BUPA Physiotherapy Tender Process

Hallo

I think this is a great place to start.

In the UK we have been or are about to be told by BUPA (the UK's main PMI) that all Physio's will have to go to a blind tendering process to be able to treat and look after BUPA patients.

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 existant. This is about squeezing a very fragmented industry so they can make more money. Our relationship with our referring GP's and Surgeon's will mean zip. The cheapest will win, not necessarily the most clinically viable option succeeding.

BUT we can do something about this - if and only if we do something (and I know this all sounds a bit right on) about it. We've 6 weeks to mould and shape the future of the profession. As a unit we can do something.

Have a look at the very new blog thephysiosvoice.co.uk and add your comments. Tell your mates. Get scared, but you are not alone....

Cheers

TPV
info at thephysiosvoice.co.uk

Afternoon

So today is the start of the Blind Tender Process - my computers broken and so I can't do it. Shame. Apparently it will be out of action for the next 6 weeks or so, or at least until Saturday 25th April ;)

BUPA has announced that with all the money that they will save, should the process go ahead, they'll spend it on new drugs. And probably try and get rid of physio all together!!

Spread the love.

thephysiosvoice dot co dot uk

TPV

So, you charge £30 or less and into the fourth year of your agreement you are now allowed to charge up to 75p more! Get real.
Maybe Bupa should advise Labour on how to run the economy.

I AM NOT going to join this charade by BUPA. I am fortunate enough to have enough self funders not to play their game.

This process is similar to what happened to Dentists and the NHS. And what did they do? Maybe we should let the press know that Bupa patients are going to possibly be seeing less experienced physios, for less time and in less pleasant surroundings! And whilst I am here, this is even more hilarious for our osteopath colleagues who really do know how to charge for their services

Should have been a lawyer or merchant banker. Damn!

Up the revolution!!!:p:p:eek:

Hello,

First I would like to make a point that I am not one who gets involved in general discussion forums regarding physiotherapy issues.

However, recently, I have learned that BUPA have given all private clinics in the UK, 4 weeks to submit a blind tender for the business of BUPA subscribers. As a clinic I remember no other discussion or warning that this was coming about and to give us all 4 weeks to go about a blind tender seems generally wrong.

I have been searching on google and I believe that this is BUPA's big plan to bring all medical providers who are currently treating their patients in-line with their pricing structure. BUPA say that this is because of the large variations in physiotherapy fees and quality of treatment around the country, however underneath this when looking at the tender website they ask questions regarding internal audit and care pathways. It may be just me but aren't BUPA an insurance company? Is it really there role to establish whether physiotherapists on their preferred list are in fact taking part in these CSP standards (I personally think not). In fact it is the job of individual clinics to meet the CSP standards.

I personally believe that the tender is going to remove/devalue practitioners autonomy, as we all know you cannot bracket all patients into care pathways, try doing that for a patient with lower back pain.

Further to this, when looking at google I notice that BUPA have instigated tenders for MRI and Opthalmology. MRI was pushed through quietly and now those who signed up the agreement are regretting the agreement and the Opthalmologist's have out right rejected BUPA's proposal.

I would like to find other members who are concerned regarding this tender, we don't have very long and we may be signing up to something that we don't yet know all the facts about and how it may affect us in the long term. I am considering contacting the press to bring this issue to the forefront

Please contact me if this is a big enough issue for you and you want to do something about it.

My name is Mike Aunger

Where do I start? SO much to say...
1. The BUPA tender is NOT about quality. It is ONLY a price cutting exercise! Be under no illusion.
2. Why are physiofirst and the CSP not doing more to support their members with this issue? It should be all over the press that BUPA are looking for cut price physiotherapy treatments and reducing patient choice?
3. Are BUPA going to reduce the number of osteopaths/chiropractors
and cut their prices too? I think not! And when your patients cant get a good physio with good skills because of this tender process, they will be going to the chiropractor/osteopath down the road!
4. How am I expected to maintain my CPD, improve and expand my skills and practice with a 30 quid treatment? Will the extra 75p in four years help fund it? I think not. Does Ms Gallagher spend more than 30 quid on her hair do? I think so!
5. What if I get the contract and am flooded with BUPA patients pushing out my other patients and in 4 years time dont get the contract- what happens to my practice then?
6. What if other Personal Health Insurance Companies follow suit and I have to charge all my patients 30 quid - I will essentially be working for 3 months of the year for free (a 25% cut in money coming in!).
7. How do BUPA plan to evaluate that the providers have these carepathways in place and clinical audits? If they did actually inspect them would it mean anything to them? Again, I think not.
8. Can anyone actually make head nor tail of the terms and conditions in this contract?
9. What about my clinical governance and autonomy?
Im angry, confused, stressed and annoyed by BUPA. I thought they were a reliable trustworthy company which provided good quality healthcare now Im not so sure and am wondering should I switch my healthcare provider. I dont want top be sent to the cheapest heart surgeon or the cheapest vascular consultant or have a cutprice hip replacement.
Im also let down by Physiofirst and the CSP - why oh why are they not doing more about this?

Where to start.....

