News - Latest and Archived
'Managing Conflicts of Interest in the NHS' – September 2016
NHS England has recently announced a consultation process for 'Managing Conflicts of Interest in the NHS' the document explaining this matter can be accessed here: Managing Conflicts of Interest in the NHS
There are some conflicts of interest that may arise and affect the profession and FIPO has no objection to the process of reviewing and increasing transparency in these areas. However, one specific issue involves private practice and it is proposed that all consultants who have private practice will be required to make public with whom private practice is conducted, the sessions conducted, an outline of their duties (specialism and common procedures) and their gross earnings in the previous twelve months divided into categories of less than £50K, less than £100K and more than £100K. FIPO will maintain that provided a consultant is working appropriately and correctly within their job description in the NHS that their private practice arrangements outside and within their own free time should not be subject to this type of analysis. It is difficult to understand exactly what conflict of interest there may be in this matter. The Royal College of Surgeons have also made a short statement and can be seen via the link below.Statement on Conflicts of Interest and Private Practice
You may give your views on this via the link below.Consultant Hub
FIPO – Economic Survey – June 2016
FIPO has launched a new economic survey for all consultants. More details can be found here
CMA Report – FIPO Appeal – August 2015
The FIPO Appeal at the Competition Appeal Tribunal (CAT) was rejected by a 2:1 majority. However, a further appeal is now being lodged at the Court of Appeal. The CMA will be defending their position.
For more details click here
CESP fined by the CMA – July 2015
CESP – The Consultant Eye Surgeon Partnership, an overarching group with over thirty LLPs of Ophthalmologist from around the UK in its membership was fined £500,000 for collusive activity amongst its membership of LLPs on fee structure. This fine was reduced to £385,500 by the CMA as CESP has cooperated positively with the authorities. The most recent announcement can be seen here here
The CMA investigation and non-confidential decision can be seen here
Bupa Insurance; Benefit Reductions and Open Referral May 2012
Bupa Insurance has engaged in a new strategy of "open referral" which means interference with the GP to consultant referral pathway. Rather than allow the patient's first choice of consultant as recommended or agreed with the GP, in many cases the patient will be offered the names of one or two alternative consultants by a Bupa administrator at pre-authorisation for treatment. This has been accompanied by cutbacks in reimbursements to patients for consultant fees. This has implications for patient choice and continuity of care.
Revalidation and Appraisal in the Independent Sector (May 2012)
Revalidation is proceeding with the first tranche of about twenty per cent of doctors expected to go through the process by the early part of 2013. FIPO is primarily concerned with consultants working in independent hospitals. Responsible Officers have been appointed in these hospitals and are trying to identify those consultants without any NHS affiliation for whom they are responsible directly. The majority of consultants also work in the NHS and so will report to their Trust Responsible Officer.
FIPO has set up a sub-group FIPO Consultant Appraisal Services (FIPO-CAppS) to provide appraisals for independent consultants and has been working with the London Consultants' Association which had an established system to update the appraisals in the light of new regulations. FIPO-CAppS has provided TOP-Up training to appraisers and has published a detailed pilot study in order to quality assure the process.
Competition Commission Market Study in to the Independent Healthcare Market (April 2012)
The Office of Fair Trading has reported on its findings with its final report in April 2012. It has recommended a Competition Commission Market Investigation having found a number of issues in the independent healthcare sector.
AXA-PPP - Fixed Fee Schedule for Established Consultants (March 2010)
AXA-PPP have written to a large number of established consultants suggesting that these consultants comply with a new fixed fee schedule similar, if not identical, to the fixed fee schedule imposed on newly appointed consultants since 2008. There are considerable implications in this for patients and consultants...
A Press Release from HMRC over Non-Compliant Consultants (January 2010)
HMRC have asked FIPO to publicise this press release about tax non compliance...
Consultant Information to Patients about Medical Insurance - FSA Rules and FIPO Guidelines - November 2009
Revalidation in the Independent Sector (November 2009)
The whole process of revalidation for the medical profession is now the subject of many publications and article emanating from the GMC, the DoH, the Royal Colleges and various other bodies.
The manner in which revalidation will be implemented for consultants in the acute independent sector is currently unclear and there are a number of specific issues and challenges that lie ahead.
