Don't just blame the NHS for the lack of new physiotherapy jobs! It's to simple.

Now that we are a few years post the BUPA blind tender we are beginning to see all the issues that we were concerned about. Yet despite this very few in the profession in the UK seem to care. The Physio First initiative seems to pander to BUPAs demands and act as a relay to the members on them, perhaps making ways to assist their members (of which I am one) to comply. Surely something is wrong with this space..... Does BUPA have an insider within?.....

More than 5 years ago I wrote about what I saw as a clear issue for the new graduate employment opportunities in the NHS. I have talked about this in person with many people over the years but it still seems no one understands what I am saying. I think perhaps you need to be a private practitioners who likes to mentor and bring on junior staff to recognize just how obvious this issue is. Anyway I would like to present the issue as i see it again in a dedicated thread. It's all to do with BUPA's (and others) 5 years minimum post graduate experience requirement to be part of their network. Of course this has nothing to do with clinic experience as it is just a number. I can confirm that as I asked BUPA for information on this more than 10 years ago to understand the experience side that matches with the 5 years + only to be told that they would be happy to take me off their network during the phone call! The did agree that I could have had 5 years off traveling the world since graduation and that would still be good enough for 5yrs + but 4 years, 2 other degrees and specialist MSK delivery in the NHS would not satisfy the conditions.

I also asked why they thought they had the experience and expertise to judge clinical competence. And how 5 years fitted with that. After all they are an insurer. Again I was told they could take me off their provider list if I wanted there and then.

OK, I digress. Sorry! Here it is in a nut shell.

The historical route of the new graduate.

1. Graduate gets a one year rotational position within the NHS, consolidating their education with experience and mentoring from senior physiotherapists.

2. At year two some are offered continued employment within the departments as expansion is permitted and as more senior people leave their posts, some to enter private practice, others for family reasons, some to travel etc.

NOW THIS RELIES ON PEOPLE HIGHER UP THE CAREER LADDER MOVING ON. ENTER BUPA'S 5 YEARS PLUS RESTRICTION.

3. We all know many people who want to move into private practice do so within the first 5 years of completing their undergraduate degree. But now the private practitioners who want new staff are only looking for 5 years + experience as only they can register with BUPA to treat their patients. Of course now they is not even possible. So very few people moving our of the NHS within the first 5 years into private practice due to limited opportunities being offered (as a direct result of health insurance company restrictions).

4. No one moving out of the NHS for 5 years means NO vacancies opening up for new graduates to take those positions.

5. After 5 years in the NHS many people do not move on, they have become senior in their departments, their lives have settled down and so a percentage that may have left now maintain long-term careers within the NHS. This of course is great for the NHS. :-)

6. Now for those that do leave after 5 years, they are a premium candidate for a private practice and come at an increased cost to the clinic. Couple that with BUPA restricting the pricing paid to treat via their network and the private practitioner has to think long and hard about the value in expanding in terms or reward for effort. I for one can say that I decided it was not worth it and so a clinic that at one time had 15 part-time contractors slowly became a sole practitioner service. This is a very real world example of how BUPA have restricted my freedom to grow my business within my profession.

7. BUPA have always offered employment within their own clinics to people with less than 5years experience. Even today they advertise jobs for people with any postgraduate experience. I suppose as they get them 'cheaper'. So they mop up the unemployed juniors that from a situation that they very much contributed to.

8. Now it is my understanding BUPA & PPP have closed their networks to any new contracts. But at the same time they continue to expand the number of clinics they run themselves, employing junior physiotherapists more and more. They force the businesses who do have contracts with them to provide information on patient satisfaction, outcomes etc etc which they can then use for their own market understanding and business development.

9. As they expand their own services they begin to cut contracted services with existing network practitioners if they think they can themselves fill the gap. Only recently have they decided that they will not renew any physiotherapy business that provided domicilliary physiotherapy services who doesn't also have a physical practice as well. Surely the idea of care in the community if to reduce the costs on the healthcare system and why would someone providing such a dedicated service want to have the huge overhead of a clinic they are never in. Maybe this is nothing more than BUPA working out where the business opportunity is in that area (from information from their existing contractors) and then working out they can axe them and fill the gap with their own business services. Am I alone in this thinking.

So there you have it folks. Just a few thoughts from the armchair this Saturday morning. I am sure to expand on this thread over time but do place your own thoughts on this issue if you like.

For the record when BUPA did their blind tender I decided it was time to say NO and not let them get a further strangle hold (especially in central London where many have private health insurance). Unfortunately many did not. And here we are today. We are developing a network of PTs who do not have contracts with such organisations as this will be larger than the existing ones. Let's see where the public will go then..