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

[physiobob]

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.

The information on this forum and on thephysiosvoice is being sent to our UK database of around 7500 physio's via direct email. It is hoped that those that read it will be discussing it with other physio's and will be emailing it on to them as well. I think therefore we do have a good email alert vehicle going & one which is much wider reaching than PF's. And the collective wisdom of the real issues is coming from these two groups which cannot be said of the brief overview alerts from PF or the CSP. Actually the CSP have sent me nothing via email except to go to their site, login and then read their response. Seems a little backwards and rather annoying that it all that important information hides behind a login/firewall.

[physiobob]

And just received from Physio First

Following some members reporting that Bupa, when contacted, were apparently not adhering to the clarifications that they had given to Physio First, we are having further discussions with Bupa regarding this.

We would suggest that until matters have been made clear that if you have not already, that you refrain from submitting your tender at this time.

We know of no reason why anyone who has tendered and who may wish to alter that tender as a result of any fresher clarification, may not re-submit their tender.

We would expect to be able to report further tomorrow.

[SuperFizz]

And thanks to TPV I have just read this on the website of the Federation of Independent Practitioner Organisations (FIPO) - Physiotherapists and BUPA Insurance (March 2009)

Physiotherapists and BUPA Insurance
March 2009

BUPA Insurance has recently written to all its physiotherapy providers in the independent sector asking for detailed returns of information both personal and professional in what is called a quality exercise. Thereafter it is BUPA’s intention to set up a preferred provider network based on price. No doubt many physiotherapy groups will be excluded.

This exercise is identical to the failed BUPA attempt to enforce a network on ophthalmologists. The physiotherapists have been vocal in their response (see thephysiosvoice.co.uk) and have raised all the arguments that were employed in ophthalmology. Physiotherapists are concerned about a reduction in patient choice and because treatments may be limited and clinical care compromised.

BUPA argue that there is a variation in the price of physiotherapy services but fail to admit that there is a variation in price for all private medical services which depends on local factors, overheads, seniority and so forth.

FIPO supports the physiotherapists and regards this as another example of an insurer intruding into clinical care matters under the guise of quality but in fact for financial reasons. Our main concern is, however, over the loss of patient choice and the possible reduction in the standards of care. There are also well established links between consultants and physiotherapists which may be broken. A further question for BUPA to answer is whether or not they have a conflict of interest in that they run their own physiotherapy services under BUPA Wellness.

Additional Comment I forgot:
It gets even scarier. Seems Nuffield and BUPA are in competition for all of this. Just saw this on thephysiosvoice site and think it should get a place here as well.

I have been told by a old patient that my clinic is no longer recognised by HSA and that they are only using The NUFFIELD network physios.I had not recieved any notification from HSA etc. I rang HSA up and they told me that i am not recognised and that I should get on the Nuffield list. Rang nuffield and were told they were no longer accepting any more physiotherapy clinics.

See more about them here: Physiotherapy | Nuffield Health. And who is registered with them? and on what deals?

[SuperFizz]

And this in relation to Nuffield directly tendering to BUPA! Does all the physios in that group realise by default they are now endorsing the BUPA tender????

I am concerned that it is not only BUPA and PPP that are dominating the market. It would be wise to watch what Nuffield are doing. We received an e mail from them yesterday saying they would be tendering on behalf of all Nuffield network Physios to Bupa. Apparently Nuffield are already the largest employer of Physios outside the NHS, they are quietly taking over our profession.They have already mopped up most of the fitness business, owning more that it may be realised.I thought monopolies were against the ”consumers ” best interests

[andylouise]

Thanks I agree, also North London, been talking with a lawyer today, they have been through similar and hes going to put something together for us to see by 2moro. quickly though we must stick together, remember we are in a strong position as we "provide" and BUPA need us. We can decide to decline the invite to tender in order to negociate more favourable conditions . We must not be pressured by fear of being left out, rushed by their imposed timescales and being weakened by competing with each other, for what? who can undervalue themselves the most! We'll be a long time stuck with the consequences.....