Tax Relief on Cars for Consultants in the Independent Sector - November 2009
Her Majesty’s Revenue and Customs (HMRC) have started to enquire about tax relief claimed by consultants for car usage in private practice...
Cooperation and Competition Panel (October 2009)
The CCP has reported on consultants' use of their non-contracted hours for other work
BUPA and PPP Ophthalmology Tender (May 2009)
Ophthalmology Update - May 2009
Managed Care and Update – March 2009
A recent review in Healthcare Market News summarises the situation...
BUPA tries to corral physiotherapists – March 2009
BUPA Insurance is trying to network independent physiotherapists...
Managed Care, an update (March 2009)
A recent article in Healthcare Market News (HMN) is reproduced here with the permission of the editor. This article gives a reasonable summary of the present position. Some parts seem confusing; for example BUPA Insurance denies in this article that it is approaching orthopaedic surgeons for a review of services whilst in the subsequent April edition of HMN there is a report that such an approach is being made to orthopaedic surgeons along with the BUPA review of physiotherapy services.
BUPA tries to corral physiotherapists (March 2009)
BUPA Insurance has recently written to all its physiotherapy providers in the independent sector asking for detailed returns of information both personal and professional in what is called a quality exercise. Thereafter it is BUPA’s intention to set up a preferred provider network based on price. No doubt many physiotherapy groups will be excluded...
BMI and Nuffield Health cut radiologists fees - February 2009
BMI and Nuffield hospitals have simultaneously announced a cut back in radiologists fees...
FIPO Newsletter (September 2008)
This Newsletter from FIPO covers a number of issues and can be accessed here...
BUPA Insurance & Orthopaedics Update - August 2008
BUPA Insurance is now making moves in to orthopaedic surgery...
CQC Manifesto (August 2008)
The Care Quality Commission (CQC) has issued its Manifesto...
New Insurance Fraud Group - July 2008
A new database has been set up by the private medical insurers to detect cases of potential fraud...
AXA PPP New Terms and Conditions for Consultants - July 2008
For the first time recognition by an insurer has been linked to a fixed fee schedule. AXA PPP’s new schedule and Terms and Conditions interfere with the contract between patient and consultant...
BUPA Insurance Purchases the Cromwell Hospital (March 2008)
BUPA insurance has announced its intention to purchase the Cromwell Hospital...
FIPO Charter for Doctors and Patients (December 2007)
BUPA Insurance and Orthopaedics (December 2007)
In August 2007 BUPA Insurance sent out a request for information (RFI) to a certain number of orthopaedic consultants. This RFI was a detailed document which involved information about each consultant’s personal, professional, academic and financial background.
BUPA Hospitals Sold (June 2007)
The BUPA Hospital Group has now been sold to a private equity group Cinven for £1.44 billion. Details can be seen here...
BUPA Insurance Initiatives and Approved Ophthalmology Network (June 2006)
There has been some concern for several months about the strategy being employed by BUPA Insurance. Some of the professional anxieties were expressed in the News item below (BUPA Insurance Initiatives - March 2006). Since then BUPA Insurance has come out with its detailed plans for an “Approved Ophthalmology Network” and consultants and hospitals have had very little time to consider this in depth.
BUPA Insurance Initiatives (March 2006)
The major news in the Independent Sector is the new strategy by BUPA Insurance of which is encompassed in its “ BUPA Insurance Initiatives”. If fully implemented these would lead, in the opinion of many, to a Managed Care scenario in the Independent Sector and a complete change in the whole philosophy of private practice for patients and doctors. Further information can be found here:
FIPO Council Meeting
8th February 2006 in the Cabinet War Rooms and Churchill Museum, London. Over 50 consultants from MACs and specialist organisations attended this Council meeting. Reports on this meeting have been circulated to subscribing members. There was considerable concern expressed about developments in private practice in relation to initiatives by BUPA Insurance. The meeting resolved to promote the quality agenda via a FIPO Clinical Governance Advisory Committee (FIPO CGAC). The new BUPA Insurance re-registration contract for consultants was rejected by a unanimous vote. The BMA has been asked to try and renegotiate this.
The FIPO Board 2006
The FIPO Board has been modified with an expanded group to take account of the increased membership of FIPO. Both the Association of Surgeons of Great Britain and Ireland and Society of British Neurological Surgeons have agreed to join FIPO and will propose a representative to sit on the FIPO Board. The current Board and supporting organisations can be seen here:
Guidelines for MAC Chairmen
FIPO has now produced Guidelines for MAC Chairmen...
