BUPA’s Shock Pressure on Private Physiotherapy
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.
BUPA has asked physiotherapists and practices to complete the online tender process by Friday 24th April, covering information about customer services, quality, the practice and the base prices they can offer. Only if approved will they be granted the status of BUPA Approved Physiotherapy Provider. BUPA stated wish is to provide their customers with proven quality physiotherapy at a fair price and close to where they live. There is also a drive to standardise the length of sessions albeit with consideration of clinical variables and to set sessional benchmark rates.
BUPAs tender document indicates the prices as:
Central London: initial assessments 55; follow-ups 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.
Once BUPA has reviewed the tender submissions it may grant physiotherapists a contract for two years without increased prices. If things go well a two year continuation could be granted, with annual prices increases. Two hundred percent differences between physiotherapy prices are quoted by BUPA as indicative of anomalies, with costs varying between 25 and 85 pounds. Large cost differences can occur in practices which are geographically very close, and with treatment frequency for similar conditions varying from one to sixteen consultations it is these anomalies BUPA is trying to address.
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.”
The Chartered Society of Physiotherapy (CSP) and PhysioFirst, the representative organisation of private practitioners, having been working cooperatively on this matter, indicating to BUPA the potential disadvantages of their approach. They have now instructed solicitors to present a formal case to the Office of Fair Trading against BUPA’s tender process.
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.