[thephysiosvoice]

TPV has now instructed lawyers, not 1 but 2. Different ones to the CSP and PF.

It's time to press the flesh. Think 6 sessions!! Think of the tax deductions!! Think of our future.....

Are you out there and would you like to contribute? Join us and many, many others. email to [email protected] and we'll get right back to you.

Spread the Love

TPV

[Jill Wigmore-Welsh]

Nuffield Health and VERY strong as I commented on TPV comments box. It wouldn't surprise me if they have a LOT of city backing to get themselves positioned to tender for masses of NHS contract work. One look at their website is enough to show they are well set up to manage "choose and book" and also many local NHS services. Their goal is to have a clinic 20 minutes from everyone in the UK.

On a lateral thinking note

Has it occurred to anyone that perhaps a consideration is the lack of Physiotherapy only insurance avaiable?

After all we have Denplan, and Chiroplan, why no Physioplan?

If anyone knows anyone in the independent insurance development sector surely this is the way forward.
I did look into trying to get an underwriter to set up this very sort of insurance 2 or 3 years ago but couldn't contact the right folk.

If there was an alternative policy for people wanting to reclaim the costs of their Physiotherapy treatment and rehabilitation then perhaps it would be another route for us as professionals to promote such a policy to our patients.

I once again reiterate that all these changes have been happening gradually over the past few years, and I really do wonder just what the CSP has been doing with its head apparently stuck under ground unaware of this time bomb.

With regard Physiofirst, all I can say is if they are meant to represent 'private practitioners' and have known that this was coming I think they should all resign.

Radically, my deep down opinion is that this whole debacle requires all Physiotherapists who work OUTSIDE the NHS to reflect on what they get for their CSP and or PhysioFirst membership.

Isn't it time we looked hard at the CSP and asked why they haven't made us aware as a membership that all this is around with companies like Nuffield Health, BUPA, UnumProvident, and the rest ?

I feel let down by the CSP

[Deedee]

I just phoned HSA and there didn't seem to be any change in their requirements just their normal HPC registration etc
Well done to all of you on your great discussion and comments which I am avidly following up in Scotland
I'd like to hear from any other scottish physios out there

[Mr Manipulator]

Gone a bit quiet round here. Is evryone busy tendering?!

[Mr Manipulator]

I see we have new Q&A's from BUPA via PF/CSP. As far as I can see, they are just that, i.e. not changes to the binding terms and conditions.

[JacobI]

I have seen nothing yet that will persuade me to go ahead with the tender; interesting though, that Physiofirst are a little more clear about what they think of it all in their last message. The idea of a 'Physioplan' is interesting, but would need a lot of marketing.
Does anyone know if Bupa Wellness and Nuffield Health are connected in any way?

[Mr Manipulator]

Glad you noticed that, JacobI, the fact that CSP/PF actually expressed their opinion about the tender. I do hope others didn't miss that. It isn't outright direction but surely we can take the hint.

Interesting also to note that, on the other blog - The Physios Voice - a contributor has confirmed that BUPA has informed them that they have only had 'a trickle' of tenders so far.

[kidsphysio]

I telephoned CSP today about something else and then asked how the BUPA tender advice was going, and also if they had a copy of the BUPA contract they could email me as I seem to have mislaid mine. Not much in the way of answers from the receptionist, so I ended the call.

Interestingly I got a call back about an hour later from the CSP head of Policy! Asking what I wanted to know. Mentioned my concerns, as per this thread and stating that I felt I couldn't sign the contract as, apart from all the other concerns, I only treat children and there is nowhere in the contract that this can be clarified. I was informed of todays update from PF/CSP but during the call it was frequently stressed that if I did not tender it would be my decision and there was no guarentee there would be another opportunity later. This was said dispite my saying that I thought that PF & CSP had advised us not to tender yet. Basically I was advised to call BUPA to clarify my position... Still v. unlikely to tender unless the contract can be more specific to my speciality and everyones autonomy.