1. I think you are correct. This is a Walmart proposal. Stack 'em high, sell 'em low. Physio is just physio. Doesn't matter by whom or where or even what....really?
2. Physiofirst are spineless and don't want to tussle with the Big Boys incase their cred is dented and the CSP has to look to and protect the "majority of it's members" i.e not the group who represent the private sector. The CSP seem to forget that like it or not, the private sector is often the public image of physio and so should give us just a modicom of respect.
3. Chiros and Osteos only represent a small percentage of relative treatment cost, so go for the biggest group - us.
4. Forget CPD. Read Frontline - that's 50% of your yearly CPD. Do it twice - et voila.
5. Eggs in one basket....
6. Unfortunately they will if this is allowed to succeed.
7. BUPA have an elaborate method of assessing and evaluating by getting us or monkeys to fill out an online form
8. No. I'm sure your folks always told you to be careful what you put your signature to - and if in doubt, don't.
9. If BUPA get their way we wont have to worry about this. We'll be told what to do, to what bit for how long. Think dank basements, think robots. Forget 2012 and the Olympic Dream.

You are not alone - the more I listen the more I hear other Physio's crying out for help. We're a pretty mean bunch when we communicate with one another and get things done.

The Physio's Voice is there for every single Physio in the land to have a voice. If you get a lot a people in a room and all whisper, you actually make quite a racket....Please look at the blog thephysiosvoice.co.uk and get involved and tell your mates too.

Cheers

TPV

As you have so rightly said physiotherapists need to think very carefully before agreeing to BUPA's tender agreement.
The idea of a PMI calling the shots on how we treat our patients is a very worrying prospect.
We fought to stop the medics from telling us how to treat patients more than 20 years ago! This is huge backward step if not even more concerning as I doubt if the decisions will made by exeprienced clinicians.
I am baffled as to why the CSP and or Physiofirst aren't more interested in this issue, I understand why they can't discuss costs and pricing but this is about the errosion of our professional autonomy.
I have friend who runs a practice in the USA and if you want to see where this is heading look no further.
She is told by the insurance company, to treat a patient so many times for a particular condition and no more.

In this world Bupa divide and rule. Having been told by Bupa that I could only charge patients at the agreed discounted rate, I then find out at a recent course that other physios have been allowed to charge their patients for the shortfall in the Bupa agreed rate compared to their normal rate. Just like Bupa allow the top surgeons to do.

It all boils down to this: we are clinicians not technicians. We are worth more than a 75p wage rise over four years.

75p is the key in the pricing argument in this campaign. 75p, that's all your skills are worth in the world according to Bupa.

Quote:

---

Originally Posted by Bupabear

Maybe we should let the press know that Bupa patients are going to possibly be seeing less experienced physios, for less time and in less pleasant surroundings!:eek:

---

Here here on that one. I think the press would like to know a lot about BUPA's new reg's. Firstly, that their clients don't get their choice of practitioner, merely BUPA's choice of the cheepest tenders, second that they are working against the European laws on age descrimination by preventing people with less than 5 yrs experience (without any clinical basis) work on their clients. Thirdly that some of the NHS backlash for no jobs is due to the private arena not taking anyone less than 5 yrs post graduation and therefore no open job opportunites are appearing in the NHS.

And the list goes on. They are even restricting trade by charging £53 per half hr appointment at their BUPA wellness clinics (one around the corner from mine) but they insist I can only charge £45.

I back a total boycott of the tender process and we tell clients that we DO NOT see BUPA members. Let's hit them where it hurts, their membership, and get their patients to walk elsewhere.

:mad:

I agree the press should know about this process and how it will affect all BUPA subscribers. I myself am a BUPA member and a provider (for the next 4 weeks anyway), I need to see a vascular consultant - are they going to send me to the cheapest, or the best? That aside, BUPA can do what they want and provide the kind of service they wish to pay for. I personally believe they are shooting themselves in the foot.

I would like to know what the csp and physiofirst have done to fight this? Did they break the cost of a physiotherapy treatment down for BUPA, did they explain that we all must have insurance, PLI, up to date CPD, good surroundings with heat electricity, parking, good administration, good up to date serviced equipment, access for disabled clients, time to complete notes, communicate with doctors, consultant etc, that we need to pay rates and so on. None of this discussion involves price fixing, its just about informing BUPA what it costs to run a good, well expereinced, efficient physiotherapy clinic. The CSP and physiofirst have washed their hands by saying they cant talk to BUPA about this due to the competition laws. They can however, talk to BUPA about the true cost of a session of physiotherapy in real terms and the implications of unrealistic pricing, they can advice their members and provide support.
I heard a rumour that a motion to be discussed at Congress on this issue was declined - why? Simple question!

Legal implication! Can someone help me with this issue?
If I dont qualify for this BUPA tender and am suddenly deemed to be below standard as set by BUPA, will the CSP defend this slur on my professional ability, even though I comply with the standards of practice set by the CSP and HPC?

Let's look at the BUPA issue in recent years. I might add I have written to the CSP and the OCPPP (entire committee) on several issues about this in the past few years and have had little CSP response and NO OCPPP response.

I think it's time perhaps the UK's private practitioners looked at forming a new association?! Maybe then they will listen.

Firstly the age discrimination issue:

In October of 2008 the European law stipulated that you could not discriminate on age for any job application. Immediately BUPA fell in breech of this issue as by demanding 5 yrs post grad 'experience' (actually time past) to be on their books. Effectively this says that no one under the age of 26-27 can apply for this job contract with BUPA. (18 yrs + 3 for the degree + 5 for experience) So 27 is a minimum.

