Doctors’ representatives have reacted angrily to Bupa’s move to remove a GP’s ability to refer a patient privately to a named consultant.

In a change to Bupa’s coporate select policy, coming into effect in January, insured patients visiting a GP and seeking private treatment will be provided with an open referral for a named procedure.

The insurer will then authorise the treatment and select a consultant from a list of its ‘recognised’ consultants.

Mr Derek Machin, chairman of the BMA’s private practice committee, said: “We’re completely opposed to this. It’s disingenuous - even insulting to GPs - to suggest that they’re not the right people to advise their patients on who is best placed to give them the treatment they need.

“GPs have the best interests of their patients at heart, as well as detailed knowledge of consultants in their area.”

The policy concerned covers 40% of Bupa’s three million customers.

A spokesperson for Bupa said the insurer was not trying to supplant the role of GPs, but help patients make an informed choice.

From April, NHS patients will be able to choose a named consultant for all referrals.

Geoffrey Glazer, chairman of the Federation of Independent Practitioners (FIPO), said: “The vast majority of patients rely on their GPs for advice on which specialist to consult. The Office of Fair Trading made this point in a survey it carried out as part of its market study into private healthcare when it said ‘participants generally trusted their GPs and were happy to pursue private treatment based on their recommendation’. We believe that to put this trust in jeopardy is a dangerous route to go down.”

He suggested that BUPA’s plans are based more on commercial concerns than on care for the patient, and expressed concern that patients with long-term conditions will not be able to continue to see their established consultant, thereby endangering their continuity of care.

“It is also strange that at a time in which the NHS is trying to restore the GP to consultant referral pathway that BUPA is trying to destroy this,” he concluded.

Consultant orthopaedic surgeons are defying health insurer BUPA’s new plans to pre-authorise funding for knee arthroscopy and surgery, a survey suggests.

The research, by the Federation of Independent Practitioner Organisations (FIPO), shows that 40% are still not signing BUPA’s prior approval forms and that many areas, such as Northern Ireland, are solidly opposed.

The dispute between BUPA and consultants erupted after the health insurer asked orthopaedic surgeons to complete an assessment form which must be approved before they can proceed with any new knee arthroscopy operations. If there are any questions about funding a procedure the surgeon’s decision will be reviewed by an external medical assessor appointed by BUPA.

The survey also reveals that those surgeons signing the forms have been placed under increasing pressure from the insurer to do so, with threats of delisting and patients being diverted to other surgeons.

The private medical insurer introduced the system following a review of the 19,000 knee arthroscopies it funds a year. It claims that the procedure rate was double that carried out in the NHS, and that some surgeons were three times more likely to operate than others

Meanwhile, the Royal College of Surgeons has written a letter in support of consultants’ concern over the pre-authorisation system.

In a letter to the British Orthopaedic Association, it points out that the variation of levels in provision of service could mean that one area (the NHS) has under provision rather than the private sector having over provision.

The letter says the RCS ‘does not support any third party review of a consultant’s decision to treat a patient’, and does not endorse the BUPA strategy.

Other findings from the survey include only 3% of respondents, who have complied with BUPA’s new procedures, agreeing with the insurer’s strategy.

Richard Packard, vice chairman of FIPO, said: “It is unacceptable that a consultant surgeon’s informed clinical decision is being called into question. The letter from the RCS clearly states it is not an insurer’s responsibility to review a senior clinician’s decision.

“It is our duty of care to put the patient first but BUPA does not seem to adopt the same approach. This new process is, in some cases, leading to delays in treatment with reports of patients becoming distressed and this is a primary reason why some consultants are feeling compelled to sign the form.”

BUPA said it is responsible for its members’ funds and needs to ensure that funding is provided for clinically appropriate, evidence-based treatments. It claimed the overwhelming majority of consultants were signing up to the new system.

Concerns about private medical insurers’ attempts to impose fixed fee schedules and restricted hospital networks on consultants are to be raised with the Financial Services Authority.

This follows a debate in the House of Lords during which Lord Walton, a neurologist and former president of the GMC and the BMA, asked whether these practices were in the public interest. He told peers that consultants were battling to protect patient choice and continuity of care.

The Federation of Independent Practitioner Organisations (FIPO) has been campaigning against insurers’ attempts to drive down consultants’ fees and to cut costs by imposing financial penalties on patients who wish to see a consultant of their choice instead of a cheaper recommended consultant.

During the subsequent debate peers of all parties expressed concerns about a lack of transparency and clarity within some insurance policies. Lord Walton said AXA PPP and Bupa, the two biggest insurers, were the worst offenders.

Lord Crickhowell complained that restricted hospital networks meant that patients could no longer go to the doctor or hospital recommended by their GP but had to go to the ones in the restricted networks nominated by the insurance company.

Lord Sassoon, the commercial secretary to the Treasury, said he would convey the points raised in the debate to the FSA.

Private medical insurers have also been criticised in two other recent debates in the Lords. Earlier in November a debate on improving the quality and quantity of life for people with cancer revealed that many cancer patients often found themselves having to pay for further treatment or cease treatment altogether after finding they were no longer covered by their policies.

In June, former NHS chief executive, Lord Crisp, asked the government what controls they proposed to put in place to ensure that private health insurers adhered to their industry codes of practice. This debate heard that patient complaints to the Financial Ombudsman were increasing.

Mr Geoffrey Glazer, chairman of FIPO, said more and more patients were unaware of the restrictions in their policies until they needed them. “Our members are concerned about the impact the proposed changes will have on patients at a time when they are extremely vulnerable. We firmly believe that choice should be in the hands of the patients and care in the hands of doctors and we will work hard to uphold this belief,” he said.

Sue Moore, Bupa Health and Wellbeing’s director of marketing, said hospital and consultant networks ensured high clinical standards whilst also controlling costs for their customers. She said: “It is our view that if such networks did not exist, private healthcare costs could spiral leading to premium increases. Furthermore, we also believe that it is not in consultants’ interests because it could impact on the viability of their private practices. Ultimately, without these networks there could be a reduction in demand and income with obvious implications for both private and NHS hospitals.”

At Bupa, she added, they took customers complaints very seriously and in the first half of 2010 resolved almost all (94%) complaints before they were escalated to the Financial Ombudsman.

A spokesman for AXA PPP said: “Our primary concern is to safeguard our customers’ interests and managing costs and keeping premiums affordable is an integral part of our approach to achieving this.”

Earlier this year the Financial Ombudsman reported that the number of complaints it received about private medical insurance in the year ending 31 March 2010 increased by 27% to 652 cases.

A spokeswoman for the FSA said: “We have ongoing conversations with the Treasury so if any issues about private medical insurers have been brought up in Parliament these will be brought to our attention.”

But she said they would also consider any information or concerns that any consultant or member of the public had about the behaviour of private medical insurers.