[physiobob]

I think I should restate the premise of all our discussions.

1. Bupa are a Private Medical Insurer
2. Bupa has a contract to cover their customers.
3. Physio's have a contract to provide a duty of care with their patients
4. Some of those patients have contracts with BUPA to cover the costs associated with the delivery of that care. Others do not.
5. By supporting patients with health care provision we enable companies like BUPA to exist and make money off the margins between cover they have to pay out on and revenues they generate from those customers annual fees.

Now we do not need to have a contract with the PMI, why would we? They make a business off our business, through extracting money out of their customers. We should not be looking to contract with any PMI on a fixed priced deal or in any deal that works for some of us but leaves many of our fellow physio's out in the cold.

The voice from the CSP and Physio First, for the good of the profession, should be loud and strong that they recommend that physiotherapists do NOT participate in any contractual agreement with any PMI. It is simply not in our interests.

We are in the strong position as BUPA makes their money off our services. If we all we to say no to BUPA patients unless they present free of any restricted terms and conditions, then BUPA has no business.

Get it!

[physiobob]

After all we have Denplan, and Chiroplan, why no Physioplan?

Payment for musculoskeletal treatment makes up more than half of a company such as BUPA's outgoings. This means that you need to make money elsewhere from the customers who are not accessing physio type treatment. If you had a physio only plan you'd be broke in the first 6 months. This is why it does not exist. We all know patients that feel if they fork out £1000 a year on cover then they are going to try and get £1000+ more back in value for treatment. And if those were just physio specific clients who just love to see their physio each week, where would PhysioPlan be? Not sure anyone would put money into backing that one

[thephysiosvoice]

Afternoon.

TPV has some very, very important news on www.thephysiosvoice.co.uk going live at 3pm.

Keep Spreading that Love

TPV

[andylouise]

Thanks for the letter.we are getting there. I want to say that we need to have insight into the positions of our professional bodies, that they will be being advised as to what they can and cannot state to us without being subject to legal action, in addition to getting legal advice about the process on our behalf. they cannot state it more directly for those reasons BUT the last statement states their positions plainly; that "they fundamentally disagree with it". Thats business speak and actually is strong. hear it as that. They cant be seen to be telling people what to do. the statement is clearly "advised" but they express their position. We as members of the profession can however throw our weight behind our stance as individuals without risk of any breaking of the law and as we are doing so, the csp and physio first may well be saying privately come on, you can do it! It has to come from us. thats the point. I just want those that are so frustrated with them to not alieniate physios that are unsure but then think from the angry posts here that we are just those radical types. As much as the prof bodies represent us their "role" places them in a slightly different place to us. Thats the very nature of their position compared to ours. I hope that people can see the whole with all its parts. We can exercise our choice wisely then. We want time to consult, get advice and deliberate and we needn't be rushed, would you usually sign a contract that someone else had put all the terms to and you hadn't contributed? Do you want a contact at all? we are "independent" providers of valued and necessary skills.We've worked hard for that, keep it that way. Thanks for those working on it, A

[JacobI]

I thoroughly agree with the above comment. Incidentally, I have not had an alert from this site for a while - surely the message from TPV should be spread as widely as possible on this penultimate day!
For those reading this, I am just an 'ordinary' physio, who has worked in the profession for over thirty years, in the NHS and then as a private practitioner. I have been involved in professional affairs within the CSP in a small way through clinical interest, so have perhaps a little more insight as to how things work there, and agree with andylouise comment regarding having to be careful what they say. But we as individuals can shout, and must shout together NO WAY BUPA!!

[physiobob]

This is today's update from the collective work of many and the instruction of our independent legal team. Many thanks to Max et al. who have worked tirelessly on behalf of the rest of us.

