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

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[thephysiosvoice]

Afternoon

So today is the start of the Blind Tender Process - my computers broken and so I can't do it. Shame. Apparently it will be out of action for the next 6 weeks or so, or at least until Saturday 25th April

BUPA has announced that with all the money that they will save, should the process go ahead, they'll spend it on new drugs. And probably try and get rid of physio all together!!

Spread the love.

thephysiosvoice dot co dot uk

TPV

[Bupabear]

So, you charge £30 or less and into the fourth year of your agreement you are now allowed to charge up to 75p more! Get real.
Maybe Bupa should advise Labour on how to run the economy.

I AM NOT going to join this charade by BUPA. I am fortunate enough to have enough self funders not to play their game.

This process is similar to what happened to Dentists and the NHS. And what did they do? Maybe we should let the press know that Bupa patients are going to possibly be seeing less experienced physios, for less time and in less pleasant surroundings! And whilst I am here, this is even more hilarious for our osteopath colleagues who really do know how to charge for their services

Should have been a lawyer or merchant banker. Damn!

Up the revolution!!!

[physiobob]

Maybe we should let the press know that Bupa patients are going to possibly be seeing less experienced physios, for less time and in less pleasant surroundings!

Here here on that one. I think the press would like to know a lot about BUPA's new reg's. Firstly, that their clients don't get their choice of practitioner, merely BUPA's choice of the cheepest tenders, second that they are working against the European laws on age descrimination by preventing people with less than 5 yrs experience (without any clinical basis) work on their clients. Thirdly that some of the NHS backlash for no jobs is due to the private arena not taking anyone less than 5 yrs post graduation and therefore no open job opportunites are appearing in the NHS.

And the list goes on. They are even restricting trade by charging £53 per half hr appointment at their BUPA wellness clinics (one around the corner from mine) but they insist I can only charge £45.

I back a total boycott of the tender process and we tell clients that we DO NOT see BUPA members. Let's hit them where it hurts, their membership, and get their patients to walk elsewhere.

[archersusie]

I agree the press should know about this process and how it will affect all BUPA subscribers. I myself am a BUPA member and a provider (for the next 4 weeks anyway), I need to see a vascular consultant - are they going to send me to the cheapest, or the best? That aside, BUPA can do what they want and provide the kind of service they wish to pay for. I personally believe they are shooting themselves in the foot.

I would like to know what the csp and physiofirst have done to fight this? Did they break the cost of a physiotherapy treatment down for BUPA, did they explain that we all must have insurance, PLI, up to date CPD, good surroundings with heat electricity, parking, good administration, good up to date serviced equipment, access for disabled clients, time to complete notes, communicate with doctors, consultant etc, that we need to pay rates and so on. None of this discussion involves price fixing, its just about informing BUPA what it costs to run a good, well expereinced, efficient physiotherapy clinic. The CSP and physiofirst have washed their hands by saying they cant talk to BUPA about this due to the competition laws. They can however, talk to BUPA about the true cost of a session of physiotherapy in real terms and the implications of unrealistic pricing, they can advice their members and provide support.
I heard a rumour that a motion to be discussed at Congress on this issue was declined - why? Simple question!

[archersusie]

Legal implication! Can someone help me with this issue?
If I dont qualify for this BUPA tender and am suddenly deemed to be below standard as set by BUPA, will the CSP defend this slur on my professional ability, even though I comply with the standards of practice set by the CSP and HPC?

[physiobob]

Let's look at the BUPA issue in recent years. I might add I have written to the CSP and the OCPPP (entire committee) on several issues about this in the past few years and have had little CSP response and NO OCPPP response.

I think it's time perhaps the UK's private practitioners looked at forming a new association?! Maybe then they will listen.

Firstly the age discrimination issue:

In October of 2008 the European law stipulated that you could not discriminate on age for any job application. Immediately BUPA fell in breech of this issue as by demanding 5 yrs post grad 'experience' (actually time past) to be on their books. Effectively this says that no one under the age of 26-27 can apply for this job contract with BUPA. (18 yrs + 3 for the degree + 5 for experience) So 27 is a minimum.

I questioned BUPA on their guidelines for the 'level of experience' required at the time and they said there was none, it was 5 yrs and that was that.