I questioned BUPA on their guidelines for the 'level of experience' required at the time and they said there was none, it was 5 yrs and that was that.


Secondly the 5yrs + and BUPA's own wellness clinics.

I am sure everyone knows that BUPA themselves recruit graduates of less than 5 years experience into their own clinics (some as little as 2 yrs). They justify this by saying they are under the observation of those with a minimum of 5 yrs experience. Not quite sure who they think we private practitioners are.

The result of the above is a restriction of trade issue

Thirdly, BUPA have told me I can only charge £45 for a half hr session when their clinic around the corner charges £53. This is ant-competitive and a restriction of trade.

All of the above point, and more, have been brought to the attention of both the CSP and the OCPPP

Let's go on.

In 2006 I wrote to the CSP explaining that the big issue lying ahead for new grads was this 5yr + issue and BUPA (and perhaps PPP who has stopped all physio's registering with their service).

Effectively what that meant was that no one under 5 yrs was going to leave the NHS as NO private practitioner was that keen to employ them without recognition of the health care companies. No one leaving means NO new jobs for new grads within the NHS.

By the time someone spends 5 yrs in the NHS they are unlikely to move into private practice. Thus no seniors leave either, the result even less new grad positions.

No let's look at the culling of the BUPA list under the current scheme, even less BUPA approved practitioners, practices will shrink, there will be more solo ([professionally isolated) practitioners and even LESS jobs for any physio outside of the NHS. Therefore no incentive to leave the NHS and NO new grad jobs for the future of the physio profession in the UK.

No I am taking a slightly extreme view on this but it will not be far from the outcome as I say this and the later ramifications whilst working in Canada in the 90's. Interestingly a similar situation that BUPA is trying to create was eventually deemed anti-competitive under the Canadian law and these super-clinics for the mass market has to disband their exclusive agreements. So BUPA will possible gain for a while but not forever.

This is an issue for the whole profession, not just the private practitioners. The NHS, the current new grads, the current students and the future students.

I would support a boycott of the tender process by the entire profession. I would also welcome media interest in this issue as BUPA are no longer offering their clients the practitioner of their choice. They will be offering one of BUPA's choice based on the cheapest offer on the table. No well established, well qualified and conscientious therapist will enter this agreement. Once their members know about it, let them react by walking. The media could have a field day with this.

Please make your comments and no that there will be a physio meeting held in central London next week (perhaps wed the 8th April) to discuss this on mass.

Watch this space.

OH and by the way the CSP continues to take advertising from BUPA for their inserts in the frontline publication. I also complained about this several times and they even printed my letter but did nothing about it. I suppose when their mismanagement has lead to financial problems they even take money from the enemy…Such a short-sighted approach to all their members’ livelihoods.

I think this will be the end of the OCPPP. They have been shown to be spineless (excuse the pun). I never expected the CSP to get involved. I am 52 and when I qualified it was considered the eighth deadly sin not to work in the NHS. Why should our NHS colleagues be worried about us greedy private practitioners charging such a large amount for treatment?

Yes let's have a boycott. Sod the lot of them. If we agree to cut our costs and lose are clinical autonomy to one insurer, the rest will jump on the bandwagon. How would you answer the question from AXAPPP " Why do you charge us more than Bupa?"

Maybe when we move away from these stupid Bupa prices, we can go on and move towards charging a proper rate. We are clinicians but get paid technician wages in the NHS and that's what Bupa think we are.

The Daily Mail might be sympathetic to our cause, what does everyone think?

I would like to voice my support for a mass exodus from BUPA. We are all working privately to be autonomous practitioners and as such able to provide a flexible service to deal with our differing patients variable needs. This would be swept away in an instant and we would be culpable in the demise and undermining of our profession
This contract is belittling and demeaning. I will not be tendering , am prepared to take the substantial financial hit to defend my position as a professional rather than a paid assistant.

As we are the only practice for an 8 mile radius it will be interesting to see how BUPA are going to fulfill their proclamation to still offer physio close to where patients live.:cool:

Further to my post I realise sadly that i am the only woman who has come out in support of a buoycott.....please..... someone tell me i am not alone???

NO! You are not alone.....

TPV

Let's boycott it all together. Let's all talk about it. Let's inform the media. And tell everyone offline too. p.s. Sorry about the site being down overnight. Our hosting company had a meltdown and many were affected. Glad all is back online now :)

Here's an interesting report I found online about this issue with the MRI professionals

Hospital files complaint on Bupa as it fails tender process

Bupa could be probed by the Office of Fair Trading (OFT) following a complaint from a hospital about the insurer's new network arrangements, writes Kirstie Redford.
St Anthony's Hospital in Surrey filed the complaint after Bupa conducted a national tender of routine elective out-patient MRI scans earlier this year. The hospital failed the tender process meaning that patients have to go elsewhere for scans, despite receiving the rest of their treatment at the hospital and listing St Anthony's as their preferred provider.

Brian Clarke, hospital director at St Anthony's, said altering network arrangements undermined the whole concept of private medical insurance (PMI). "The move by Bupa goes against the heart of PMI, which is that patients have the choice of where, when and by who they get treated," he said.

Clarke added that narrowing the choice of radiologists could put the quality of treatment in jeopardy. "Operating surgeons choose radiologists very carefully and often work closely with them so that they can speak the same language when interpreting results. Separating reporting radiologists from surgeons has already led to requests for repeat scans," he said.