The following represents a legal challenge that has been presented to BUPA. We wanted this to come from the CSP - they have been given so many opportunities to make a better job of representing you, their members best interests. They have singularly failed to do so. Competence comes in to the equation not just hard work.

This has been sent to BUPA this afternoon. Read and decide for yourself if, given the legality of the situation you still want to sign up to the tender. This has been drafted by the Head of Competition Practice at Nabarro LLP not a medical negligence lawyer instructed by the CSP…enough said.

Tender for physiotherapy services

We are writing in connection with BUPA’s tender for physiotherapy services.

We understand that BUPA has been in discussion with the Chartered Society for Physiotherapy (”CSP”) and Physio First and that through these discussions BUPA will be well aware of the considerable concerns which the industry has raised about BUPA’s proposals for a network and about the conduct of its tender process.

We now seek urgent clarification of BUPA’s tender, and in view of the impending closing date for tender submissions (Friday, 24 April 2009) we request that you immediately suspend the tender process so that the concerns raised are properly aired and addressed.

The issues of concern are as follows:

1. We remain concerned that the tender process will have the effect of significantly reducing the number of providers which BUPA recognises and is willing to reimburse. BUPA’s Advisory Notes for the Tender state: “The number of providers selected for each region will depend on our volume requirement in that region … we will then appoint sufficient providers to ensure that there is appropriate local capacity to meet the requirements of our members.“
We understand that BUPA has been in discussion with CSP and Physio First and has indicated that it is prepared to remove any cap on the number of providers which will be admitted to the network.

We seek BUPA’s urgent written clarification that, notwithstanding the terms of the invitation to tender, there will be no limits on the number of providers selected within any region. Furthermore, if this is indeed the case, and all providers are potentially able to secure a place on the network, tenderers need to understand how BUPA will evaluate tenders and select providers. Will there, for example, be a “minimum” price or quality requirement, which a tenderer must meet in order to secure appointment to the network? If so, tenderers are entitled to understand what these minimum requirements are.

BUPA’s apparent indication that it will not have any limit based on volume requirements represents a fundamental change to its tender. In the interests of transparency and fairness, BUPA now need to explain to tenderers how the selection process will operate.

2. We are concerned that the requirements imposed upon physiotherapists under the new contract may constitute regulated activities under the Financial Services and Markets Act 2000 (”FSMA“). Since contravention of FSMA is a criminal offence, we propose to seek clarification from the FSA prior to recommending that physiotherapists enter into the new contract with BUPA. If the physiotherapists would be carrying out a regulated activity under the new contract, and the contract terms were not changed by you, each physiotherapist would need to become an appointed representative of BUPA prior to his entering into the new contract with you.

Under the Financial Services and Markets Act (Regulated Activities Order) 2001 (as amended) (”RAO“) physiotherapists may provide information about an insurance policy to BUPA members on an incidental basis. In addition, they may manage claims on behalf of BUPA. We propose to seek clarification as to whether clauses 3 and 4 of the new contract impose obligations on the physiotherapists which are beyond those which are permitted under the RAO and, more generally, confirmation as to whether a regulated activity would be carried out by the physiotherapists under the new contract. Our key concerns are twofold. Firstly, since physiotherapists act as agents of the member (who is their principal), they owe fiduciary duties to that member. This means that in entering into the new contract with BUPA, the physiotherapist is putting himself in a position of conflict. Further, the new contract requires the physiotherapist to advise on and explain certain terms of a member’s policy to them including level of coverage, exclusions etc. If such activities are regulated activities under FSMA then, by entering into the new contract with BUPA without first having become an authorised representative of it, the physiotherapists will be committing a criminal offence.

