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BUPAs Shock Pressure on Private Physiotherapy

Physiotherapists across the country are angry and disappointed at an attempt to drive their prices down by BUPA, the health insurance provider. The UK's largest private medical insurer has been conducting a review over the last year into the provision of orthopaedic services, which includes independent physiotherapy provision. Their view appears to be that the cost and quality of physiotherapy provision varies across the country, in some cases representing poor value to customers. The result is that 6,000 physiotherapists have effectively been asked to compete on price for treating BUPA patients.

The tender process initiated by BUPA involves physiotherapists and practices filling in an online questionnaire by Friday 24th April, setting out information about their practice, quality requirements, the best prices they can offer and parking offered. They will be allowed to be a BUPA Approved Physiotherapy Provider only if they pass this process. BUPA is reportedly looking to ensure high quality physiotherapy provision close to patients' homes at a good price, with an attempt to get session length standardised within clinical variability.

BUPA has set the prices in their tender document 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

The tender process asks about the facilities and services offered in the practice, the quality of service provided, the patients service experience " the standard available, price and value for money and innovation and development. The BUPA review is not concentrated on physiotherapy as the have already adopted this approach to appraise magnetic resonance imaging and ophthalmology with reported savings of 10 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." 

Talks have taken place between BUPA, the Chartered Society of Physiotherapy (CSP) and PhysioFirst which represents many private physiotherapists to try and resolve the differences and point out counterproductive elements of the tender process. Solicitors have now been instructed to bring a case formally against the process to the Office of Fair Trading.

The CSP chief executive Phil Gray has indicated that the BUPA price comparisons are unfair and inappropriate as they did not take into account the patient's clinical condition nor the specialist expertise of the practitioners. He feels that patient choice and the operation of a competitive market are not compatible with the tender process and proposed new contracts. Market forces are impinging more and more strongly on both private physiotherapy and NHS physiotherapy provision and this is an example of this process becoming very obvious. Commercial competition is increasing as different organisations enter a market where many things have been done traditionally for many years. Improving business skills and making business cases have been recurrent themes recently in the advice and courses run by PhysioFirst and the CSP.


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