Lara Gorman, spokesperson for the OFT, confirmed it had received a complaint from St Anthony's saying it had been unfairly prevented from joining Bupa's preferred provider network for MRI scans. "The OFT is currently still considering the substance of this complaint," she said.

Natalie-Jane Macdonald, medical director of Bupa UK Health Insurance, said the objective of the tender was to ensure consistent quality of service, together with fair pricing. She said: "St Anthony's was unsuccessful because it was too expensive. The hospital was given the opportunity to improve its pricing during the tender process but chose not to do so."

Are "Blooper" intending to impose a similar tender process on orthopaedic surgeons? Anyone know? They might be useful allies for us: imagine a surgeon not been able to refer to a physio they trust.

One very interesting point in the letter we received from Bupa is when they say they would only be able to guarantee pre-authorisation to physios in the network. Reading between the lines, does this say:

"If you are a corporate member, we don't want to upset your company so we will allow authorisation in this case."

or

"Don't shout at us and threaten to withdraw your membership, we will allow pre-authorisation in this case."

Any thoughts on this ambiguity?

Spoke with Roger Hint Customer Relations Officer (0207 306 6695) from the CSP, and Chris Hammacott (0207 314 7839). Both men were very helpful, firstly Chris pointed out the standard line that the CSP could not be seen to directing members as to what to do, etc. as we have heard before.

Later in the afternoon I spoke with Roger who said that due to the large volume of calls received regarding this matter the CSP in conjuction with the OCCCP (check the website this evening for further news I was informed) were now considering a media campaign to highlight our issues and even examining legal alternatives as to what can be done to protect THEIR/OUR membership, which I think they initially failed to take into full consideration. The CSP is our governing body, and it is up to us to continue the pressure so that our collective voices are heard.

I think all the issues that have been raised in this forum and the physiosvoice.co.uk, are excellent ones and their is no need to re-hash them, but I emplore you all to be passionate about this matter and continue to keep fighting the good fight.

cheers mark

Good work.

This is what we need. We need the support of the CSP. The more we "hassle" them, the more they have to take notice. By hook, or by crook.....

Spread The Love

TPV

Don't bank on the CSP doing anything. They are probably only calming the waters by saying they will assist. Any media campaign organized by them is likely to have little affect, be to soft and be to late. Afterall they continue to book and advertise BUPA in their frontline publication!

There is now a meeting scheduled for Wednesday, April 8th at 7pm in Central London. UK physio's on this forum and on our Physiobase membership will receive details with more information. We are trying to invite all local london press. Stay tuned...

What about inviting representatives of other health insurance providers PPP, PRU etc.. who might be able to offer discounted membership to BUPA members who wish to continue with their choosen physio. This discounted membership could roll out till the patients BUPA membership finishes, and then the member joins the new Insurer.

Be guarenteed that BUPA will more than likely have a 'spy' in the midst of the Wed. meeting, so let them know we are prepared as a collective group know that we will be informing our patients/their members about their actions, and suggesting that might want to change providers. Just a thought.

Also note that Bupa physio's working in their own private clinics are being subjected to the same measures and are definately on our side.

cheers mark

Physio First/OCPPP have been in negotiations with Bupa and all the other major insurers for many years. They have fought long and hard for us and do not deserve the comments that they are not doing anything. The difference here is that, as when Bupa first started the pilot contracts in the North East some years ago, the competition act effectively gagged them and the CSP. It does not mean that they have been doing nothing. What is also different about this scenario is that with sites like this and Icsp then physios have the opportunity to know what is going on and get active!
I spent 15 years on the committee for OCPPP, and believe me, the members of that committee work exceedingly hard - and are working physios just like the rest of us. This situation affects them as much as the rest of us and if there was a way round it they would have found it. Unfortunately it is now down to individual physio power. Let's go for it!

I too am in favour of a boycott of the BUPA tender - where BUPA lead with this others will follow.

The email below was sent to all OCPPP members. Whilst it is nice that they are saying something, it reads as a very weak commentary and to suggested we are "frustrated" is NOT a term I would use for the feeling of the members. We are outraged and are seeking legal action, not just for this tender process but also for the Age descrimination of their 5+ yrs post graduation terms that have been in place for a long time AND for the anti-competitive pricing by making insisting we charge less than they themselves charge in their own clinics.

Here's what the OCPPP sent

Email Alert – Physio First & CSP go to Press and OFT over Bupa

Following Bupa’s formal letters to private practitioners last week requiring everyone to enter into their blind tender process, we are now able to announce that as a result of meetings that occurred between the CSP and Physio First on 1st April 2009, the long planned collaboration to raise issues in the national media and to instruct solicitors to submit a formal complaint to the Office of Fair Trading, has been agreed.

Although both Physio First and the CSP have known of Bupa’s stated intention to force members to take part in a blind tender process since we met with representatives of Bupa in October 2008 (full details of which were published in the October Update), neither we nor the CSP have been able to take any formal steps with the media or the Office of Fair Trading, until the details of Bupa’s blind tender were actually produced.

The Media Campaign

The media campaign was kicked off with Physio First and the CSP submitting the following joint press release to media channels:

Joint Statement from Physio First and The Chartered Society of Physiotherapy (CSP)

BUPA, the largest Private Medical Insurer in the UK, has recently announced to private physiotherapy practitioners that if they want to continue to treat BUPA patients, they must now participate in a “blind” tender process.

