Quote:
Dear …..MP
I am writing to you today to make you aware of a sizeable confrontation that is current between the Private Medical Insurers (PMI’s) and the Physiotherapy profession throughout the UK. The issue focuses around the blind tender put forward by BUPA Health Care and the dangers it poses to both the clinical autonomy of these primary health practitioners plus the patient’s choice to access whom they deem appropriate to their needs.
Here is a sample of what is being said by the physiotherapy community right now about this matter:-
“The prices they are quoting are for inner & outer London and the rest of the UK. The prices are nearly impossible to provide a profitable service. That is the least of our worries.”
“The biggest threat is to our clinical governance and clinical autonomy. The PMI’s will be able to decide which patient is seen by whom and for how many sessions at whatever price they choose. This means that, no matter what you clinically decide is best for your patient, the PMI will dictate how you treat them. BUPA’s so called “quality” is non existent. This is about squeezing a very fragmented industry so they can make more money. Our relationship with our referring GP’s and Surgeons will mean nothing. The cheapest will win with, not necessarily, the most clinically appropriate option succeeding.”
In a nut shell, BUPA has over 12,000 physiotherapists on its books. This is a small percentage of the over 40,000 physiotherapists in the UK. From that 12,000 it has sent blind tender offers to around 6,000. All of those are more than 5 years post qualification and therefore must be over about 26-27 years of age. They do not provide any clinical justification for that figure as they cannot provide a document to support the experience obtained within those 5 years. From that 6,000 it is believed that as few as 1,000 physios might be eligible to win a tender.
In the tender BUPA have included a base rate and have suggested that physios tender below that rate to increase their chances of success. These rates are, in fact, lower than many have been charging in order to build economically viable pratices. Furthermore, BUPA, who themselves operate physiotherapy practices under the BUPA Wellness brand, charge the public a higher fee than they are suggesting the rest charge per treatment session.
The Chartered Society of Physiotherapy (the UK’s major representaive body), PhysioFirst (the sub group which represents private practitioners) and an independent group of private individuals all have submitted complaints to the OFT and elsewhere on the grounds of diminished patient choice, price fixing in the market, the erosion of clinical autonomy and more. This week a major media campaign is set to take place.
Perhaps one of the scariest things BUPA mentions is that, with the money it hopes to save with this initiative (although they actually state it is not a cost saving initiative), they will spend the increased revenue on pharmaceuticals.
We know that the major drug companies would love us all to become a more ‘pill popping’ nation. Well so would BUPA! It costs them less because they don’t cover out-patient medication. Manual treatment will go out of the window.
Don’t let BUPA turn the UK’s public into a nation of ‘pill poppers’. They (the Great British Public – and electorate) need individual care, advice, encouragement and supervision. In short they need independent access to expert physiotherapy, on a private basis, should they so wish.
Some points to consider from this tender that affect the Physiotherapy Profession:-
1. The real issue is that physiotherapists do not need a contract with BUPA or any other PMI. The BUPA proposal does not add value to a physio’s business. In fact it takes considerable value away because it demands a significant increase in the volume of work necessary to comply with its terms and ensure payment. The pricing structure delivers less than before. The only reason anyone would sign up to it is fear. Fear that BUPA might withdraw its business. Fear is not a basis on which to do business. Fear unfortunately has been the emotion that has caused many to tender when they felt they had no other choice, rather than to go out of business.
2. Physios need to be free to conduct their business with patients as they choose unencumbered by any contract with a PMI. Patients should be free to select the physio of their choice. Payment should flow from the patient to the physio. If the patient carries insurance then he settles the claim with his insurer against the physio’s invoice, i.e. the patient has a contract with a PMI to provide some cover for their medical service needs. That same patient makes a contract with a health care professional to provide them with a duty of care in fulfilling their needs. The patient then pays a fee for the delivery of that service and, if they are able, then talks to their PMI to reimburse the amount that accords with their contract with them.
