BUPA Physiotherapy Tender Process

[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

[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.

[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 [email protected]. 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]

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.

[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&[email protected] 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

[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.