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

Similar Threads:

• Help Needed in Finding Physiotherapy Tender Opportunities
• Advice to give patients on the BUPA tender
• bupa tender
• BUPA tender poll. Did you submit? Vote here
• Nuffield Physiotherapy Group tender to BUPA

[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.

[physiobob]

Here's the update from thephysiosvoice and the panel that lead last weeks discussions. Over this easter weekend anti-competition lawyers are taking a good look at the case and will present back to all next week. You can comment here or on the "What we can all do" link on thephysiosvoice website.

BUPA Tender - What can we all do?

What next?

We need to be very clear that all we can do is present the facts, pose the questions and let each and every individual make their own decision. We cannot take collective action and we cannot collude - that is anti competitive. What is interesting though is that the Opthamologists faced the same issues and were unhappy enough with the implications for their profession that were raised as regards clinical governance and professional autonomy that they individually decided not to take part in the tender process. Despite what BUPA might claim there is no effective opthamology preferred provider network in the UK.

It’s an understandable reaction to say that BUPA is so important to my business that I cannot afford to ignore the tender. The truth is our clinical independence and commercial autonomy is so important to us that we all have to think, independently, but very hard about the consequences of taking part in this process.

Let’s be clear that signing up to this tender will:

1. Start the erosion of the very clinical autonomy that allows us to deliver the best outcome for our patients.

2. Tendering will mean a loss of choice for patients and will effectively break our contract with them. Tendering will mean you have a legally binding contract with an Insurance company who will be able to dictate who you see and how you treat and the price you can charge for doing so.

3. Tendering is no guarantee of success - BUPA have made it explicitly clear that tendering at a level below the guide pricing is more likely to lead to success.

4. Tendering will mean agreeing to some very one sided terms and conditions and if you think for a moment that BUPA have the desire or resources to negotiate with us all separate terms and conditions then please think again.

5. The other insurers will follow if this tender process is successful - that’s almost guaranteed in my eyes.

6. I also think that what is on the table today and indeed not on the table today will change at some point and if you think your negotiating position is weak today then once you have a contract and a network is established it’ll actually be weaker.


What can we all do?

1. Write to BUPA the CSP and to PhysioFirst and let them know about your concerns and pose your own questions. Do not hope that someone else will do this on your behalf. We all owe to our patients and to the profession we care so much about to do that much.

2. Talk to your fellow practitioners both locally and nationally. Nobody is alone and nobody should feel bullied in to acceding to BUPA’s demands. We all share the same concerns.

3. Tell as many people as possible about this site to ensure that everyone is well informed. The site is a blog - it is open, everyone is allowed their say - we don’t agree with all the views expressed but we live in a democracy

4. All take part in the polls on The Polls Page we can use this in submissions to the press and the OFT so get voting - it’ll only take a few minutes!


What will we do?

There are potentially a number of angles we can follow up on but given the time constraints (imposed by BUPA) everyone needs to think very hard about submitting a tender as there are still many unanswered questions, valid concerns about clinical governance and autonomy and the outstanding legal action involving formal complaints to the OFT being submitted by the CSP. Our view is that we should not have to be rushed in to making decisions with such serious implications.

1. Continue to apply pressure to the CSP to do more. If I contrast the CSP’s efforts and the clarity of the messages they put out with other groups like FIPO I see a huge difference. I think that the CSP could do more to inform. They could do more to ensure every physiotherapist in the UK is better informed so they can make an independent and reasoned decision as to what to do. I think given the serious implications of this tender process the language the CSP use could be clearer and less ambiguous. Have a good look at the following website and you decide for yourselves. Federation of Independent Practitioner Organisations (FIPO)

2. We will continue to inform as best we can and keep the dialogue going by updating this site regularly.

3. We will attempt to get some independent legal advice on a number of aspects this tender process raises namely:

a. conflict of interest issues raised by BUPA’s role as an insurer and provider through its’ ownership of BUPA Wellness

b. possible abuse of dominant market position by both BUPA and PPP

c. legality of some of the contractual terms contained within the tender document

d. the cost implications and contractual obligations of providing the enhanced claims management and processing service as defined in the proposed terms.

