight. This is a restriction of trade.

Does everyone not see that the CSP, OCPPP and even HPC should be involved in this issue.

[JAW]

A boycott wont work, because BUPA will always have Physios who need work to earn money, and wont stop work for others. Hard but true.
There are issues with BUPA for example not treating chronic conditions, and now not allowing PT's to accept patients without a referral, which they used to. I would propose that perhaps pointing out to your clients the drawbacks with BUPA and encouraging links with medical insurance brokers who can offer other policies is a way foreword.
OCPPP wont form a united front to block BUPA because of the monopolies and mergers issues, we have had these discussions before.
CSP wont get involved because it backs junior physios getting experience.
HPC is about regulating protection of title, and I have just contacted them to point out that either their website breaks trading standars, OR they are not protecting our title, which I wont go into here
Just to add, my 'list' of private health insurance companies who I claim from runs to about 20. BUPA is just one of them, and AXA another.
Why so hot and bothered by BUPA? Personally BUPA and AXA are teeny tiny percentages of my PHI clients, more and more work is through injury claims, I dont see the issue here.

[physiobob]

Why so hot and bothered by BUPA? Personally BUPA and AXA are teeny tiny percentages of my PHI clients, more and more work is through injury claims, I dont see the issue here.

Because they are restricting my trade and are breaking the law and our association is doing nothing about it. For the record I try not to take insurance clients so that I am not relying on any insurer. Also all my clients have to pay up front so any issues thereafter is between client and insurer. But I work in London and I would like to grow my practice, and I would like to do so by taking on some PT's with 3-4 years experience, not over 5 as such. In the city BUPA does insure many of the bigger companies whose business one needs to expand in any meaningful way. Although this could be done without BUPA they are setting an illegal precident which other may decide to follow. AXA PPP of course just decided to close their doors.

I also take your point about recommending other insurers. This I do as well, but why does the OCPPP not get together with a broker and promote their own policy which is PT friendly and which we could then promote in a much larger way to all our clients? Let's be proactive about this rather than just ignoring it. It is a small issue now but it could be a big issue later and it is definately a big reason why there are fewer junior NHS posts becoming available.