Consultant Income and Expenses (October 2005)
Although the recent Laing and Buisson survey shows that private medical insurance subscriptions are being maintained this year this is not reflected by the experience of many consultants as many around the UK have noted a decline in their private practice. Mr Derek Machin (FIPO Board member and Chairman of the Private Practice Committee of the BMA) confirmed this when he spoke at the Laing and Buisson conference in October. The results of this years BMA review of consultant fees and expenses has revealed that average income fell and expenses rose. Mostly the rise in expenses was due to medical indemnity and so the UK experience is following that in the USA where medical insurance and Medicare reimbursements are falling and medical indemnification costs are rising. This has forced many specialists in high-risk areas of surgery to abandon practice all together.
FIPO Annual Report and Economic Review January 2005
The FIPO Board circulated to its members and to MAC Chairmen an annual report and a detailed current economic review of independent healthcare. Accurate data was only available from recognised sources up to the end of 2003 in terms of the whole market. The rate of growth was seemingly slowing according to Laing and Buisson. The impact of ISTC’s and other treatment centres has yet to show on the private sector in terms of self pay patients but a fall off is anticipated. This might be countered by an increasing volume of NHS contract work around the country with less in London.
Private medical Insurance companies report substantial profits in the last year as a result of strict cost controls, increasing hospital and clinical efficiencies and higher premiums. The corporate market would seem to be holding up but it is unclear if there is any growth in the overall numbers insured.
London hospitals seem to be maintaining an adequate patient flow due to the relatively affluent population, the concentration of medical expertise and the overseas market. Whilst this may apply to other major cities there is a hint of a fall in overall private practice around the UK.
One recurring theme is the fact that those independent hospitals who are engaging in large volumes of NHS contract work are deterring consultants who have found difficulty in gaining access for their private patients. Rumours abound about the commercial logic of this NHS contract work that many say has been accepted at very low unprofitable and unsustainable rates. Some groups are suggesting consultant fees at as low as 20% of BUPA Insurance rates in an attempt to mitigate losses. Consultants who take on this work should do so in the knowledge that this makes a mockery of their professional status and places them on a hourly rate that would be unacceptable to any self respecting artisan.
NERA report – update JULY 2004
Although quoted periodically in the national press, the NERA report, which suggested that British Consultants are paid more than their contemporaries aboard, has now been refuted. In a detailed economic analysis produced by the British Medical Association (BMA) Health Policy and Economic Research Unit it is been pointed out that the systems of healthcare in the overseas areas chosen by the NERA researchers were inappropriate. Essentially the NERA report is comparing apples with oranges and quite apart from the differences in general prices, taxation and economies it is inappropriate to compare consultants’ earnings in a nationalised or government sponsored healthcare system with those in a fee paying service.
FIPO has always stated that consultants should charge fair and reasonable fees but has not been alone in pointing out that patients’ insurance reimbursements for consultant fees have remained virtually frozen over the last 10 to 12 years despite rising premiums and hospital prices. It is true to say that some reimbursements for more complex and less common procedures have been increased, although it has to be made clear that consultant’s fees are not set by insurance companies.
The advent of the National Tariff and the increased opportunities for NHS contract work in the independent sector may exert downward pressure on fees and at the moment the extent of this is difficult to predict. There is evidence from the MORI poll commissioned by FIPO that expenses of private practice are rising (click here for MORI Poll results).
In addition, some established accountants dealing with medical practitioners have alluded to rising expenses in the medical press. The broad economic circumstances faced by consultants in the independent sector has been summarised in two short reviews by two leading accountants and can be found here:
Private practice – the future JULY 2004
Consultants and others will have noted a series of articles in the Financial Times, the Times and other newspapers which have suggested that the advent of ISTCs and foreign contractors will lead to a collapse of private practice. There seems no doubt that independent practice in the UK may face a downturn as a consequence of these Government sponsored changes. On the other hand, there may be opportunities for NHS work to be contracted out as noted in recent Government statements. Many consultants, including the FIPO Board, are concerned about the destabilising effects of these transactions on NHS Trusts and the implications for training.
