Nuffield Hospitals Announce A Change In Emphasis, Nov 2003
Chief Executive of Nuffield Hospital Group, Mr David Mobbs, announced on 12th November 2003 a change in profile for this chain of independent hospitals. He considers their not-for-profit status makes them “the acceptable face of private healthcare” and better placed to support the Government in the delivery of a genuinely mixed healthcare economy. Nuffield Hospitals believe that these changes would be placing the patient at the centre of healthcare delivery and would allow them to work towards a more accessible and affordable facility for the public.
An article in the Financial Times (18 November 2003) comments that Nuffield are looking at new patient systems (such as e-booking for cataracts) and are considering supporting consultants moves into “chambers “ from which Nuffield would buy their skills (possibly at lower rates than now). This is obviously something the profession needs to examine closely.
Consultant Fee Inquiry
– Are British Consultants overcharging?, Dec 2003
Nick Timmins of the Financial Times wrote on 29 December 2003 about consultant fees and comparisons between British and overseas medical charges. This article was based on a report from NERA (National Economic Research Associates) which had been commission by the Norwich Union Healthcare and the Financial Times. The report compared British consultant fees in the independent sector over a range of nine common procedures and compared these costs with Medicare in the US, Saskatchewan Health (Canada), Australia and a German insurance company (GOA). The report stated that British fees were higher on average between 22 and 59 per cent to the other countries surveyed. However, the authors of the report admit that the results have to be interpreted with caution.
Although it was made clear in the report that specialists in the UK and abroad have been affected in recent years by declining fee values (corrected for inflation) this did not stop this report being interpreted as showing that UK consultants are over-priced. FIPO has pointed out to the FT that such comparisons are meaningless unless placed carefully within the economic framework of each country and its healthcare system. Clearly overall salaries, taxation and workloads are considerations. Furthermore, the fact that the UK is supported by a National Health Service, where consultants work at relatively low rates, adds confusion to the whole debate.
DTC: FIPO Conference, October 2003
A major conference was held by FIPO on 7th October 2003 to discuss Diagnostic and Treatment Centres (DTCs - now called TCs or ISTCs, Independent Sector Treatment Centres) and their impact on the NHS, the independent sector and the profession. There was considerable concern about the potential implications for patients and the need for quality control and clinical governance. These ISTCs will open a third market that will affect independent practice in the UK for consultants and private hospitals.
Annual Laing and Buisson Conference, September 2003
The possibility of sub-consultant employment in BUPA Insurance hospitals and an attack on the profession for fraud by PPP were just some of the issues raised at the annual Laing and Buisson Acute Healthcare Conference.
Private Practice in the UK
There are many issues and problems facing patients and medical practitioners in the UK Independent Sector.
- The need to maintain the highest possible clinical standards and to serve the patients with probity, transparency and sensitivity
- The economic trends in the private medical industry
- The value for money patients anticipate in the private sector
- The increasing bureaucracy in healthcare delivery and the difficulties often faced by patient and doctor
- The pressures on consultants from the Government, the NHS, the insurers and from increasing regulations
- The specific limitations being placed on consultants in the private sector (Managed Care, loss of independence of practice and preferred provider lists) all of which may impact upon the quality of care given to patients
- The possibility of non-consultant grades being employed in the private sector and of some independent hospitals actually employing consultants thus restricting patient choice and possibly quality of care
- The advent of foreign managed Independent Sector Treatment Centres around the UK, many to be staffed by nurses and doctors from overseas will result in a major shift in the traditional consultant based service expected by British patients in the NHS and Independent sectors.
Consultant Contract Update... July 2003
Following further discussions with the new Secretary of State, Dr John Reid, about the NHS consultant contract the BMA negotiating team have brought new proposals back for discussion within the BMA and the profession at large. It remains to be seen exactly what effect the new proposals would have on the general consultant opinion.
With regard to the right to practice privately there have been some improvements, in the sense that new and established consultants will be treated equally, but all will be required to offer an extra session of four hours before being allowed to commence their private work.
Exactly how this will actually pan out is something of a mystery and much will depend on the interpretation and whims of the local NHS managers.
Some have questioned whether the new contract will in fact restrict private practice to an extent that some consultants will cease all independent work.
NHS contract issues and Department of Health Code of Conduct for private practice... June 2003
The NHS consultant contract issue has not been resolved and recent events suggest that the Government is trying to persuade NHS consultants to take up new contract by local arrangement. A dialogue with the BMA has not been re-established in any effective way and there seem to be no efforts to involve other professional bodies in what has become an intractable process. The new Secretary of State, Dr Reid may now be meeting with consultant leaders which would be a small step forward.
As part of the process of redefining contractual issues the DOH has published its document entitled “A Code of Conduct for Private Practice”.
This document has resulted in some adverse comments in the press but by-and-large, is reasonably fair and defines the actual status of NHS consultants viz a viz their private and NHS work. Clearly NHS contracted work must have priority but there is anxiety that some of the loosely written text will give local mangers increased license to involve themselves in their consultants’ private practice.
The consultant’s responsibility and actions in a clinical emergency (whether public or private) is another matter of concern. Whilst routine scheduling of private work during contracted NHS time is indefensible, the consultant must be free to decide on in an emergency on clinical priority where he/she should first direct his attention.
The manner in which consultants will be required now to report details of their private practice to NHS managers remains undefined and could give ammunition to some intrusive managers who may wish to go beyond a simple work schedule explanation and control the consultants private work. Overall however, it does give an opportunity for a rational balance to be worked through with sensible co-operation from both sides.
