BUPA Physiotherapy Tender Process

[markphysio]

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

[Wendy Emberson]

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!

[ckaren]

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

[physiobob]

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.

[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!!!!????????

[physiobob]

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).

[Jill Wigmore-Welsh]

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

[physiobob]

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.

[thephysiosvoice]

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

[ndavey]

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.

[physiobob]

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.

See the details on www.thephysiosvoice.co.uk

[physiobob]

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!

[sarahhayes]

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

[tamsinmann]

Have just read through the comments here and on 'thephysiovoice' and strongly recommend physio's take a look there too, to increase their awareness of all the issues so we can all make an informed choice about how we proceed as individuals, like this website it is being updated as often as possible.

Initially I was just worried about the financial implications short term but now my clinical autonomy is head of the agenda, long term implications second and any short term loss pretty irrelevant in the big scheme.

[archersusie]

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...

[Chartered Physiotherapist]

What are the Bupa tender price levels based on?:

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

[JacobI]

I've been following this discussion with interest, as right from the start, when I got the letter from BUPA, I felt like telling them where to go. I am old enough to remember when we had to follow the instructions from referring doctors for 'SWD and exercises x 12', 'hand class', 'quads drill' etc. Thankfully not for long, as we then acheived autonomy of practice. Since then the quality and scope of practice has improved hugely, and I have been proud to call myself a physiotherapist, both within the NHS, and in the past 10 years as a private practitioner. I have striven to provide an excellent quaility of service to my clients, which has resulted in a situation where I now have regular referrals from local GP's and Consultants, and also self referrals on 'recommendation'. I do not want to go back thirty years, and have my clinical judgement questioned and dictated to. I charge what I feel is a reasonable rate for my time and expertise, and based on my premises costs, and other expenses, over which I have little control. I love my job, but have to make a living! I would be losing income if I agreed to BUPA's prices, and even more, if the rest of the PMI's follow suit. We have to take a stand now, and boycott the process.