BUPA Physiotherapy Tender Process

[physiobob]

Here's an update that members of Physio First we sent this morning. Of course they cannot say that the preference is to boycott any form of tender or contract but if you were to consider it then here's some useful comments. I would suggest any discussions are merely hearsay and that BUPA have not changed their tender document in anyway for any and all clauses remain open to interpretation. I hope the CSP and PF are not blind to that reality.

Importantly though was their first point to all members

The view of the Physio First Executive Committee (which includes myself as Chairman) is that whilst the Bupa tender process is obviously not something that we, as a group, can do anything other than condemn,

Summary of Points of Clarification following Meeting with Bupa on 15^th April 2009
As a result of a meeting between representatives of Physio First/CSP and Bupa, Bupa have provided the following clarification in relation to their tender process. In view of the points of clarification as set out below and the differences that these could make to the way in which members approach the tender, Physio First has asked for a 2-week extension of the deadline but this was rejected by Bupa.

• Bupa have confirmed that there is to be no cap on numbers i.e. Bupa will not be limiting the numbers of preferred providers that they intend to recruit as part of their tender process and have formally stated that it is possible for all current preferred providers to succeed in being offered a contract.

• If a practice, participating in the Bupa tender, is rejected it will be on one of two grounds.

<dir> "Value" i.e. where Bupa consider the fees offered to be unacceptable
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• 
  
  • If the tendering Physio wishes to negotiate further then Bupa will engage
  • Having indicated a wish to negotiate further, Bupa have confirmed that they will make an opening offer
  • In view of clarifications provided here Bupa will accept revisions to the tender document for those who have already submitted their tender at the date of having received this update up to the deadline date which remains midnight on Friday 24^th April 2009. These should be done by resubmitting your tender on line at
  
  

www.bupa.co.uk/physiotender <dir> <dir> "Quality" – If the tender rejection is upon "quality" grounds e.g. the non-use of patient feedback forms - if the Physio expresses a willingness to introduce them going forward, then they will be accepted.
</dir> </dir>

• Where Physios are asked at Question 80 of the tender document whether they wish to accept the price increase of 2.5% after 2-years, Bupa have confirmed that this bears no relationship to the outcome of the tender. This is meant to be offered as an option i.e. if "yes" is checked then price increases are predictable at 2.5% at the end of 2-years. If "no" is checked then it will be a matter for renegotiation at that point.

Bupa confirm that its purpose of seeking details of sessional averages is not to challenge individual judgements by physios. Their stated purpose for requiring sessional averages is so that they can react in the event that they should change and are then able to enter dialogue with the practice or practitioner to understand the reasons. An example cited was where the Physio began to receive referrals from a different source where patients are routinely presenting with more difficulties due to say their conditions. Bupa have stated that they do acknowledge that there are differences in injury severity or difficulty or patient health that affect the number of sessions required however they may require an explanation of why these differences affect the treatment.

• Bupa wish to clarify that when Physios are trying to decide whether to apply "as a practice" (i.e. in circumstances where there are others working as partners, shareholders or self employed associates) or "as individuals", they should take into account the following

<dir> If applying as a practice (i.e. for a practice number) then:
</dir>

• 
  
  • Individual Physios within the practice do not need to apply separately.
  • Although it will be the responsibility of the practice principle(s) to ensure that those within the practice, who are less than 5-years qualified, are sufficiently experienced, the 5-year PQE period will not apply.
  • Self employed associates who do not have individual recognition can move to other practices with practice recognition and treat Bupa patients.
  
  

• Bupa wished to clarify that where Physios have a particular specialism e.g. paeds or neuro, that Bupa do understand that there are particular aspects to the treatment of these types of patient that require treatment times to be longer. Bupa have created separate categories for these types of specialism.

• With regard to "how sole practitioners are expected to audit their own notes, etc?" Bupa now understand that whilst there are some "peer review" processes in existence and that this is encouraged by the Professional Bodies:

• 
  
  • Peer review opportunities for private practitioners are not widely available at the moment.
  • In private practice this can require sole practitioners to have to, in effect, rely upon competitors to audit which they accept is not necessarily satisfactory.
  
  

<dir> Bupa are therefore content not to require external review of notes at this time and are content to rely upon adherence to the rules that apply to CPD that require practitioners to relay any learning to their practice and to record in their CPD portfolio how their learning was incorporated into and how it affects their practice.
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• Bupa wish to make it clear that they are in no way wishing to undertake any regulatory role which they acknowledge is the task of the Professional Bodies. They are purely asking Physiotherapists to adhere to standards set by the CSP.