e. to appraise and understand the requirement for physiotherapists to be registered with and regulated by the FSA to qualify them to advise their patients about insurance cover terms and conditions.

f. the cost implications and contractual obligations of providing the enhanced claims management and processing service as defined in the proposed terms.

g. the implications of the proposed contract terms being ultra vires i.e. beyond the capacity of physiotherapists to contract.

h. the conflict that arises with physiotherpaists obligations under their contract with their patients because of the application of “Sessional Averages” which constrains the physiotherapist from independently applying the full extent of his/her clinical expertise thereby increasing exposure to claims for negligence from patients.

i. the continual pressure for physiotherapists not to discuss matters with ‘BUPA members’ undermines physiotherapists obligations to their patients.

4. Consider lodging our own complaint to the OFT about both BUPA and PPP

5. Pursue the appropriateness of the clinical aspects proposed by BUPA

The meeting last night showed that there are lots of us who care deeply about this profession and want to hold on (rightly) to our clinical governance and autonomy because we care about what we do and our patients.

[phizzio]

I have also been following this thread. I would like an answer to a simple couple of questions please- I work in private practice in London and I charge what I deem fit to my skills and the outgoings for the successful running of a busy practice-
What is the cost of a unit of time for physiotherapy in the NHS and what is the cost in a BUPA hospital. Not I might add what the physiotherapist is being paid. Also what is that unit of time. ...

[thephysiosvoice]

Just in on TPV.....

Physio First Email Alert - Bupa Announces the Blind Tender Process

Q: How can I negotiate?
A: In short you cannot. This is a take it or leave it proposition.

This is a direct quote from Eric Lewis Chairman of Physio First.

How can this negative statement possibly be the only way forward or the right advice for a powerful body of 6000 (or is it 13,000) highly intelligent professional physiotherapists in the private sector running successful businesses?

Do physiotherapists have such a low opinion of themselves that they are prepared to be railroaded? Do something. Let your opinion be heard.

Nice one Eric!

[physiobob]

Another comment sent to us by email

Hi, Thanks for update.

This may seem useless now, but my initial proposal to the csp was that we as a profession refuse to recognise BUPA.
My idea was that if bupa refuse to recognise recent graduates and demand this 5 year post grad thingy before allowing us to register for bupa work then they are setting the clinical standard not us as a profession or even the hpc.............hope you follow this

If we had the guts to have an embargo, bupa would be unable to offer physiotherapy to its clien' base. Patients would complain, there would be downward pressure on bupa's insurance fees as patients would be getting less for their money.

This would also have stopped bupa dictating what we got for our services. We could have set a rate that they would have to pay us.

Anyway probably all too late and anyhoooo couldn't seeing the profession being sufficiently together on this, not to mention the short term losses to those who depend on bupa for their income................however even the threat might have brought them to the table.

Cheers derek adams mcsp.................still not bupa registered

[physiobob]

I have also been following this thread. I would like an answer to a simple couple of questions please- I work in private practice in London and I charge what I deem fit to my skills and the outgoings for the successful running of a busy practice-
What is the cost of a unit of time for physiotherapy in the NHS and what is the cost in a BUPA hospital. Not I might add what the physiotherapist is being paid. Also what is that unit of time. ...

I can't say first hand what the BUPA unit cost although it is said an NHS charges at least £48 for a half hr. And the BUPA wellness clinic around the corner from me £53 for a half hr. Yet they are asking us to charge less.

It's also worth considering the wish to :

1. Hold your money for 30 days post receipt of the invoice
2. Run a billing service and reconciliation for their services
3. Provide all sorts of reports and audits for their organisation

In any normal business these would be considered as added services. Thus your fees should be more for BUPA than for self paying patients or for patients whose PMI's do not request this additional (billable) work. Today I received a cheque for £20 from the Pru Health Insurance after thet requested a simple patient update and report. There letter told me they would be happy to pay for this service in addition to my normal charges. So I provided the service and they paid. This is what I expect from BUPA as well.