3. BUPA’s own primary care business – BUPA Wellness – is a significant provider of physiotherapy services. We call on BUPA to explain what safeguards it will put in place to ensure that the tender process is fair and non-discriminatory and that tenders from BUPA Wellness clinics are evaluated on an arm’s-length basis. BUPA is aware that both the OFT and the Competition Commission have previously raised concerns about the lack of “Chinese walls” between BUPA’s insurance and clinical services activities. Our understanding is that the BUPA Wellness business is closely integrated within BUPA’s insurance operations and therefore it is difficult to see what information barriers are in place to ensure that tenders are treated on a non-discriminatory basis and without preference to BUPA Wellness. We therefore call on BUPA to explain – in the interest of ensuring that tenderers have full confidence in the tender process – what measures it is taking to ensure even-handedness in relation to BUPA Wellness.

4. We also ask BUPA to clarify the extent to which providers in a network are entitled to charge additional fees above the BUPA reimbursement level – so-called “top-up fees” – to subscribers. Clause 4 of the standard terms and conditions appears to require that the provider may only submit invoices to BUPA and may not separately invoice patients in respect of any shortfalls. This is a fundamental departure from the normal practice between insurance companies and providers, where providers have been typically free to negotiate top-up fees with patients above the insurance company’s reimbursement level. We would view with considerable concern any attempt to restrict top-up fees, which appear to raise significant competition issues.

These concerns are shared by many other members of CSP and Physio First, as you will be aware from your discussions. It is impossible for BUPA to run a fair tender process, and to expect applicants to be in a position to bid, until these important issues of principle have been addressed. In the circumstances, we would ask you to suspend the tender process pending clarification and proper discussion to resolve the industry’s concerns.

In the event that BUPA proceeds, we are seeking legal advice as to the legal remedies which may be available, and we intend to bring these matters to the attention of the Office of Fair Trading by way of complaint.

Yours sincerely...

Now again from thephysiosvoice team..

Let’s be clear. This may not be a silver bullet but it will make BUPA think hard about what they are doing. It will force them to clarify, in writing, their position on some key commercial issues not the inconsequential bits and bobs negotiated so far by the CSP on our behalf. This will take some time and will force them to take a less aggressive and overbearing approach to this process. Let’s just take the time to revisit some facts. Signing up to this now, in the current state would be extremely foolhardy. Signing up to any form of restrictive network and breaking your contract with the patient is not a smart move either. We all do have a choice and should not feel bullied in to something we don’t like and we know is bad for the profession. We really are at a cross roads. Which road do you want to go down? Sorry - the facts:

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.
Let us know what you think. Let others know…

[alithephysio]

I posted a naive comment about 7 days ago (seems like 7 years). I have just treated 16 patients really well and with great professionalism. They all left my clinic happy. GET STUFFED BUPA you need us more than we need you. I will not be tendering. Not now. Not ever in its present form.

[Mr Manipulator]

Re. the recent legal challenge (TPV), Brilliant! Any way this can be forwarded to the email accounts used previously?

[Once Mighty]

Hello Everyone,

I have been following developments from a distance and I admire and commend the tenacity and resolution of the members posting their comments.

However if I may I would like to play the devil's advocate on the whole process.

Is it possible that BUPA have factored in the physiotherapist's reaction to their tender process.

Now let's assume that every tender that is submitted before the deadline is accepted on the list of "approved providers"


So in effecct I may be a Patient of my chosen therapist
Then I suddenly have problem that I need help with.

I follow my normal "clinical care pathway" (They do not actually start with the therapist )

They phone BUPA and I give my preferred therapists name.

BUPA then tell the patient that their preferred therapist is not on the list of approved providers.

The patient asks why and BUPA says "We are unable to disclose that information. We suggest that you direct that question to your therapist"

Sorry but a bit long winded; here's the point.

Supposing that BUPA accept EVERY physio who has "tendered" (To me personally an erroneous word in this context) a contract to provide services for their patients.