QBE Health and independent doctors... June 2003
An LCA member working entirely in the independent sector appealed to the LCA because QBE Health, a medical insurance company, had decided that any doctor working outside of the NHS would no longer be recognised by the company. Following discussion with the LCA the insurer has agreed to withdraw from this position. QBE fully accept that the new regulations under the National Care Standards Act are quite stringent in terms of consultant appraisal and reviews.
QBE have accepted that they do not themselves need to act as a “recognition body” and all consultants who are suitably appraised in the private sector will continue to be able to treat their patients.
Office of Fair Trading Rule on their inquiry into Anaesthetic Group Practices in the UK... May 2003
The Office of Fair Trading (OFT) has now completed their Inquiry into ten group Anaesthetic practices in the UK and found that there has been no infringement of competition law.
A statement on the OFT findings can be accessed here
A press release on the ruling from the Association of Anaesthetists
can be accessed here
FIPO has always argued that consultants should organise themselves in a manner best suited to deal with clinical matters. Clearly the provisions Competition Act must be adhered to and it has always been FIPO’s view that consultants working in partnerships or some form of Chambers can provide the framework for best practice. Clearly the result of the OFT Inquiry into a number of Anaesthetic groups has proved the legality of their actions and points the way for suitable models for other disciplines.
FIPO will be forming a sub group for consultants in chambers and for those complementing chambers, partnerships or similar working arrangements.
Consultants vote against the NHS contract... March 2003
As anticipated, the consultants in England rejected the NHS consultant contract (approximately 66 % against 33% for). There were regional differences with Scotland accepting the contract. The specialty breakdown of the vote is not clear nor is there more information on detailed geographical variations in consultant voting patterns.
Following the rejection of the contract the media have been adopting various approaches with some castigating consultants for their alleged intransigence and failure to accept their responsibilities. Others however have adopted a more moderate line noting that consultants have rejected pay increases in order to maintain professional autonomy.
The whole debate has engendered new interest in consultants' working practices in particular consultants in chambers and some commentators are beginning to suggest that substantial groups of doctors might leave the NHS in order to form chambers and contract for services. At the moment this seems an unlikely scenario and not one which is FIPO's policy. However, if a sub-consultant grade is introduced and the new NHS contract is imposed on new consultants, there is a danger of professional fragmentation and new types of working practices. There would also be an impact on the independent sector where a decline in the numbers of active consultants over the next few years would have a profound effect.
The interest in doctors in chambers is acute and this issue was discussed at a meeting on 19th November at the Royal Society of Medicine on this subject:
Relative Values Review and the Office of Fair Trading - Update August 2002
The Relative Value Review (RVR) was instigated by several major private medical insurance companies, with the help of members of the profession, some time ago. The purpose of this exercise, which was undertaken by Newchurch Ltd - a healthcare consultancy and information service (www.newchurch.co.uk), was to restructure the reimbursements to patients for consultant fees for various operative procedures and other treatments.
The concept was developed because it was recognised that some reimbursements were inappropriately funded and the changing practices and technology also required a rethink of the whole fee reimbursement system.
The RVRs published by Newchurch left many in the profession confused because there were still a number of inconsistencies. However, before the RVRs could be implemented in any guise, PPP (who were not part of the RVR process) reported the whole matter to the OFT (the Office of Fair Trading). PPP's claim was, we understand, that such a new fee structure would amount to some form of cartel as it was to be implemented by several insurers.
At the moment no official response has been made by the OFT although unofficial rumours suggest that they have rejected PPP's claim. BUPA Insurance are currently negotiating a limited number of increased fee reimbursements to certain specialty groups. Anaesthetists have agreed a number of procedures with increased fee reimbursements.
It is unclear what the overall impact of these increases of fee reimbursements will mean to different specialties but it remains the FIPO position that such reimbursements are made to the patient for consultant fees and any shortfalls remain the responsibility of the patient. FIPO reiterates its position on fees, which is that it does not condone excessive or unreasonable charges.
Healthcode and Electronic billing – Update August 2002
Healthcode is a company owned by several of the major insurers and hospital groups providing electronic billing facilities for private hospitals and consultants.
Electronic billing (EDI) may be seen as an efficient and inevitable advance but there have been some reservations expressed by members of the medical profession. These concern the question of patient confidentiality, sharing of professional information between insurers and the manner in which the consultant can maintain his/her direct contractual relationship with the patient.
Some discussions have taken place with the CEO of Healthcode, Mr Stephen Carroll, and further meetings and discussions are planned to try and resolve some of these questions.
Current Issues in the Private Medical Industry
The Private Medical Industry (PMI) is going through a major upheaval. The Care Standards Act, accepted and approved by FIPO, will affect the regulation of hospitals and other independent facilities.
Private medical insurance is changing with new policies, increasing demands on consultants and patients and a creeping bureaucracy. FIPO's stance will always be to maintain freedom of choice and clinical control over clinical decisions. Patients should be guided in their choice of consultant by their GP and should not be deterred from this choice by any outside interference.
Another trend in the independent healthcare market is the growth of self-pay patients. The reason for this is probably two-fold;
a) the unfortunate state of the NHS and;
b) the disinclination of some people to pay for medical insurance premiums.
As a consequence a number of package deals maybe found and patients should take note of some of the problems which can be encountered with these.
For patient information, whether insured or self-pay, please visit our Patient's area
A further role in the independent market is the breakdown of barriers between the NHS and the private sector. This has been promoted as the NHS/Private Concordat by the Government. Uptake on this has been patchy and the future unclear.
For further information on some of these topics see below:
- The NHS Contract Proposals
- The Care Standards Act - the regulation and accreditation of hospitals, including consultant standards
- The NHS/Private Concordat
- Private Medical Insurance - News and Views
- Health Select Committee Inquiry into the Role of the Private Sector in the NHS
- Consultants' Workload