It is normal in many health care areas to charge more for insurance clients as the PMI's require more admin time than non-pmi clients. This is typical in the USA and in fact it is also common in the UK as well.

This is just another aspect why the BUPA tender agreement is unacceptable. Everyone should in fact consider how much more they should charge BUPA clients if BUPA want us to provide more non-clinical work for them.

[SuperFizz]

This was just sent on to me from the USA. Very interesting for what could lie ahead

Dear Colleague and Hands-On Seminars Participant:

Thank you for taking the time to read this e-mail. We are urgently asking for your help.

I am writing this e-mail on behalf of many physical therapists in New York. We recently received an ultimatum from HIP insurance company in New York that they are decreasing their already low reimbursement rates to physical therapy by 20%. Meanwhile the top 10 executives of HIP have doubled their salaries within last year. We are very much afraid that if this passes, it will have a snowball effect to other insurance carriers to reduce their reimbursement rates. This will cause the extinction of private practice physical therapy in New York State.

Furthermore, this will encourage insurance companies in other states to decrease their reimbursement rates with imminent danger for the physical therapy profession.

Whether you are a PT or a PTA, an OT or an OTA; whether you are practicing in New York State or in another state I am now asking for your help.

Please take a few moments, download, sign and mail this letter to the administration of HIP expressing your dissatisfaction with what is going on. The letter is a word document and you can modify it in any way you want. An alternative to mailing a letter is to send an e-mail to: mdq&aDownstate@emblemhealth.comm expressing your dissatisfaction.

Download this letter (Word DOC)
Download this letter (Acrobat PDF)

I am counting on your help. Therapists when United, we can Win!

Help us Save Physical Therapy in New York State.


Warm Regards,

Dimitrios Kostopoulos, PT, PhD, DSc
Co-Founder Hands-On Seminars
Manual Therapy Training Education Seminars Classes Courses Publication Books

[alithephysio]

I have read everyone's views on the BUPA tender with great interest. This may be quite naive, but what is wrong with submitting a tender but not reducing our current fees? Surely if we all did this then they would have to accept that we will not be financially undervalued?

[Wendy Emberson]

One of the emerging big issues here is not just the price, but the incidious removal of our clinical autonomy. We need to think very carefully about giving them enough information about how we treat patients with specific conditions as they may well intend to nail us down on cost per condition and treatment. ie they will only pay for previously agreed treatments in the same way that the dentists have to get pre authorisation for any procedure. We all know that every patient is different and requires subtle, and even not so subtle changes to a treatment plan depending on a very wide variety of variables.my feeling is that people who do tender, at whatever price, are digging themselves a hole that they will find very difficult to climb out of. It is all about control.

[physiobob]

I have read everyone's views on the BUPA tender with great interest. This may be quite naive, but what is wrong with submitting a tender but not reducing our current fees? Surely if we all did this then they would have to accept that we will not be financially undervalued?

Firstly I must agree with Wendy's comments above. This is more about a much larger issue, much more than $$.

If it were just a pricing issue then your thoughts might be fine in some respects. However if you consider the amount of extra work BUPA are asking you to do then you should tender to them for MORE than your fees to other clients. Also they are holding onto those fees for at least 30days post receipt of your invoices. If you only invoice for a client at the end of a treatment this could be months.

Then if you add in your own rate increases as a yearly increase well that is not permitted. You are tendering for 4 years really as you are agreeing to one small increase in yrs 3 and 4. So you should factor that into you current pricing now to account for it now should that small future increase not be enough. After all those considerations you probably would fail their tender process.

That said there are a lot of legal aspects to the contract that actually require you to be at least an insurance broker to agree to. As we do not have those legal skills, by law we cannot agree to any document in the current form.

[physiobob]

This was just sent our from Physio First ( The Former OCPPP) and Private Practitioners Group in the UK. A lot of waffle really and it scares me that they are meeting with BUPA unless they are going to tell them to take a walk. Any and all negotiations by PMI's should be with their customers and we are NOT their customer although they are trying to make it that way.