At the present time there is still confusion and doubt about which new ISTC providers have actually signed off their contracts with the DoH and whether or not it is going to be possible to obtain and sustain the services of the foreign teams of doctors and nurses that these centres will require. It may be that there will have to be a breach of the DoH “Additionality” clause (which essentially bans UK consultants with an NHS commitment to have any dealings with an ISTC). If so this would certainly irritate those UK providers who made unsuccessful bids for ISTCs based on a UK consultant workforce.
Some have predicted that self-pay patients in the independent sector (which in some areas reached as high as 30%) will entirely disappear and that the private (and to a lesser extent the corporate) insured market could reduce by as much as 50%. However reliable or accurate predictions at the moment are virtually impossible to make and as yet (July 2004) very few patients have been treated in ISTCs.
Consultants’ reactions around the country have depended to a large extent on their speciality and their local opportunities for independent practice. Some areas such as central London may be buffered to some extent from these winds of change.
Independent Healthcare Forum (IHF) launches May 2004
The IHF came into being to replace the old Independent Healthcare Association (IHA) with an inaugural meeting on 17 May 2004. Several industry speakers presented at the meeting and a programme for the organisation was announced. Although some hospital provider groups have not joined (Nuffield and certain individual independent hospitals) the new group’s philosophy would appear to be one concentrating on operational policy such as complaints procedures, consultation with the Healthcare Commission and consultant validation etc. Much of this continues work undertaken by the IHA. It is not intended for the IHF to have a political agenda or strategy.
Hospital Provider Activity – dramatic changes continue July 2004
The announcement by the Nuffield Group that it was changing its position in the market and looking to contract more with the NHS has been followed by other providers. Capio, like the Nuffield, has now signed up for a large orthopaedic contract with the NHS at prices which some other providers believe are not sustainable. It is unclear which doctors will actually perform this contract work and even some private groups of consultants are shy of contracting at these rates.
BUPA Insurance has also made a surprise move with an announcement on 11 June 2004 that, not only would it be selling 10 of its hospitals, but would also be looking for new lower priced contract work. Specific details of the type of work and the consultant or sub consultant grades who might be involved are still unclear. It is not known if new style “limited” medical insurance products are envisaged.
Some provider groups, in particular the BMI group with hospitals around the UK and the HCA group (with its mainly London base), are for the moment sticking at the upper end of the market with the traditional fee for service system.
BUPA Insurance Orthopaedic Preferred Provider proposals: update March 2004 with news of consultant orthopaedic questionnaire results
In 2003 BUPA Insurance sent out a consultation document about hip and knee joint replacement and revision surgery and hip resurfacing surgery. In this proposal BUPA Insurance argued that only surgeons performing a certain number of each procedure annually would be eligible for “recognition” by the company. In addition BUPA Insurance proposed some detailed care plans and some financial inducements for consultants who were selected and who adhered to these care plans. A series of road shows by BUPA Insurance have been conducted to discuss this proposal with the profession.
FIPO, in conjunction with the major orthopaedic professional organisations (British Orthopaedic Association, British Orthopaedic Trainees Association, British Association for Surgery of the Knee, British Hip Society and Orthopaedic Sub-Committee of the BMA) met to discuss this issue. All were agreed that cost effective and carefully controlled surgery with considered professional audits were appropriate. However, there was no evidence whatsoever that the arbitrary numbers chosen by BUPA Insurance would in any way reflect quality of care. There are fundamental objections to an insurer developing a preferred provider list of consultants and acting as a quasi-regulator. There were also other reasons for rejecting the BUPA Insurance proposal which included the impact on training of registrars, the ethics of the financial inducements and the fact that many competent academic or female surgeons, or indeed others for various reasons, would be excluded from recognition.
Orthopaedic Consultant Questionnaire
In the light of the BUPA Insurance proposals, FIPO in conjunction with BOA, BASK and BOTA sent out a questionnaire to 1,700 orthopaedic consultants throughout the UK. There was an overwhelming response of 858 consultants representing 50 % of all orthopaedic surgeons. A fuller analysis of the questionnaire results will be made available in due course. A preliminary report has been published in the British Orthopaedic News. In this report it was noted that 88% of consultants believed the BUPA Insurance proposal was driven primarily by financial consideration and 18 % believe it driven by quality. A large number of surgeons would have been disenfranchised by the BUPA Insurance proposals with a particularly heavy cut back in those “recognised” for hip or knee revision and hip resurfacing. The profession was clear in its support for professionally led audits and outcome studies based on BOA and other professional guidelines.