Secondly the 5yrs + and BUPA's own wellness clinics.

I am sure everyone knows that BUPA themselves recruit graduates of less than 5 years experience into their own clinics (some as little as 2 yrs). They justify this by saying they are under the observation of those with a minimum of 5 yrs experience. Not quite sure who they think we private practitioners are.

The result of the above is a restriction of trade issue

Thirdly, BUPA have told me I can only charge £45 for a half hr session when their clinic around the corner charges £53. This is ant-competitive and a restriction of trade.

All of the above point, and more, have been brought to the attention of both the CSP and the OCPPP

Let's go on.

In 2006 I wrote to the CSP explaining that the big issue lying ahead for new grads was this 5yr + issue and BUPA (and perhaps PPP who has stopped all physio's registering with their service).

Effectively what that meant was that no one under 5 yrs was going to leave the NHS as NO private practitioner was that keen to employ them without recognition of the health care companies. No one leaving means NO new jobs for new grads within the NHS.

By the time someone spends 5 yrs in the NHS they are unlikely to move into private practice. Thus no seniors leave either, the result even less new grad positions.

No let's look at the culling of the BUPA list under the current scheme, even less BUPA approved practitioners, practices will shrink, there will be more solo ([professionally isolated) practitioners and even LESS jobs for any physio outside of the NHS. Therefore no incentive to leave the NHS and NO new grad jobs for the future of the physio profession in the UK.

No I am taking a slightly extreme view on this but it will not be far from the outcome as I say this and the later ramifications whilst working in Canada in the 90's. Interestingly a similar situation that BUPA is trying to create was eventually deemed anti-competitive under the Canadian law and these super-clinics for the mass market has to disband their exclusive agreements. So BUPA will possible gain for a while but not forever.

This is an issue for the whole profession, not just the private practitioners. The NHS, the current new grads, the current students and the future students.

I would support a boycott of the tender process by the entire profession. I would also welcome media interest in this issue as BUPA are no longer offering their clients the practitioner of their choice. They will be offering one of BUPA's choice based on the cheapest offer on the table. No well established, well qualified and conscientious therapist will enter this agreement. Once their members know about it, let them react by walking. The media could have a field day with this.

Please make your comments and no that there will be a physio meeting held in central London next week (perhaps wed the 8th April) to discuss this on mass.

Watch this space.

OH and by the way the CSP continues to take advertising from BUPA for their inserts in the frontline publication. I also complained about this several times and they even printed my letter but did nothing about it. I suppose when their mismanagement has lead to financial problems they even take money from the enemy…Such a short-sighted approach to all their members’ livelihoods.

[Bupabear]

I think this will be the end of the OCPPP. They have been shown to be spineless (excuse the pun). I never expected the CSP to get involved. I am 52 and when I qualified it was considered the eighth deadly sin not to work in the NHS. Why should our NHS colleagues be worried about us greedy private practitioners charging such a large amount for treatment?

Yes let's have a boycott. Sod the lot of them. If we agree to cut our costs and lose are clinical autonomy to one insurer, the rest will jump on the bandwagon. How would you answer the question from AXAPPP " Why do you charge us more than Bupa?"

Maybe when we move away from these stupid Bupa prices, we can go on and move towards charging a proper rate. We are clinicians but get paid technician wages in the NHS and that's what Bupa think we are.

The Daily Mail might be sympathetic to our cause, what does everyone think?

[pragmatic pat]

I would like to voice my support for a mass exodus from BUPA. We are all working privately to be autonomous practitioners and as such able to provide a flexible service to deal with our differing patients variable needs. This would be swept away in an instant and we would be culpable in the demise and undermining of our profession
This contract is belittling and demeaning. I will not be tendering , am prepared to take the substantial financial hit to defend my position as a professional rather than a paid assistant.

As we are the only practice for an 8 mile radius it will be interesting to see how BUPA are going to fulfill their proclamation to still offer physio close to where patients live.

[pragmatic pat]

Further to my post I realise sadly that i am the only woman who has come out in support of a buoycott.....please..... someone tell me i am not alone???

[thephysiosvoice]

NO! You are not alone.....