Here's hoping they make that clear tonight and here's hoping they have some legal counsel with them at the meeting.

BUPA developments - the story so far…
As there has been some frenetic activity since our Conference, regarding the BUPA blind tender, we thought it best to keep you informed as to events so far.

You will remember that in July 2008 following several attempts to engage BUPA over a period of months, BUPA tried to survey our members by questionnaire without prior warning to us (see Update newsletter July 2008). This led to various alarm bells being rung and the reinforcement to members whenever possible to decrease their reliance on commercial firms. It also caused the initiation of a cursory look at the relationship legally between our members and BUPA.

Finally a meeting was arranged between BUPA, the CSP and Physio First in early October 2008 but was heralded by BUPA asking us to sign confidentiality clauses. We refused and the meeting went ahead without them. On the day itself the BUPA representatives asked that we ignore the agreed agenda and just focus on one part – that of BUPA’s future plans (see Update October 2008).

At that meeting they informed us that their intention was to make all physiotherapists who had carried out work for them to tender a new bid to be a preferred provider and also that their intention was to dramatically cut the number of physiotherapists they used. They also informed us that they would be requiring the enforcement of their own ‘quality standards’.

Following the meeting a series of high level and detailed meetings were attended by both CSP and Physio First representatives to analyse the situation and the potential consequences. During and over the Christmas period 2008 a number of letters were exchanged between BUPA and Physio First, which resolved nothing. We requested that they postpone their plans until further thought and some consultation had taken place (see Update Feb 2009).

The CSP and Physio First then seriously considered the legal scenario in which this whole situation existed in and after further deliberations the CSP offered to finance top-level advice from a firm of City Lawyers on the situation. One of the more eminent barristers in this field at that time advised that we could not fight the Competition Act and that at that time there was little chance of making a convincing case to the Office of Fair Trading.

Subsequently nothing more was heard from BUPA but Physio First began planning for various possibilities that might occur. Nothing at that stage could be initiated because BUPA had only stated their intent and had actually not carried out their plans or communicated with us that they would.

As you are all aware BUPA sent out the letters to 6,000 of their providers on the Friday before our Conference which was pretty clever timing as we were unable to “do” anything until the following Monday.
At Conference, for those of you not present, Eric Lewis and Paul Donnelly made themselves continually available for members to discuss their own personal concerns and a great deal of time was dedicated to the subject at the AGM itself.

On April 1^st, 2009 Physio First had meetings with both the CEO and members of the Communications department of the CSP which resulted in an agreement to collaborate in seeking further advice and in the instruction of solicitors to make a complaint to the OFT. There was a further agreement to use the journalistic skills within the CSP’s Communications dept to mount a media campaign, which in turn resulted in an e- alert on April 3rd to our members informing them of this action.

We realise that there is a lot of high feeling surrounding the whole process of the BUPA tender and many members are feeling quite isolated at the moment. We want to do as much as possible to help our members through this difficult time, whatever they as individuals decide to do regarding the tender and feel that any information has to be helpful.

Last Thursday we added to the BUPA - FAQs on our website, giving the answers to the questions that have come into the office so far about the tender itself and put out an e-alert asking for any further feedback individual members may have from BUPA so we can also put these responses onto the web.

Following our contact with BUPA last Thursday, the CSP and Physio First are meeting with them tonight at their request. Who knows what, if anything will emerge but at the very least maybe we can gain some further clarification on the situation.

You can be assured that your Physio First Executive (and Main Committee) work tirelessly on the behalf of all members of this great Organisation and that includes ourselves, as we are all practicing independent practitioners.

Change is very difficult but Physio First members are up to any challenge thrown our way; we are, if nothing else survivors.

[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
</dir>

• 
  
  • 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.
</dir>

• 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!!