In effect:

We have self policed our profession

Taken the onus off BUPA to legislate who is fit to effectively practice

And they can turn around and say "Every physiotherapist that tendered has been included on the list of BUPA recognised providers. Why your specific therapist did not tender is not within our control.We suggest that you ask them directly the reason for their decision not to tender"

Put our own regulatory bodies in a ( in my personal opinion) in a dim light somewhat.

Last Thought. If this did happen and BUPA accept every tender submitted then the therapists who did not tender have in effect done BUPA's job for them.
If hypothetically every physio tendered, then it would be up to BUPA to decide which therapists were not up"to the mark".

As I understand it they would then have to decide who they would or wouldn't accept as service providers.

Surely it would be easier for the CSP an PF to fight individual cases on this basis.


I welcome your input on this issue

[fizziophil]

Hi All,

Thanks for all the useful comments, views and opinions that have been posted on this and other sites in the last few weeks. It has been great getting to know that there is such strong support and standing for our profession.

I'm affraid i still have questions and i am still not convinced on the best thing to do for my profession and my patients. Hopefully i am not the only one with the headache i am about to pose.

Firstly the CSP and PF stand point.
I wish that they weren't, as is suggested, making us read between the lines and guess whether or not we should all tender. Why can't they just be straight?

Secondly, I have built up a good relationship between my clinic and BUPA patients.
I feel that if I dont tender and nothing comes to fruition through the legal onslaught then i will have let down my patients.
I do however know i could survive without BUPA input.

Thirdly, if Itender.
If i tender and opt for the 2 years - i have an out.
I think i am also correct in saying if i want to terminate the contract then i still can but a time frame may be imposed.
If i tender and i am successful and the legal onslaught is also successful and BUPA are held to account on the points mentioned about the FSA etc. then surely that would nullify the tender as they have asked me to do something that is essentially ileagal ( as suggested).

I want to do whats best for physios and the profession, and therefore i am happy to follow the lead of my organisational body. So please, i ask, back yourself CSP and tell us the correct course of action in black and white.

So finally my position, as stands at the moment is -i am going to wait untill tomorrow to submit my tender in the hope that some clarity and a defiant position is upheld by the CSP and FP.( I think the odds are stacked against it though). If i have not heared i will, contradictory to most blogs on this site, reluctantly, post a tender, at my current prices. If i was asked to negotiate on these I would stand firm happily.

[physiobob]

Latest Updates:

Firstly if you are backing the letter that has been produced by our legal teams then please let Max and the team know you would like your name and practice also on the letter. That letter is a few posts above this one. Email him at [email protected]

Here's another update from thephysiosvoice.co.uk blog

Hot off the press:

Well after much hard work from our CSP liaison (Claire Small from Pure Sports Medicine) she has managed to persuade CSP CEO Phil Gray to instruct his lawyers (Hempsons) to write to BUPA raising the issues we have been banging on about all week: namely, the conflict of interest angle (BUPA and BUPA wellness), the FSA angle and BUPA’s initial aim of significantly reducing the number of physios they register. We have seen site of the CSP’s letter and while it isn’t as beefy as we would like, it is certainly better than no letter at all. Please tell all your physio colleagues not to give up hope....even the CSP seem to be coming on side now.

However, please do not be lulled into a false sense of security at this stage. We will certainly not be taking our foot off the gas and we are under no illusion that the legal angles do not provide a silver bullet solution. We will keep battling for our twin aims of clinical independence and commercial autonomy. We will be sending a further letter on the FSA points tomorrow.

If you haven’t already done so, please don’t forget to write to BUPA yourself and make sure you send your letter to Jane Gallagher as well as BUPA’s physio tender email address. Our lawyers letter appears in full on the website if you want some pointers (www.thephysiosvoice.co.uk).

Best to all,

Max

[physiobob]

Don't tender, you're letting the side down. So far almost no one is tendering so the situation with BUPA and their patients will remain ISQ. You don't have anything to fear unless you do tender which will affect everyone. Say No to the tender.