BUPA Physiotherapy Tender Process

[thephysiosvoice]

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

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[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!

[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

[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

[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.

[physiobob]

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 physiotender@bupa.com. 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>

[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

[Hanz Off]

hi everyone
firstly let me say its great to see all us physios getting together on this because if we do not the future will not be a bright one. i have worked hard for 18 years to build up a thriving clinic and have no intention of letting BUPA dictate to me. In their last round of squeezing and bullying i held solid and they went quiet. It is interesting to talk to local collegues in private practice and apart from everyone being very angry at these proposals we have all noticed a steady decline in BUPA numbers over the years, me thinks they may be struggling a tad. i certainly have no intention in reducing my charges or increasing my session times and i will not be jumping through their flaming hoops.
Yep lets boycott it.

[physiobob]

Firstly I must say a big thank you to those who organised a very civil and well balanced meeting last night. Secondly I have to say I did not realise the amount of tension within my own mind about this issue until I sat amongst my peers. I felt like I needed to go 10 rounds with Mike Tyson to get rid of the adrenalin that just had to sit there.

I will later post the minutes of this great first step meeting but for now I wanted to post an observation made by someone in the room who also sees the bigger picture, the much bigger picture. And this is perhaps a view that is fundamental to our profession as a whole, not just the current BUPA approved practitioners, nor just Physio First, but indeed a view that should command the CSP to act.

This view could be summarized as follows:

BUPA are a Private Medical Insurer (PMI). They are also an ever expanding group of private practices and poly clinics. Those clinics employ physio's of their choice according to their needs. These clinics, as far as I am aware, do not have to sigh up to the same tender process as the non-BUPA clinics do.

These BUPA 'wellness' clinics are becoming more prevalent around the entire United Kingdom. BUPA wellness clinics are providing job opportunities for the non-BUPA accredited physiotherapists (e.g. juniors and people leaving the NHS). Those same individuals are not getting places in non-BUPA clinics so easily.

This raises two interesting points. If we agree to a BUPA tender, now or in the future, then we are creating an ever expanding BUPA mega-clinic around the country. This suits BUPA well for reasons I will explain later. If we don't accept a BUPA tender then we are less likely to expand our clinics as the rate we otherwise might have. In fact many of us might shrink the size of our businesses and move away from BUPA patients. This means the BUPA clinics that are out there are able to expand with less competition and with more demand for their services. This therefore also enables BUPA to expand its operations with home-owned businesses (perhaps this in fact is their preferred option).

The later option is however only a viable one if they already have enough wellness clinics on the ground to mop up the potential demand. The longer people boycott any BUPA tender (meaning years and not months) the weaker their position will be. The less physiotherapists willing to work for BUPA the weaker their position will be.

So what you might say? They can start a competitive business just like anyone of us can, can't they. I would say in general yes they can (albeit the different standards in who can and cannot treat BUPA patients, a framework which might well be anti-competitive). What many people are not seeing is the real fact that the NHS will and is beginning to privatize. BUPA is placing itself in a position to be the largest potential provider, at the lowest cost, to tender for the NHS contracts. Should BUPA or any other large PMI win and NHS tender for physiotherapy services the NHS physio's (and other professionals) who lose their jobs they will be required to sign up as BUPA employees to continue. Of course under BUPA's terms and conditions.

I think the mood of the meeting was in general that individuals were probably going to boycott the tender process, at least initially while we wait for more time and proper advice. Only after the right advice, from the right people can we make an informed decision about the future of our profession.

If you understand the far reaching implications of what I have outlined above then you should see that BUPA have no place being both a PMI and a provider of direct care. We should stop them in their tracks as soon as we can. I will be saying no to the tender process and hope you will to.

[thephysiosvoice]

THE PHYSIO'S VOICE SAYS "LISTEN TO PHYSIOBOB"

Thanks for all the support last night.

Please, Spread the Love

TPV

[ckaren]

Thank you for that interesting report Physiobob.

What percentage of the independant physiotherapists are expected to boycott the initial tender?

Unless a high proportion of private practitioners boycott the tender we may actually be playing into the hands of BUPA who may award tenders to the few that have agreed to their initial demands.

[thephysiosvoice]

Spot on about the numbers. But, also pity those who will be left to pick up the pieces. Yes, some private practices rammed to the rafters with BUPA patients - it's never good to have all your eggs in 1 basket.

The issue here is BUPA can get out of the 4 year contract whenever they like. IF you Tender and are successful then you CANNOT get out of the contract for 4 years, so what will BUPA do then?