[skeetaus]

As an outsider, surely the spirit of the competition law was to increase competition and stop people acting in union and therefore artificially creating a fixed price.This is what BUPA are doing. It will be worse when the other insurers join in. It results in far less competition. It seems like a case for getting all health providers together to fund a campaign to change the law. Or at least point out that the law is limiting competition rather than increasing it. Can you get the opthalmologists, the radiologists etc talking about it? If there was a BUPA for barristers it would change tomorrow.

Also who owns BUPA. Share holders? Can they be spoken to by individuals?

[blondie]

Having read the latest posts plus PF's e-alert, I'm inclined to agree - BUPA have not actually re worded the tender document, they have just stated that they will not hold certain things against us if we decide to tender! Yes we can negotiate on price (probably on their terms not ours) but if we sign they will still be dictating how we practice. I don't think much has changed - certainly not enough for us to change our minds about tendering.
If BUPA want Physios to be 'Prefered Providers', they need to realise that we are all individuals & treat us as such.
I think we should all still think very carefully before signing away our independence.

[physiobob]

Also who owns BUPA. Share holders? Can they be spoken to by individuals?

Perhaps you aren't such an outside. BUPA is slowly but surely trying to run the world of health care, carefully and progressively merging and acquiring medical facilities all over the world.

Here's some extract from their wikipedia entry to highlight the real BUPA

Overview

Bupa (originally, the British United Provident Association) was formed in 1947. Initially, Bupa was purely a UK health insurance provider, offering policies to individuals, companies and other organisations. This continues to be the largest business within the company and around half of Britain's top companies are presently Bupa customers.

Over the years it has diversified away from its core health insurance business and is now an internationally established health insurance and care company with services that include health insurance, care homes, health assessments, occupational health services and childcare.

Bupa is a private company limited by guarantee; it has no shareholders, and any profits (after tax) are reinvested in the business.

Operations

The company has its head office in central London, with main contact centres in Staines and Salford Quays. Bupa also has offices in Brighton (Bupa International), Bristol (Bupa Health Assurance), Ashford, Surrey (Information Systems) and Leeds (Bupa Care Services).

Bupa has businesses in Asia, Australia, Egypt, Saudi Arabia and Thailand. It also owns several healthcare companies overseas including Spain's largest healthcare company, Sanitas, and acquired IHI Danmark (Copenhagen, Denmark) and Amedex (Miami, US) in September 2005. In November 2006, Bupa acquired Clinovia, the UK’s home healthcare specialist, in a move that gave BUPA new opportunities in the expanding out of hospital care market. In December 2007, Bupa purchased DCA Agedcare Group in Australia and New Zealand, making it a leading player in these markets. Also in December 2007, Bupa announced the purchase of Health Dialog, a leading provider of chronic condition management and ‘shared decision making’ services.

During 2008, Bupa acquired the Cromwell Hospital in London to create a flagship hospital in England’s capital, providing healthcare to Bupa members and other private patients, including those living outside the UK, who wish to be treated in London. Approval was given for the merger between Bupa's Australian arm and insurance group MBF, which also includes HBA and Mutual Community. The merger created Australia's largest private healthcare insurer. Bupa International and International Medical Insurers had their launch event to celebrate their collaboration, making International Medical Insurers(IMI) the sole distributor for BUPA plans in Singapore. On 1 December 2008, Clinovia's name was changed to Bupa Home Healthcare Bupa recently announced its entry into the Indian health insurance market through a joint venture with local conglomerate, Max India. The new venture is called Max Bupa Health Insurance Limited.

[physiobob]

We can also see in the 2007 article from the Guardian that BUPA likes to accumulate things and then sell them on for profit. Don't underestimate that this might still be something worth achieving as the NHS becomes privatized. They might well be aiming to be in the box seat to both deliver services and to be able to sell that business once they take control.

BUPA sells hospitals to private equity firm

* Julia Kollewe
* guardian.co.uk, Monday 18 June 2007 14.37 BST
* larger | smaller
* Article history

BUPA has sold its 25 private UK hospitals to the private equity firm Cinven for £1.44bn, to focus on its main health insurance business.