TPV

[physiobob]

Let's boycott it all together. Let's all talk about it. Let's inform the media. And tell everyone offline too. p.s. Sorry about the site being down overnight. Our hosting company had a meltdown and many were affected. Glad all is back online now

[maunger]

Hello,

First I would like to make a point that I am not one who gets involved in general discussion forums regarding physiotherapy issues.

However, recently, I have learned that BUPA have given all private clinics in the UK, 4 weeks to submit a blind tender for the business of BUPA subscribers. As a clinic I remember no other discussion or warning that this was coming about and to give us all 4 weeks to go about a blind tender seems generally wrong.

I have been searching on google and I believe that this is BUPA's big plan to bring all medical providers who are currently treating their patients in-line with their pricing structure. BUPA say that this is because of the large variations in physiotherapy fees and quality of treatment around the country, however underneath this when looking at the tender website they ask questions regarding internal audit and care pathways. It may be just me but aren't BUPA an insurance company? Is it really there role to establish whether physiotherapists on their preferred list are in fact taking part in these CSP standards (I personally think not). In fact it is the job of individual clinics to meet the CSP standards.

I personally believe that the tender is going to remove/devalue practitioners autonomy, as we all know you cannot bracket all patients into care pathways, try doing that for a patient with lower back pain.

Further to this, when looking at google I notice that BUPA have instigated tenders for MRI and Opthalmology. MRI was pushed through quietly and now those who signed up the agreement are regretting the agreement and the Opthalmologist's have out right rejected BUPA's proposal.

I would like to find other members who are concerned regarding this tender, we don't have very long and we may be signing up to something that we don't yet know all the facts about and how it may affect us in the long term. I am considering contacting the press to bring this issue to the forefront

Please contact me if this is a big enough issue for you and you want to do something about it.

My name is Mike Aunger

[archersusie]

Where do I start? SO much to say...
1. The BUPA tender is NOT about quality. It is ONLY a price cutting exercise! Be under no illusion.
2. Why are physiofirst and the CSP not doing more to support their members with this issue? It should be all over the press that BUPA are looking for cut price physiotherapy treatments and reducing patient choice?
3. Are BUPA going to reduce the number of osteopaths/chiropractors
and cut their prices too? I think not! And when your patients cant get a good physio with good skills because of this tender process, they will be going to the chiropractor/osteopath down the road!
4. How am I expected to maintain my CPD, improve and expand my skills and practice with a 30 quid treatment? Will the extra 75p in four years help fund it? I think not. Does Ms Gallagher spend more than 30 quid on her hair do? I think so!
5. What if I get the contract and am flooded with BUPA patients pushing out my other patients and in 4 years time dont get the contract- what happens to my practice then?
6. What if other Personal Health Insurance Companies follow suit and I have to charge all my patients 30 quid - I will essentially be working for 3 months of the year for free (a 25% cut in money coming in!).
7. How do BUPA plan to evaluate that the providers have these carepathways in place and clinical audits? If they did actually inspect them would it mean anything to them? Again, I think not.
8. Can anyone actually make head nor tail of the terms and conditions in this contract?
9. What about my clinical governance and autonomy?
Im angry, confused, stressed and annoyed by BUPA. I thought they were a reliable trustworthy company which provided good quality healthcare now Im not so sure and am wondering should I switch my healthcare provider. I dont want top be sent to the cheapest heart surgeon or the cheapest vascular consultant or have a cutprice hip replacement.
Im also let down by Physiofirst and the CSP - why oh why are they not doing more about this?

[thephysiosvoice]

Where to start.....

1. I think you are correct. This is a Walmart proposal. Stack 'em high, sell 'em low. Physio is just physio. Doesn't matter by whom or where or even what....really?
2. Physiofirst are spineless and don't want to tussle with the Big Boys incase their cred is dented and the CSP has to look to and protect the "majority of it's members" i.e not the group who represent the private sector. The CSP seem to forget that like it or not, the private sector is often the public image of physio and so should give us just a modicom of respect.
3. Chiros and Osteos only represent a small percentage of relative treatment cost, so go for the biggest group - us.
4. Forget CPD. Read Frontline - that's 50% of your yearly CPD. Do it twice - et voila.
5. Eggs in one basket....
6. Unfortunately they will if this is allowed to succeed.
7. BUPA have an elaborate method of assessing and evaluating by getting us or monkeys to fill out an online form
8. No. I'm sure your folks always told you to be careful what you put your signature to - and if in doubt, don't.
9. If BUPA get their way we wont have to worry about this. We'll be told what to do, to what bit for how long. Think dank basements, think robots. Forget 2012 and the Olympic Dream.