BUPA has asked 6,000 Physiotherapists to compete against each other to be allowed to continue to treat BUPA patients.

BUPA’s tender questionnaire requires practitioners to quote the lowest price that they are prepared to work for. BUPA has not made clear how much weighting will be given to each part of the tender and our presumption is that price will probably be BUPA’s main determinant.

There are indications that BUPA may significantly reduce the number of private physiotherapy practitioners who will be able to treat BUPA policyholders.

Speaking on behalf of Physio First, which represents the interests of private physiotherapy practitioners, and the CSP, Eric Lewis, Chairman of Physio First, said,

“BUPA’s approach to this tender has quite naturally caused considerable frustration amongst our members. These feelings are heightened by the fact that this process is not one that Chartered Physiotherapists have been subjected to before, nor is it one where the bargaining position, between very small and multi-million pound businesses, can be equalised through collective action, as coordinated action is prohibited by law under the Competition Act.

“Whilst Physio First and the CSP recognise that it’s entirely appropriate for BUPA to regularly review the services provided to their policy holders, we are concerned that patients may lose out if price is the primary consideration in this tender process, rather than the quality of health care provided, or the particular needs of individual patients. We hope that BUPA will ensure that their policy holders continue to have easy access to a full choice of Chartered Physiotherapists, and that patients will be able to continue to see a practitioner they have learned to trust.

“The vast majority of private physiotherapy practitioners are single-handed or small group practices. They are highly qualified, work very hard to treat patients, and they comply rigorously with professional standards. Physio First has had meetings and exchanged correspondence with BUPA and has pointed out the potential pitfalls that this tender strategy may produce”.

Commenting on the press release recently issued by BUPA about its tender to private physiotherapy practitioners, Phil Gray, Chief Executive of the Chartered Society of Physiotherapy (CSP), said:

"The CSP and Physio First are very concerned that BUPA’s press release appears to show that their primary motivation is reducing prices to a uniform level. BUPA’s quoting of price variations among Physiotherapists is unfair and inappropriate if they are not also quoting the differences in the clinical condition of the patients concerned, or the specialist expertise of the practitioner.

"BUPA’s apparent desire to have a uniform, fixed price for private physiotherapy does not fit with the expectation of choice of those taking out private medical insurance, or of the operation of a competitive market. If BUPA wants a uniform service standard at a uniform price, they may be encouraging customers to choose NHS services rather than the additional costs of BUPA private medical insurance."

As with all press campaigns it is difficult to predict the level of press uptake. Our view is that there are items of sufficient interest to the public to warrant press coverage and some open public debate about Bupa’s blind tender process; we are working hard with the CSP’s Communications Department, to generate the level of interest that this issue deserves.

A joint statement by Eric Lewis, Chairman of Physio First and Liz Cavan, Chair of Council “We fully understand the anguish and frustration that this Bupa initiative has caused to private practitioners. Both organisations intend to hold this process up to public and government scrutiny”.

Reporting Bupa to the Office of Fair Trading

As with the media campaign, any possibility of launching a complaint about Bupa to the OFT has had to wait until Bupa actually announced the details of their initiative.

Now that this has occurred, solicitors have been instructed to file a complaint with the OFT.

The basis of any such complaint is described in detail in the OFT Guidance note “Abuse of a Dominant Position”. A brief extract provides a flavour:

“… the OFT is empowered to apply two substantive provisions which prohibit conduct by one or more dominant undertakings which amounts to abusive behaviour … Article 82 and the Chapter II prohibition. The Chapter II prohibition provides that: '… any conduct on the part of one or more undertakings which amounts to the abuse of a dominant position in a market is prohibited if it may affect trade within the United Kingdom.'

Both Article 82 and the Chapter II prohibition provide, in similar terms, that conduct may constitute an abuse if it consists of:

(a) Directly or indirectly imposing unfair purchase or selling prices or other unfair trading conditions

(b) Limiting production, markets or technical development to the prejudice of consumers

(c) Applying dissimilar conditions to equivalent transactions with other trading parties, thereby placing them at a competitive disadvantage

(d) Making the conclusion of contracts subject to acceptance by the other parties of supplementary obligations which, by their nature or according to commercial usage, have no connection with the subject of the contracts.

2.6 These are no more than examples, and are not exhaustive. The important issue is whether the dominant undertaking is using its dominant position in an abusive way. This may occur if it uses practices that have the effect of restricting the degree of competition which it faces, or of exploiting its market position unjustifiably.

For full details follow the link to the OFT Guidance Paper on the subject at

http://www.oft.gov.uk/shared_oft/bus...ines/oft402pdf

Conclusion

As with any legal remedy the outcome cannot be guaranteed nor is it possible to control the timescale – this will be a matter for the OFT.

Physio First with the full and welcome support of the CSP is however determined to take action to the extent that the law permits, to take Bupa to task over this new and unwelcome initiative.

This is a frustrating time for all of us and we are all in the same boat having to make our own decisions on how to navigate our practices in relation to Bupa’s blind tender; everyone on the Physio First Executive Committee, your Regional Officers and members of our Sub Committees would like to be able to make it go away, but we cannot and to pretend that there is a “silver bullet” would be irresponsible.