Cinven beat off tough competition from CVC, which also made it through to the final bid round, and other private equity groups including Guy Hands' Terra Firma.

Its healthcare experience gave Cinven the edge over rival bidders. The firm already owns Partnerships in Care, a provider of specialist mental health services which operates 940 beds in 17 facilities around the country. Its previous investments include General Healthcare and Générale de Santé in France.

Britain's traditional private hospital market is dominated by six players: the NHS and five private groups, including BUPA. Of those, two have already been acquired by private equity firms.

General Healthcare, which runs 49 private hospitals in the UK, making it the biggest operator, was sold last year to a consortium led by the South African healthcare group Netcare and the private equity firm Apax. HCA International, which owns six hospitals in London, including the Harley Street Clinic and the Wellington Hospital, was bought by three US private equity firms last July.

The sale price was higher than expected - when the hospitals were put up for sale in early April they were expected to fetch up to £1.25bn.

"I expect some degree of consolidation in the sector beyond where we are," said Graham Kendall, acting general manager at NHS Partners. "We're going through quite a shift at the moment. The government has encouraged independent providers to get into the [healthcare] market."

BUPA, Britain's biggest medical insurance provider, said the sale would not affect its insurance customers, who will have access to the same 230 hospitals as before.

"The separation of our hospitals from the insurance business will allow the two, as separate entities, to fulfill their potential and make a greater contribution to the UK healthcare economy," said chief executive Val Gooding. "We are confident we will continue to enjoy a good relationship with the hospitals group under its new ownership."

BUPA will use the sale proceeds to pay down debt and to invest in the group. Hospitals accounted for just 11% of its business last year, with three-quarters coming from health insurance and the rest from care homes for the elderly. The company controls 40% of the health insurance market in the UK. It is a not-for-profit organisation, which reinvests any surplus into the business.

BUPA announced in early April that it was in talks to sell off its UK hospitals, with Citigroup appointed to handle the deal.

It set up the hospitals in the 1970s to ensure its insurance customers had sufficient access to private healthcare. As the number of private hospitals in the UK has increased, BUPA no longer feels the need to run its own hospitals.

"The two businesses have to be run at a complete arm's length for competition reasons," a spokesman explained. In 2000, BUPA was blocked from buying Community Hospitals on competition grounds. The sale of the hospitals will make it easier for the company to expand further.

It has also ventured overseas, to countries including Spain, Australia, Denmark and the US, where it now generates a third of its revenues.

[SuperFizz]

Wow, I couldn't believe yet again I opened the Frontline magazine to find a BUPA leaflet. I just has to write to the editor of Frontline again to complain about this as ask that they put my letter in the next edition. Unfortunately they appear to be silencing all member comments right now. Read on as it is a disgrace,

To: Frontline
Subject: Letter to the Editor

This letter is sent with the hope of being included in the next edition of Frontline.

"Clearly a double standard"

I was just amazed yet again to open a Frontline magazine and have a BUPA Health Care brochure fall out of its pages. On the one hand the CSP and Physio First have just instructed lawyers to make a formal complaint to the Office of Fair Trading in relation to the recent BUPA blind tender. On page 5 of this edition I see a note about this and read comments such as "... the two organisations [CSP/PF] were determined to take action to the extent that the law permits to take BUPA to task..." and "...was 'like having a gun put to our heads'..."

Why, why, why (and I have asked this of the CSP in the past) does Frontline continue to take advertising from, and therefore promote, an organisation that is behaving in a way that is both destroying our professional autonomy and our freedom to compete openly in the market place. BUPA restrict our fully qualified graduates from getting jobs in private practise yet we still promote their organisation. And we all know that marketing in this form and in this magazine is almost like an endorsement of BUPA by the CSP and Frontline.

When will the CSP and Frontline show some backbone and tell companies such as BUPA that they are sorry but cannot endorse or continue to promote their services for the simple reason that they contradict our core memberships values.....

