Consultants are at loggerheads with private medical insurers over attempts to regulate their private professional practice and drive down fees.
BUPA has angered specialists by insisting on monitoring the professional standards of newly appointed consultants and the way they run their private practices.
The insurer launched a new contract three weeks ago which requires consultants to provide information about their clinical practice including, appraisals, audits and outcome data and also about their practice administration. It also imposes fixed fee schedules on them.
Mr Geoffrey Glazer, chairman of the Federation of Independent Practitioner Organisations (FIPO), accused BUPA of acting as a regulator.
He said the stance was vehemently opposed by most FIPO members. Over 90% of consultants who responded to a survey said that insurers did not have either the capability or the right to act as regulators.
“There was a strong sense (among 95.7% of respondents) that an insurer should not be responsible for monitoring the progress, appraisal and audit results of newly appointed consultants or indeed for any consultants.” This was part of the process of revalidation and came under the remit of the GMC, not a financial services company such as BUPA, said Glazer.
Significant numbers of specialists are also reporting problems with de-listing, capping and lack of recognition, another survey by the Independent Doctors Federation (IDF) has revealed.
More than 10% of the 224 IDF specialists who responded reported that they had been de-listed by an insurer; 36 reported a problem with recognition and 92 had had their fees capped.
AXA PPP and BUPA headed the list on both capping and de-listing issues with disagreement over fees cited as the major cause of their actions. IDF claims there have been widespread examples of inconsistency and lack of transparency in the application of these sanctions.
IDF chairman Dr Jack Edmonds said doctors who had been de-listed, capped or not recognised had often had previous reputations for excellence but were being suddenly disciplined by insurers “on a whim” for having the “temerity” to stand up for their independence.
Insurers were blaming “expensive doctors” for their current financial problems. But their profits were currently being hit by downward pressure on premiums, a reduction in clients, medical inflation and overheads charged by private hospitals. Doctors’ fees had generally remained static over the last five years.
“The private medical insurers have failed to discuss these issues, have not published transparent codes of practice and have not treated specialist doctors on a consistent or like for like basis. At the moment they seem intent on dictating their terms without negotiation or dialogue,” said Edmonds.
These concerns follows pressure from both BUPA and AXA PPP - who between them control 70% of the private medical insurance market - to impose financial penalties on patients who wish to see a consultant of their choice instead of a cheaper ‘recommended’ consultant. Private practice organisations say this harms the patient-consultant relationship, impacts on established care/referral pathways and restricts patient access to the most appropriate specialist.
Katrina Herren, medical director of BUPA Health and Wellbeing UK, said hundreds of specialists had already signed up for their contract for newly appointed consultants.
The contract only asked consultants to tick a box and to provide a date on an online form to let them know that they were abiding by the regulatory processes of the GMC. One of the reasons it introduced this was because there were gaps in plans for the regulation of consultants working solely in private practice. Consultants had specifically asked them to recognise specialists who do not hold substantive NHS posts.
“We just want to make sure that these consultants are abiding by the recommendations of the GMC as they are self-employed individuals. It’s very much easier and fair if we treat everybody in the same way,” she said.
She said it was asking consultants about administrative issues, such as how long patients had to wait for appointments or whether they could easily get hold of a secretary, because these were quality concerns that were important to the patients in the private sector.
Herren said the pressure to keep costs under control, which was particularly important to their corporate members, was the reason they had to sign up new consultants to fixed fee schedules. “One of things we are trying to do is balance the needs of people who would like to be paid a lot more with needs of large corporations who want to keep medical insurance products open to as many members of staff as possible.”
No consultant, she said, had been de-listed because they had refused to reduce their fees.
New figures from the consultancy Lang and Buisson show that demand for private medical insurance fell by record levels last year.