BUPA Physiotherapy Tender Process

[Jill Wigmore-Welsh]

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

[Wendy Emberson]

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.

[physiobob]

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.