You are not alone - the more I listen the more I hear other Physio's crying out for help. We're a pretty mean bunch when we communicate with one another and get things done.

The Physio's Voice is there for every single Physio in the land to have a voice. If you get a lot a people in a room and all whisper, you actually make quite a racket....Please look at the blog thephysiosvoice.co.uk and get involved and tell your mates too.

Cheers

TPV

[londonphysio]

mr manipulator, what i could tell you could really make your hair curl! I will not elaborate as i would not put it past the protagonists to sue me for libel. (and they would be identifiable from the most serious of allegations) My reference to successful business models was a thinly veiled finger pointing towards those practices that I know, have this approach as a policy. I find that those practices are as guilty, or even more so, of interfering with a physio's autonomy than BUPA currently are.

[physiobob]

mr manipulator, what i could tell you could really make your hair curl! I will not elaborate as i would not put it past the protagonists to sue me for libel. (and they would be identifiable from the most serious of allegations) My reference to successful business models was a thinly veiled finger pointing towards those practices that I know, have this approach as a policy. I find that those practices are as guilty, or even more so, of interfering with a physio's autonomy than BUPA currently are.

We all understand where you are coming from and indeed I could name a few of them as well. This however does not have a bearing on the tender issue. It does of course on your financial and local business viability issues. I have always found that doing a good job gets you business, perhaps not as fast a growing clinics as others but a more stable, more loyal client base. This becomes highly important in situations like those we are currently in. The 'Big Guys' are usually billing a lot on the old PMI cheque book and so they are the ones forced to tender or lose some staff. The small, high quality, stable practice with excellent word of mouth won't be affected much at all with no BUPA referrals. And if they're good their clients will come back anyway.

In a world where tenders are the winners you'll have both those large highly competitive practices and a PMI driving your prices down....surely a place worse off?..

[londonphysio]

not if you refuse to drop your prices. I think, for central London, having 40% self paying patients is pretty high. The only reason my BUPA % is high is because of a corporate contract. I have tried to diversify the way my patients are funded and not 'put my eggs in one basket', but in central london the fact is that the majority of patients will be claiming on their work policy. I have takent he view that it is best to fight this from within. I agree that the tender as stands may be the thin end of the wedge, but I can 'out statistic' pretty much anyone. I audit 100% of patient notes for example.
I think other peoples practices are relevant in this discussion. I think they have brought this on us. I am not surprised that BUPA says that 80% of the physio bill goes to 10% of practices. With a variation of £20+ between the cheapest and the most expensive physio 30 min sessions in central London, it is quite feasible that the cost could easy be quadruple when comparing one practice to another, in the same area, if you take sessional averages into account.
Until we can evaluate outcomes reliably, this cannot be justified. this is why i take outcome measures for all patients, even if they are not deemed reliable at present. It is my 'insurance policy' against further, more sinister actions by the PMIs.

[Chartered Physiotherapist]

I think a very clear dividing line is being drawn between practices that have had to tender because of their high proportion of Bupa patients and those that have a low amount.

I am outside London and PMI patients account for 20% of my list. Of that Bupa and AXAPPP make up most of the insurance work.

From a purely business point of view, I have not been forced to tender.

[ckaren]

What happens next?
I didn't tender so do I just keep accepting/treating BUPA patients until advised by BUPA?
My latest BUPA patient this morning has been told that she has to phone for a new authorisation number on May 1st and isn't sure whether it is just that it is her policy renewal date or that they wil ask her to go to another physio.

[Mr Manipulator]

Hi 'ckaren', Looking at everything that came with the process, the cut off date for authorisations on the old system is 15.5.09, after which the new network (such as it might be) goes live on 17.5.09.

However, it will be intersting to see if BUPA has enough people to form a network and, if they haven't, the above could change!

