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BUPAs Shock Pressure on Private Physiotherapy

Private physiotherapists throughout Britain have been shocked and angered by the attempt by BUPA, the UK's biggest medical insurer, to push through new terms of service and contracts in return for being allowed to treat BUPA patients. BUPA has styled the review, which is not confined to physiotherapy services, as an investigation of value, service provision and quality, which they feel has inappropriate inequities across the country. This has resulted in 6 thousand physiotherapists effectively being required to enter a price competition for the privilege of 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


Physiotherapists and practices have to fill in a lot of information for the tender including their sessional prices and value for money, the experience patients have in their practice, quality of treatment and practice facilities. Physiotherapy has not been particularly singled out for this rather tough process as ophthalmology and magnetic resonance imaging have already been scrutinised in this way, apparently with a 10 million pound saving.


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.


“Unfair and inappropriate” is the comment on the process which Phil Gray, chief executive of the CSP, gave about the tender system, due to patients' clinical variation and physiotherapists' variations in expertise and ability. He added that he felt the tender process and the proposed revised contracts were not compatible with a competitive market and effective patient choice.

Private physiotherapists and NHS physiotherapy provision are both being increasingly affected by business and market forces, with the recent BUPA affair being the most extreme example. Many physiotherapy treatments are traditional and are ready for new business practices, with health businesses stepping in to these markets. Both PhysioFirst and the CSP have been advising on the necessity to update business skills by provision of information and courses.

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