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.