Looking at the polls here and on thephysiosvoice.co.uk they might have a bit of a problem. I sincerely hope they do!!

Even if they don't to start with, they probably will down the line when their client base starts to complain about availability of choice of practitioner.

[alasdairjon]

Just thought I'd let you know, I received the following email after informing several government ministers of BUPA's "process". Perhaps another helping hand to come? Also, If ANY of you are Federation of Small Business members, they would love to hear from you. They are one group which do lobby hard on behalf of their members, and advised me to speak to my local MP, giving me details of the direct line to him in the Houses of Parliament. Believe me, the FSB could be an invaluable tool in our fight.

Email as follows
"

Thank you for your email regarding BUPA's change in their service terms that affect physiotherapists. I am passing your email to Stephen O'Brien MP, Shadow Health Minister, who leads on this issue for his consideration.

Yours sincerely

Andrew Lansley "

Keep fighting. From within, or without.

[archersusie]

Has anyone emailed the BBC Watchdog yet, they are running a series on Insurance Companies at the moment and this would probably be of interest to them.

[JacobI]

Dear archersusie - I hope you have? I wrote to Jane Dreaper last week, and have had two replies, unfortunately, as you can see on TV, she is rather occupied with Swine flu at the moment, but I did urge her to read the discussion here and on physiosvoice, and to check FIPO, as they have the connection with the opthalmologists, and to look at the original prees release form CSP. Maybe you can do the same to Watchdog.

[Jill Wigmore-Welsh]

First to say well done to those of you organising the meeting in London. Unfortunately I cant be there but send my support. My own feelings on this whole issue are mixed.
Do any of the rest of you recall when we Physios could accept BUPA patients direct, without a GP referral ?
I do, about 12 years ago it was fine for me to take on a patient without a GP referring.
Same with Axa, up to 7 years ago I was accepted as a specialist and in my occupational health clinic, I could take on Axa patients direct access, and could sign off my own forms.
Do you remember when we could give patients an absence certificate to enable them to be off work? I still have the forms in my practice. But all is now changed on that score as well.

Over the past 5-7 years there has been a huge sea change in the way our profession is placed by insurance companies, GP's, solicitors, and more.

At heart we are now viewed as a secondry care profession, just providing referred to: treatment/therapy. Our professional autonomy has been completely eroded, we really cant accept patients direct unless they self pay. Both within the NHS, where direct access is a joke, because no independent Physio can apply to provide NHS Physio, as Dentists currently do, and the independent sector, where any insurance work has to be doctor advised.
This has taken our profession in the opposite direction from where we should be.
In my estimation 95% of Physio work is NOT autonomous.

The health service is 'led' by the Doctors, Nurses, and Pharmacists.

At core, I consider that the current action by this insurance company, is just in parallel to what is happening through all other insurance companies and PCT's. Almost on a daily basis I am approached by case management companies who seek to drive down the cost of their client's therapy, by asking Physio practices to compete on the basis of cost. This process is undertaken to enable case management companie to maximize on the money they make from each case.

Unless we make a stand as a profession to move ourself into a primary care position, then I cant envisage how things will change.

I feel that this incident could be a wonderful opportunity for Physiotherapists to unite, make a real change in our profession, and reclaim our autonomy.

Firstly, to do this, it is time that either the CSP move from their fixation on the NHS, providing an NHS biased trade union which is of no use to me as an independent practitioner, and writing articles in the journal about NHS services.
Its time that the CSP focus on promoting the profession of Physiotherapy, and not the NHS Physiotherapy profession.


Secondly, and more importantly, we need to answer the question

How we 'sell' our autonomy to the government ?

I'm not sure.
I can understand how the Pharmacists sold themself, because most NHS care is still entenched in the drug/ pharmaceutical industry, and using a Pharmacist to do some of the prescribing is cheaper than using a GP clinic.
I can understand how the nurses did it because a nurse led clinic is also cheaper than a GP led clinic and nurses can carry out a lot of routine health screening, injections, etc

My query therefore is:
What as a profession can Physiotherapists offer the government, to enable us to move our profession to primary care, from secondry care, and therefore to gain the respect, and fees we deserve?

Unless we have this position, then I can only ever see the insurance companies paying us as therapy hand maidens

Cheers
Jay