Hopefully you will print my letter in the next edition

regards

Richard Bolton MCSP, Member Physio First
Director Performance Physio ®

This was their response (x2)

Subject: Letter to the Editor
Dear Mr Bolton,

Thank you for your comments. We are currently reviewing the situation with BUPA, and we will be in touch again when we have any further news about our position on the matter.

Yours sincerely,
Sandra Hempel,
Contributing Editor,
Frontline

Dear Mr Bolton,

As the CSP is currently reviewing its position on this matter, we will not be publishing letters on the topic in Frontline for the time being. As I mentioned in my previous email, however, we will let you know the outcome of the review.
With best wishes,
Yours sincerely,
Sandra Hempel,
Contributing Editor,
Frontline

[physiobob]

Seems the physiosvoice group (of which I am a member) are also very disappointed with the response and action (of lack thereof) taken by the CSP and Physio First. Here's their latest email advice. I for one have put up at least £250 for the cause.

Well I have to confess that I got my hopes up when the e-alert came from Physio First telling us to hold off from tendering until they had had their meeting with BUPA. How naive of me! I really don’t want to get into the blame game here as it’s an unnecessary distraction so I’ll bite my tongue.

What I will do instead is tell you what we intend to do now:

• We have now had discussions with 3 competition lawyers and will be meeting this evening to decide which one to instruct. All of them have stated quite clearly that there is scope to take a more robust approach than the one adopted by Physio First and the CSP.

• Several of you have indicated that you are prepared to contribute to the cost of this. If you haven’t already done so please let me know if you are. The time has come for us to put our money where our mouth is. We are in the process of tying down the costs and I will circulate a breakdown of these this evening.

• Despite Physio First’s assertion that they have negotiated concessions from BUPA, nothing has really changed. We are still in the same position, being asked to submit to the same blind tender with the odds utterly stacked against us. Please tell me if I’m missing something but how is that position any better than it was before Physio First and the CSP met BUPA last week?

• We have been contacted several times by BUPA now to ask if we need any help with the tender process (we very politely said that no we did not). I know that they have contacted several other practices. Perhaps a sign that they’re getting nervous?

Please continue to pass this on to all the physios you know. As the clock continues to count down to Friday I’m sure there will be some nervous people. They need to know that they are not alone. Please also keep blogging at www.thephysiosvoice.co.uk.

More coming later this evening.

Best to all,


Max

[Mr Manipulator]

Don't have a problem with contributing - just tell me how and where. But please advise how many of us are viewing all the detail on this site. We need as near as possible to the 6,000 physios contacted by BUPA initially in order to be effective.

[thephysiosvoice]

Well, what a day.....More phone calls from BUPA, more frustration from the CSP and PF. We need them, just as they need us. We only hope they can hear us.

How are the numbers going? Good, massive day on TPV in excess of 1650 hits.

What can you do? Ring 10 local clinics. Arrange to meet up tomorrow or the next day - just for 30 mins. Chat, talk and discuss. Don't "fix", that's naughty!! Write to BUPA or email Jane Gallagher (gallagja@bupa.com) ask some questions, make sure you get answers before you decide what to do....

The CSP advice remains don't tender. It's an individual thing.....

Spread the Love

TPV
thephysiosvoice.co.uk

[Jill Wigmore-Welsh]

Hi, Good luck with this. There is a meeting in Berkshire on Wednesday evening. All being well we can all have a chat about how we feel. I think there are lots of thoughts on this

[physiobob]

This comment has been posted on behalf of Alison Smith as it was received by direct email

Have been following all the messages with regards to the dreaded BUPA tender process and would like to add my bit but I have failed miserably at being able to register.

In case i can't get registered on time put out a plea for all Physios north of London to get involved as most of the comments come from people in the South. I agree with all I am hearing, and have been educated on quite a few points, especially with the long term effects and the erosion of our professional autonomy, therefore I feel strongly that we should go the way the Ophthalmologist's did. However, if this information is not reaching enough people then I fear there will be alot of Physios signing up to this deal without understanding its full impact. How can we be assured of that with such little time left? Lets all move to Guernsey!

Alison