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.
Physiotherapy practitioners must complete an online questionnaire by Friday 24th April, with questions about the practice, parking and lowest prices they are prepared to accept. Only then will they have a chance of becoming a BUPA Approved Physiotherapy Providers. The stated point of the tender process is to provide to BUPA customers high quality physiotherapy close to where they live and at a fair price. They also want to standardise session lengths with some allowance for clinical variation and to establish benchmark rates per session.
The prices indicated in BUPA's tender document are:
Central London: first assessment 55; treatment 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.
Successful applicants will be invited to agree a two year contract with no price increases during this time, with an option for a further two years with annual price increases. BUPA had found a variation of over 200% in the cost of a physiotherapy session (25 to 85) as against an NHS sessional rate of 20. Considerable price variation may occur in physiotherapy practices very close to each other and there can be huge differences in the number of sessions to treat similar musculoskeletal problems. The number of sessions varied from one to 16 treatments.
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. - 14130
Physiotherapy practitioners must complete an online questionnaire by Friday 24th April, with questions about the practice, parking and lowest prices they are prepared to accept. Only then will they have a chance of becoming a BUPA Approved Physiotherapy Providers. The stated point of the tender process is to provide to BUPA customers high quality physiotherapy close to where they live and at a fair price. They also want to standardise session lengths with some allowance for clinical variation and to establish benchmark rates per session.
The prices indicated in BUPA's tender document are:
Central London: first assessment 55; treatment 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.
Successful applicants will be invited to agree a two year contract with no price increases during this time, with an option for a further two years with annual price increases. BUPA had found a variation of over 200% in the cost of a physiotherapy session (25 to 85) as against an NHS sessional rate of 20. Considerable price variation may occur in physiotherapy practices very close to each other and there can be huge differences in the number of sessions to treat similar musculoskeletal problems. The number of sessions varied from one to 16 treatments.
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. - 14130
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in London, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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