BUPA Shocks Physiotherapy
Posted: Tuesday, May 12, 2009
by Jonathan Blood Smyth
BUPA's introduction of its recent tender process has caused anger and grave concern amongst private physiotherapists. BUPA is the largest private medical insurer in the UK and has been reviewing orthopaedic services recently, now moving on to the reported inequalities in private physiotherapy services. BUPA's intentions are stated to be to look at the alleged inequalities in quality, cost and customer service in physiotherapy provision across the country. Six thousand physiotherapists have been effectively requested to enter a price competition to be allocated BUPA patients.
The prices indicated in BUPA's tender document are:
Central London: initial assessment 55; follow-up treatments 45
Outer London: assessment 45; follow-up treatments 35
Rest of the country: assessment 40; follow-up treatments 30
BUPA's questionnaire enquires about practice services, facilities provided, clinical treatment quality, the patient experience of the service, evidence of development and innovation, session prices and value for money. BUPA are not singling out physiotherapy in this process as they have already applied the pressure to other services, including ophthalmology and magnetic resonance imaging, reportedly saving around ten million pounds.
On offer for successfully passing the tender is a two year contract without price increases with the possibility of another two years with some price increases. The cost of physiotherapy BUPA has noted as extremely variable, with costs from twenty-five to eighty-five pounds in private practice as compared to twenty pounds for a NHS sessional rate. Even physiotherapy practices close to each other can show both great price variation and large differences in session numbers for treating similar clinical problems. Session frequency was found to vary between one and sixteen attendances.
Dr Rebecca Small, assistant medical director for BUPA UK Health Insurance, said: "Recent changes in the NHS mean that physiotherapists are increasingly being required to demonstrate the effectiveness of what they do in terms of clinical outcomes and cost. No such requirements exist in the independent sector. We want to work with physiotherapists and their representative bodies to address both the variation in the provision of physiotherapy and the cost for private patients so that together we can continue to deliver high-quality, evidence-based care and drive better value for our customers.
"We are also increasingly being asked by our customers for more information about the physiotherapists who treat them. Our new approach to physiotherapy will enable us to meet this growing need.... Our initiative is designed to offer customers high quality healthcare at affordable prices and, whilst it is disappointing that both organisations have decided not to support it, we respect their position."
PhysioFirst, representing private practitioners, and the Chartered Society of Physiotherapy (CSP) which represents the vast majority of physiotherapists in the country, have been working together on the problem and talking with BUPA to try and resolve matters. They have indicated there may be disadvantages to the approach taken by BUPA and have now formally presented a case via their solicitors to the Office of Fair Trading.
Phil Gray, chief executive of the CSP, has called the price comparisons used by BUPA unfair and inappropriate because they have both ignored the variations in clinical conditions in the patients and levels of specialist expertise in the clinicians themselves. He indicated that complete patient choice and a fully competitive market are not consistent with the proposed tender and new contracts. Both NHS physiotherapy provision and private physiotherapy are being increasingly impinged upon by market forces and business processes, the BUPA tender being the most marked recent example. New organisations are entering the market which is ripe for revision of traditional practices which have not altered for years. Both the CSP and PhysioFirst have been encouraging business awareness and skills by advice and running courses.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in London, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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