We are however determined to help members emerge from this trying time. Perhaps this development will be a catalyst for change that could leave Physio First members as a very large and unlooked for competitor of private medical insurers. After all they and other businesses are the middlemen, but we provide the service – something to think about as we produce and review our business plans and how we direct our marketing in the future!

The CSP and Physiofirst have put an OFT complaint in about BUPA through their solicitors - well done, thats a great place to start. Let the momentum continue!
I know this is controversial - we should thank BUPA, never before have the physios got together to communicate and value their own self worth before. It looks like we are turning the negative into a positive, keep it rolling as its shaping our profession...

What are the Bupa tender price levels based on?:

• Discounted rate already given to their members
• Full rate charged to non-Bupa members

:rolleyes:

This is a great Forum that i have not come across before so thank you. We need places like this at times like this. I am pleased that CSP and OCPPP have got involved and i will be at the meeting on Wednesday. I think as many as possible should go. We need to stand united on this and fight for autonomy and our Profession as a whole. Otherwise we may as well all go and work in America!
Sarah Hayes :D

First to say well done to those of you organising the meeting in London. Unfortunately I cant be there but send my support. My own feelings on this whole issue are mixed.
Do any of the rest of you recall when we Physios could accept BUPA patients direct, without a GP referral ?
I do, about 12 years ago it was fine for me to take on a patient without a GP referring.
Same with Axa, up to 7 years ago I was accepted as a specialist and in my occupational health clinic, I could take on Axa patients direct access, and could sign off my own forms.
Do you remember when we could give patients an absence certificate to enable them to be off work? I still have the forms in my practice. But all is now changed on that score as well.

Over the past 5-7 years there has been a huge sea change in the way our profession is placed by insurance companies, GP's, solicitors, and more.

At heart we are now viewed as a secondry care profession, just providing referred to: treatment/therapy. Our professional autonomy has been completely eroded, we really cant accept patients direct unless they self pay. Both within the NHS, where direct access is a joke, because no independent Physio can apply to provide NHS Physio, as Dentists currently do, and the independent sector, where any insurance work has to be doctor advised.
This has taken our profession in the opposite direction from where we should be.
In my estimation 95% of Physio work is NOT autonomous.

The health service is 'led' by the Doctors, Nurses, and Pharmacists.

At core, I consider that the current action by this insurance company, is just in parallel to what is happening through all other insurance companies and PCT's. Almost on a daily basis I am approached by case management companies who seek to drive down the cost of their client's therapy, by asking Physio practices to compete on the basis of cost. This process is undertaken to enable case management companie to maximize on the money they make from each case.

Unless we make a stand as a profession to move ourself into a primary care position, then I cant envisage how things will change.

I feel that this incident could be a wonderful opportunity for Physiotherapists to unite, make a real change in our profession, and reclaim our autonomy.

Firstly, to do this, it is time that either the CSP move from their fixation on the NHS, providing an NHS biased trade union which is of no use to me as an independent practitioner, and writing articles in the journal about NHS services.
Its time that the CSP focus on promoting the profession of Physiotherapy, and not the NHS Physiotherapy profession.


Secondly, and more importantly, we need to answer the question

How we 'sell' our autonomy to the government ?

I'm not sure.
I can understand how the Pharmacists sold themself, because most NHS care is still entenched in the drug/ pharmaceutical industry, and using a Pharmacist to do some of the prescribing is cheaper than using a GP clinic.
I can understand how the nurses did it because a nurse led clinic is also cheaper than a GP led clinic and nurses can carry out a lot of routine health screening, injections, etc

My query therefore is:
What as a profession can Physiotherapists offer the government, to enable us to move our profession to primary care, from secondry care, and therefore to gain the respect, and fees we deserve?

Unless we have this position, then I can only ever see the insurance companies paying us as therapy hand maidens

Cheers
Jay

Fair point Jill. But the only way we are going to have any recognition for the work we do is by proving that we are clinically effective. That is why the research project with Ann Moore at Brighton University, funded by PhysioFirst/PPEF is so essential. For years now Physio First has been trying to set up new research protocols that raise the perceived value of physiotherapy by PhysioFirst members. With PPEF, we now have the funding to be able to do this.
I was in Lloyds chemists the other day and in their book on back pain, by Michael Grayson, physiotherapists apparently offer massage and gentle exercises - why do we need a BSc Hons to do that?!
This is one area where we have all allowed our professional image to sink even further than it has been for the last 105 years. The issues are complex and include the level of education of our students as much as the lack of marketing and PR. This is not something that a small band of physios is going to achieve. The other problem is our NHS colleagues. They think that eveyone who goes into the independent sector is providing poor standards of physio for vast amounts of money. Having been to 7 ARC conferences, I can assure you of their attitude! We are on our own - which is why Physio First needs as much support as we can give them. They have been working for years on all fronts. The first 2 treasurers of CSP have been Physiofirst members; the Chairman of the Professional Practice committee is a PhysioFirst member for the second year running. There is a huge amount of work and history to PhysioFirst and few people seem to understand or appreciate it. This is very much the case of Identify the Battle.

I tend to partly agree with the above comments. However in a democracy the way to change things is to get the public on side. The government will bend to the wants of the people. We should not be spending more time lobbying government than we do promoting the profession to the public. Research is useful, but again that has been primarily done to feed the needs and wants of the insurance companies and the government. The reality is that is it a stalling process to coral us into something they can later decide to back or withdraw support from. Don't be mistaken.