• New start-ups will be free to apply for Bupa recognition. If they fulfil the criteria that Bupa require all such applications will be considered. Bupa say that there will be an update given in October about this which will be published on their website

www,bupa.co.uk/therapiesonline

At Q 64 of the tender document (Musculoskeletal service details)

Bupa understand that where:

• Physios who have not dealt directly with BUPA to date (i.e. where patients just ask for a receipt and don’t mention BUPA) they will not know exact answers and have no way of finding out
  
  • Even where physios have dealt with Bupa directly many, even with practice management software, will not have had it set up to provide reports on this and so would have to undertake an arduous task of producing this information manually.
  
  

In either case Bupa confirmed that if figures are not known they will be happy if Physios enter their best guess and qualify it in the box "for further information" at the end stating that the figure entered is an estimate.

At Q 71 of the tender document (Care Pathways)

Bupa confirm that either many members don’t use clinical pathways and that there are not many in existence anyway. They say that the purpose of the question was so that they could collect data as to who was using them and that there is certainly no intention to seek to impose any care pathways. So confirmation by Physios taking part in the tender that say that they do not use care pathways will not be interpreted negatively.

At Q 81 of the tender document itself (Request to provide service data)

Bupa confirm that in view of the fact that most practice management software is either not yet capable of or that Physios have not yet adjusted it to produce reports on the information sought that Bupa will take this into account when seeking it in the future. Bupa also confirm that no information will be sought from practitioners that does not relate only to Bupa patients.

At Q 82 of the tender document itself (Request to share quality & service data)

If a Physio were to agree to share practice data the information available to Bupa policy holders would be that which is included in Q81. Bupa say that they appreciate that the practice may have reasons why they feel uncomfortable in sharing this data and have confirmed that not agreeing to share this information will not disqualify the provider from the tender.

[kidsphysio]

I have been following this thread and am still confused about what to do - although I am of a mind to agree with all that is being said. I am having difficulty with the implications of the contract. Has anyone had a solicitor to look at it and give an opinion? I would be very interested to see what they say. I have tried finding more info from the Bupa therapiesonline section of thier website but all you get is:
Welcome to Therapies Online

Important notice

As a result of scheduled maintenance activity, this website will be unavailable from 8.00pm Friday 17th April until 07.00am Sunday 19th April.
You will be able to access the website as normal from 07.00am on Sunday 19th April.
We apologise for any inconvenience this may cause and would ask that you bear with us while we carry out this important maintenance.

GREAT Lots of help there then!

[Mr Manipulator]

I think this (copied from 'The Physios Voice') puts it in a nutshell:-

The CSP/Physio First have published the outcome of their meeting with BUPA on Wednesday. I expect most have received the e-alert from Physio First, and are equally as disappointed and frustrated that they seem to have mis-understood the underlying reasons for member discontent.
There are two fundamental reasons why we, as a profession, oppose these measures. Both our clinical independence and commercial autonomy will be significantly eroded. This is unacceptable.
Contrary to the feelings of the CSP and Physio First - “in our judgement the outcome (of the meeting) greatly ameliorates the immediate consequences” - the outcome of these discussions has had, in my view, no effect on this potential erosion.
While the CSP/PF received verbal assurances from BUPA (haven’t we been there before), the actual contractual terms we would enter into have not changed. This is worth emphasising. It is beside the point that the CSP/PF believe that the potential consequences have been ameliorated, the contractual terms HAVE NOT CHANGED.
There is seemingly a lack of understanding at how negotiations are conducted. One does not simply take verbal assurances that something is so, while happily signing a contract that says something to the contrary. Taking BUPA at its word is naïve. The CSP is giving excessive weight to the “stated” responses of BUPA in respect to a number of issues. Unless there has been a documented change in the tender document and terms and conditions, the stated BUPA responses carry no weight.
I wonder if the meeting can be summarised as follows.
CSP/PF: We’re not happy with a number of points in the tender document.
BUPA: Actually it’s not as bad as you think! We only want to use this information for good things, and the Physiotherapy profession will not suffer for it. Of course we can’t change the tender document, nor the terms and conditions, nor the timeframe, but don’t worry because you have our word that we only want what is best for patients.
CSP/PF: Well if you say so, perhaps we shouldn’t be that concerned. But I’m sure you gave us your word last time?
BUPA: That was different. We’ve changed. You’ll see. Trust us.
CSP/PF: Ok.
The CSP and Physio First have again delivered an insipid response. Thankfully there is a groundswell of support for this site, and for the huge numbers of practitioners that are supporting actions taken outside of the CSP and Physio First. This is a watershed moment for the profession. Stand strong now, and the profession will reap the benefits. If we crumble, we will forever lose our clinical independence, and be remembered as the generation that allowed it to happen. We cannot understate the implications.

[Dawnphysio]

Hi,

Really interesting to read all this. Just to let you know what we are doing in Guernsey. We have just under 40 physios here and have decided unity is our strength and and that none of us in Guernsey are tendering and have written to Bupa to tell them that. We are waiting to see where they will send their clients if the island has no preferred providers!!
There is no competition law here so that helps us work as a group.

Keep fighting!!