They'll pull the contract you are on, knowing you have a clinic full of BUPA patients and re-offer a new contract to you for, say a 50% discounted price......

How do we get more people involved? Go viral, use the web.....that's why we post.

If you email 10 clinics, today and tell them to email another 10 clinics and they do the same.....

This is not a London problem. This is not a large clinic problem. This is about the UK. North, South, East and West. This is about the individual practitioner and the groups. We are all involved.

Spread the Love

TPV

[physiobob]

Thank you for that interesting report Physiobob.

What percentage of the independant physiotherapists are expected to boycott the initial tender?

Unless a high proportion of private practitioners boycott the tender we may actually be playing into the hands of BUPA who may award tenders to the few that have agreed to their initial demands.

We cannot say really. We cannot work as a collective and so only could offer up what we would do as individuals. I would hope the majority boycott. Of course only a small percentage of the currently BUPA registered physios will win a tender anyhow. That number is likely to be as low as 1000 (if of course anyone does tender). That in itself is only 1000 of the over 13,000 physio's working in the private sector. This is an issue for the 13,000 and more.

Some larger practices have built themselves on seeing BUPA clients. They pay and employ their staff based on getting that income. Worse than that they do all the billing for BUPA and BUPA pay them on account. Outrageous behaviour I know but with no major rate cuts in recent times that has been a gravey train for some. Unfortunately that puts them in the worst position of all. They have to look after their businesses and their staff.

If we all say NO then they will be OK as the tender will collapse and things will probably remain as they are. They should then start to charge clients directly and back out of the mess they have got themselves into. If however the tender is successful and they don't tender then there is the possibility of real business collapse for some of them. (and some do think like that as it could be very real for some of them). I hate to say it but many of us have been warning them for years. I can understand, however disappointing, why they might therefore tender.

We need to all say NO to any tender for services by a PMI. We need to maintain our autonomy and our right to be a primary care practitioner to the citizens of the UK. Any PMI contract should be between them and their clients and we should take no part in it whatsoever.

Who else is saying NO? Say NO and help your fellow physio's, those of the future and those of today!

[perfphysio]

I was sent this email today from a physio, Grace O Malley, working in the USA. I am posting it on her behalf as it is a useful foreign perspective.

Hi,

As an Irish PT now residing in the US I have to urge you all to really make a stand on this issue. It is very clear that here, in the privatized system the autonomy and decision-making of 'free-thinking' physical therapists is far more eroded than in the UK/Ireland/Europe/Australia/Canada. The PMI's seem to treat physio. within a strict medical paradigm, which even though PT has an ever-growing evidence-base, it's effects cannot be simply measured with the same tools as a drug or surgical approach. As physiotherapists we are all aware of the time we spend listening to our patients, helping them cope with depressive symptoms post injury and working tirelessly to instill the self-efficacy and confidence required to really improve function and well-being. We simply cannot accept a system that offers a certain number of sessions to eg. all patients with stroke and if treatment is not effective within that time, well then, either the patient pays for more treatment (at highly inflated costs) or treatment is deemed ineffective.

We all must remember that PMIs are private companies with one basic tenet......to make as much profit as possible. If our primary concern is with providing the most cost effective and clinically effective holistic treatment to our tax-paying patients...we must defend our right to practice autonomously as highly skilled physiotherapists within the multidisciplinary healthcare team.

My vision would be for nationalised healthcare to move toward a more preventative approach where PTs would have a pivotal role in promoting musculoskeletal and cardiorespiratory health throughout the whole population. Prevention is the only method of saving tax-payers money in the long run afterall. We are in a time now economically where companies/corporations will do their very best to work toward a privatized system as the health of a nation when privatized is a cash-cow.

Just a few thoughts. Keep up the good work and I will continue to follow this with great interest.

Grace.

[perfphysio]

Another email I am posting from M Hastings

Interesting perspective on the future direction of the in England and I think I agree that there probably is a hidden agenda to move to some form of payment for physiotherapy. NHS may give immediate in-patient care, but OP may move to voucher system with limited supply in NHS and top up from independent sector. Of course this goes totally against the NHS ethos of free at point of care. I see parallels with the changes in Canadian Healthcare. Does a member led organisation have the business skills to analyse the wider environment and make strategic decisions wthin the timescales within which private sector work? Members should be lobbying their MPs to ask questions in parliament about the hidden agenda.

[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.