The way to improve the physiotherapy profession at large is to promote it's benefits to the public. The public who come and see a physio by and large understand and reap the benefits having done so. The more we get in the doors the larger the public opinion. That includes getting gov. ministers in as patients!! 99% of people who have seen a physio would promote the profession.

So let's make sure our activities are looking at the wider picture and are no pandering to government lead, insurance company provoked, initiatives. :rolleyes:

For those of you who have not seen the BUPA tender page, you can see it here:

It contains the following (see attachments also): Welcome to the Bupa Physiotherapy Tender

Welcome to the Bupa Physiotherapy Tender

Thank you for your interest in participating in Bupa UK Membership's Physiotherapy Tender. This tender is for the provision of out-patient non-hospital physiotherapy services to Bupa insured members. It is open to all providers of physiotherapy services who are currently recognised by Bupa.

This website provides you with all the details you will need about the tender process and how to complete and submit your proposal. We recommend that you read through all the documents on the site to familiarise yourself with the process before starting to input any information.

To make it easier for you to submit your proposal, the tender is being conducted electronically. You will find all the documents you will need by clicking on the 'Physiotherapy online tender' web link below. Please complete and submit your proposal from noon on Friday 27 March 2009 to midnight on Friday 24 April 2009.

Proposals received after this date will not be considered. Only those proposals that are submitted electronically will be accepted.

To make it easier we suggest that you follow our step by step guide set out below.
<dl><dt>Step 1) Advisory Notes</dt><dd>We recommend that you read the attached Advisory Notes which give you more information about the Physiotherapy Tender initiative and how to submit a proposal. > Advisory Notes</dd><dt>Step 2) Questions and Answers</dt><dd>> Please click here to view answers to some questions you may have</dd><dt>Step 3) Terms and Conditions</dt><dd>Please review the attached terms and conditions for providing physiotherapy services to Bupa members. You will be required to confirm your acceptance to these terms and conditions in order to submit a proposal, and if your proposal is successful then the future provision of your physiotherapy services will be governed by these terms and conditions. > Terms and Conditions</dd><dt>Step 4) Physiotherapy Tender - PDF version</dt><dd>To help you prepare the relevant information to complete the online questionnaire, we have attached a PDF version for you to view and print. Please do not return this copy to Bupa. > PDF version of Physiotherapy Tender</dd><dt>Step 5) Physiotherapy Tender - online tender</dt><dd>We anticipate that the online tender will take no more than one hour to complete although this may vary depending on the complexity of your practice and the availability of your records.

Please click on the link below to begin your online submission. Please note that you will need to complete a separate submission for all additional facilities where the price you propose for any physiotherapy service (subspecialty) varies between facilities. For further clarification please review the tender section of the 'Questions and Answers'. Please also note that you will not be able to start the tender, save and complete at a later date; the tender will need to be completed in one session. > Physiotherapy online tender (Opens in a new window)It is your responsibility to ensure that all details included in the tender submission are correct and completed online by midnight on Friday 24 April 2009.
</dd><dt>Step 6) Proposed contract for physiotherapy services</dt><dd>Once you have submitted your proposal, a document containing the details of your submission and our standard terms and conditions will be available for you to print. Please print two copies of this document, sign them and return both copies to Bupa using the pre-paid envelope provided in your invitation letter.

Please review this information carefully and ensure that you complete your tender submission by pressing the 'Submit Tender' button at the end of this page. By completing the tender, signing both copies of the terms and conditions, and sending the signed copies to Bupa, you are making an offer to us. If we choose to accept your offer we will return a countersigned copy to you. You may wish to print additional copies for your records.
</dd>Once all proposals have been assessed, we will write to advise you of the results by Friday 15 May 2009. If your proposal is successful, we will return a countersigned copy of your proposal prior to Monday 18 May 2009 when the network goes live.
<dt>Contact us</dt><dd>This tender is being operated by Bupa Insurance Services Limited. If you need any clarification or assistance about this online tender, please email your query to [email protected]. Alternatively please contact the support team on....

*Lines are open between 9am and 5pm, Monday to Friday. Calls may be recorded and may be monitored. Local call charges apply; however, charges from some providers may vary.

Thank you for your interest.

The Bupa Physiotherapy Team </dd></dl>

Additionally here's a few dozies from their terms. I love how they as an insurance company think they are above the HPC and the CSP. Also they seem to think you need to be part of the CSP which of course we do not have to be to practice. I also like that you must bill them, not the client, something discouraged by Physio First. They say the'll pay on 30 days post invoice.

And get this, anything you tender for here in the UK, well that goes for any BUPA international schemes as well!! Unbelievable:

Read Below some more extracts:

6. Quality of Physiotherapy; You warrant that the information provided by You to Us in Your Tender Submission is, on the date that You sign this Agreement, accurate and correct. You agree with Us that each Physiotherapist and Facility shall at all times during the Term comply with:
(a) the quality standards contained within Your Physiotherapy Tender Submission; and
(b) the service standards contained within Your Physiotherapy Tender Submission.