It was also evident that very few consultants had attended a BUPA Insurance road show, and of these only 25 % were convinced by the BUPA Insurance arguments. Discussions have since taken place with BUPA Insurance who have issued a revised consultation document. This has moved closer to the professional views about training but nevertheless the profession remains opposed to any suggestion that insurance companies should regulate or recognise consultants.
Independent Sector Treatment Centres (ISTCs), March 2004
The Department of Health (DoH) recently announced that a group of ten ISTCs referred to as the “spine chain” in central and northern England has been awarded to Capio UK the independent group. Mercury, and its parent company Tribal, were awarded only five new ITCs in the South East. There appears to have been some change in the terms of the contract and the type of work that the DoH was wishing to commission and with a shift to more inpatient procedures.
There still remains some confusion over the volumes of work that will be carried out in each of the ISTCs although the DoH has stated that 250,000 extra procedures will be carried out in both NHS and independent centres by the end of next year.
The Secretary of State, Dr John Reid, speaking on the BBC Radio 4 Today programme stated earlier this year that 15 % of NHS funded operations would be contracted out to private providers “within our lifetime”. He saw a progressive from 5 to 10 % to reach maximum of 15 % at some unspecified future date.
The Government can expect opposition from within its ranks to its contracting out policy. The Times of Monday 22nd March 2004 reported David Hinchliffe, the Chairman of the Health Select Committee, as stating “scarce resources should be invested in the NHS where they can benefit more patients rather than providing profits for the private sector”.
NHS tariff prices, March 2004
The new NHS tariffs which have set fixed prices for almost 30 surgical procedures have been announced. It would seem that private sector costs for common operations are some 40 % higher. The Times reported a hip replacement costing on average £4,660 in the NHS but £6,848 privately. Leading hospital providers have challenged the discrepancies because the NHS tariff does not include VAT on drugs and prostheses, pensions and centrally funded capital and other development programmes. The fact that consultants are salaried in the NHS and working to a fee for service in the private sector will also affect costs. Many operations in the NHS are also performed by non consultant grades.
The NHS tariffs will gradually provide a method for comparing costs across this whole healthcare sector, whether or not they will impact on NHS work contracted to the private sector remains debatable. Much would depend on the spot contract rates and whether or not the NHS believes that it can secure good value for money.
The mixed economy of healthcare means that consultants will have to consider carefully reimbursement rates for various procedures.
Independent Healthcare Association, Jan 2004
The IHA comprises several divisions’ namely acute hospitals, long term care and mental healthcare. Founded in its current form in 1991, it was the mouthpiece for the independent hospitals. All the major independent hospital groups supported the IHA financially and met regularly to discuss policy and strategy.
There was some surprise therefore that an announcement was made in December 2003 that the acute healthcare division was to be disbanded from 1st January 2004. Chief Executive, Barry Hassell has announced his resignation. It remains to be seen what if any organisation will replace the IHA acute division.
Consultant Questionnaire On Private Practice, Jan 2004
An analysis of just fewer than 100 of the first responses from the consultant questionnaire in the UK shows some interesting trends. Practice expenses are rising for several reasons but one predominate feature is the rise in Medical Indemnity Insurance. The majority of consultants still charge according to insurance reimbursement rates but it is apparent that some patients will be facing shortfalls for consultants’ fees due to the rise in practice expenses and with the freeze on insurance reimbursements.
In terms of chambers, approximately 25% of consultants were working in a group, the majority in an informal arrangement. A further 50% of consultants are contemplating some chambers arrangements in the future. The consultants’ views about private medical insurance companies do show some variation between the four companies selected. However, because it may be considered that the consultants who returned the forms were self selected and thus that the results may be biased, FIPO has commissioned a MORI poll of consultants’ views. This MORI poll will be a telephone inquiry with consultants selected entirely by MORI. The results of the MORI poll will be published at a later stage. If you are contacted then do please help with this survey which should take no more than 10 - 15 minutes. There will be a donation of £25 paid to St John’s Hospice in London for every completed telephone interview.
2003 News Archive
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