3. Physios need to be able to focus on providing the highest quality care to their patients to the very best of their experience and ability. They do not need to be conducting an insurance business or a claims management service or a clinical audit facility for a PMI.
4. If BUPA requires physios to process their insurance claims they should pay market rates for the service in addition to the treatment fees. This should therefore show an increase in the base fee for BUPA clients. Furthermore BUPA have said that their chosen physiotherapists cannot charge the client directly for the service, nor can they charge any top-up fees above their base rate. This is an attempt to devalue the profession into a ‘TESCO like’ arrangement where quality suffers, majorities go out of business and essential services disappear from outlying areas. We have seen this with the farmers, we have seen this in the USA and now we are in danger of letting it happen in the UK.
5. The person best qualified to set clinical care pathways and monitor them is the physio. How does the patient derive benefit from a treatment guideline monitored by an unqualified administrator based in Salford Quays who has no direct contact with the patient and his problem? If sessional averages are appropriate and beneficial to the patient, no doubt physios will apply them. How can unqualified administrators determine how many treatments are required without having assessed the patient and his particular condition in person? A PMI has no place in deciding the medical/clinical treatment pathway for any individual. This can be seen as nothing more than a cost saving initiative.
6. The BUPA tender has one objective only which is to force physios to carry more of BUPA’s work, so it can reduce its costs, reduce its staff burden, protect its margins in a recession and steal market share from its competitors. The outcome is to deny the patient choice both in terms of availability and quality whilst simultaneously abusing the physio’s role and adversely affecting his or her business to enhance BUPA’s bottom line. Not tendering preserves the clinical and commercial integrity of the physiotherapy profession.
Important NHS considerations:-
Now other issues surround the future privatization, in part or full, of the NHS.
BUPA, through this tender and other (failed) tender’s with the ophthalmologists and MRI technicians, is positioning itself to being the leading candidate to offer a national network of health care suppliers. By ‘forcing’ practitioners to tender they are consolidating that position.
The typical scenario for the Physio graduate is that they first gain additional experience (though not required to practice) within a well established NHS teaching environment. Then 2-3 years in, those who decide to go into the private sector, leave the NHS, thus vacating positions down the line for career advancement and new graduate positions. The 5 yr cap BUPA has put on this for several years has meant that no one under 5 years post. Grad. in the NHS was leaving the NHS. Why? No one would employ them because they couldn’t get BUPA recognition. (As the largest PMI in the country this is like a big kid in the play ground bullying everyone else into their game plan).
What that means is that, in 5 years, jobs are not becoming available within the NHS for our graduates. Add to that issue the fact that once someone is working in the NHS for more than 5 years they probably have climbed up the ranks and might not wish to leave. That further compounds the issue that BUPA and others have already helped to create. This is a real problem for the current and future students, as well as those huge numbers currently unable to gain NHS or private sector employment.
We have seen the flack the government has taken over this issue but no one seems to be holding the PMI’s to account. AXAPPP is just as guilty on this matter as they have not taken anyone on their books for years. Club AXAPPP and BUPA together and you find that the market is no longer a market.
I could go on for a longtime about this but that is not my intention. I simply wish to draw to your attention this deveplopment that is taking place in the UK Health care market at present. Perhaps the Government is aware, perhaps it is not.
I hope my letter has made you aware of the current situation so that you might be able to comment on it from a number of angles when needed. We need to stop the PMI’s in their tracks. We need to ensure we do NOT become like the American Health care system where there is access for the few and not for the many. We need to keep our Nation healthy and we need to protect the rights of our health care workers to deliver primary, autonomous, high quality treatment. In addition, those services should be delivered in a free and open market place based on experience, skill and results. A PMI delivering healthcare based on lowest price, never mind the quality, does nothing to support that cause.
Thank you for taking time to read my letter and I do hope to receive your response in due course.
Yours sincerely