You agree that each Physiotherapist shall be:

• a member of the Chartered Society of Physiotherapy (CSP);
• fully registered with the Health Professions Council (HPC);
• under 70 years of age;
• able to demonstrate advanced clinical skills in their chosen speciality and able to provide patient audit and outcome data for at least the previous 2 years that supports their status as a senior clinician in that speciality; and 2 of 5
• able to provide on request a copy of their physiotherapy graduation certificate (or if a qualification was obtained outside the UK, then written confirmation from UK HPC confirming that the qualification is equivalent to a UK Physiotherapy Degree/Diploma).

You also agree that:

• You will provide on request up to date documented evidence of audit reviews and professional development;
• patients will be: given printed information regarding their condition and treatment options; given the opportunity to complete a customer satisfaction survey; seen on a one to one basis; and offered an appointment for physiotherapy within 2 working days of a request;
• You will ensure that You comply with all relevant legislation relating to the confidentiality of information held about Members.

In particular, You will ensure that You comply with the Data Protection Act 1998.

I agree that Bupa shouldn't be doing this etc etc - the only people who will work for peanuts is monkeys etc and lead to hopelessly unqualified people working for them etc, but

What actually can we do?

We need constructive advice about how best to as a united group appeal against this.

Any ideas anyone!!!!????????

Quote:

---

Originally Posted by 21fairy

I agree that Bupa shouldn't be doing this etc etc - the only people who will work for peanuts is monkeys etc and lead to hopelessly unqualified people working for them etc, but

What actually can we do?

We need constructive advice about how best to as a united group appeal against this.

Any ideas anyone!!!!????????

---

That will take some time, more than the BUPA tender period. Thus my opinion is that the we should ignore the tender all together as a first step. Following that we should work on getting our own house in order (CSP/OCPPP).

While I respect my colleagues views that we need to promote to our patients, and that the public will help to promote us. It is undeniably a necessity that we must bend to behave as our GP, Nurse, and Pharmacist colleagues have done, and act politically to lobby government and review the way that we, as a profession, can help them to achieve their health agenda outcomes.

A couple of years ago GP's achieved a BIG increase in salaries, with new contracts, and in return have taken on the massive job of gatekeeper to NHS health services.

In the same vein Pharmacists have worked WITH government to assist them to achieve their targets. In return they have been moved into a primary care position.

Same with nursing. Who would have thought that so many occupational health roles would now be available to occupational health nurse managers ?

Question is. How can we as a profession help the government to achieve their targets, for example of preventing heart disease, diabetes, and the other priority dis-ease groups.
If we can show Government that what we do can help them achieve their statistics, then we are in prime position to be helpful primary care folk.

The research is often already there. Many overseas Physiotherapy organisations, UK universities, and individuals have undertaken research.
What is needed is a strong collating of the global research, and strong arguing that our role in helping the government achieve their targets for the main issues of heart disease, stroke, diabetes etc, is already there.

This is the job of the CSP, if they want to be our membership organisation.
If another group want to be our main membership organisation then let them take the main mantle whether its Physiofirst, or the Physios in Independent Hospital Practice, or and other group

BUPA is just an insurance company. Although they want to pay less for Physiotherapy interventions, and it is an across the board cut for all practitioners, the bigger picture is to get our profession moved to primary care, which is where we should be.
For example...can Physio prescribed exercise prevent type 2 Diabetes?
Is there a test we can do to help identify those at risk ?
I dont know, but if we could find evidence that exercise prescribed by a Physiotherapist could help then we can help the government.

Same goes for heart disease, and all other government targeted 'diseases' that cost them money.....

Lobbying is the real World.
10 years ago I discussed this very issue with a patient of mine. A professional lobbyist, and his immediate response when I moaned about our profession, was to question how many of us there are, and how we could help government.

Its a fact of life, in the UK health industry, because we have the NHS, which is unique in the globe. We will not move ourself to a higher profile in the UK through public approbation, but via the NHS recognising and moving us to primary care posts. If we can become equal to GP's we will be equal in the eyes of the insurance industry, if not we are hand maidens.
Sad reality but fact

Jay

Thanks Jill for your further comments. Whilst I tend to agree in part that this is a reality, I do also think it is a reality because of the way all those professions have reacted to the pressures put on them. Kind of if we can't beat them join them attitude or a pavlovian experiment to jump through a hoop to get a cookie. It is rather exploitive. Unfortunately that's not my mind set and though it might well be the way to work in an already dysfunctional healthcare system, I would prefer not to make it any worse.

It's a bit like everyone getting involved in ergonomics, and it's affect on occupational low back pain. The govt. loves it, industry loves it, physio's seem to love it, we spend millions every year on it. Unfortunately the stats clearly show that ergonomics does not work. That said with such intrenched pathways, product development, funding, education etc. it is unlikely to go away. I suppose we should continue to learn more about it though as it is interesting and does lead to better business processes and efficiencies. It doesn't do anything for back pain though.

Sorry if that's a bit of a digression. Looking fwd to weds meeting as it's so nice to have physio's talking together with passion. ;)

Great discussions by one and all. Validity in lots of directions, we now need to channel them in one direction. Having just been to a meeting with Phil Grey, CEO of the CSP, I believe we have made progress - and lots of it.

Hope everyone can to come to the meeting tomorrow, knowing that the CSP has given it the green light.

Cheers to all, and physiobob.

Spread the Love

TPV

Where is the meeting to be held and at what time? I am very keen to come along and hear a balanced debate on all the issues and to help to support any group decision.

Thank you.