The healthcare market in the UK is changing!

Although the idea of networks and bidding for work began in the NHS, the private sector is now also moving in that direction.
Both BUPA and AXA-PPP have begun to introduce restrictive networks initially with MRI and oral surgery but over the last year in ophthalmology.  Although BUPA had initially tried to impose a quality review followed by a value review this has largely been rejected.  It was recognised almost immediately that the quality approach was a smokescreen and inappropriate for an FSA regulated insurer. The “value” stage and the need for tenders with hospitals has also largely been rejected. The main reason for this is the effect on patient choice of consultant being taken from the patient and the GP.  The insurers and administration at “network” hospitals taking over this role. At the same time the reimbursement paid to patients for our services and their hospital stay was being substantially cut leaving them with the likelihood of shortfalls. All this being done during the term of their policies without adequate notification or reduction in premia to reflect the reduced nature of the policy.  If the networks in ophthalmology are successfully introduced other specialities will be similarly affected and private medicine in this country will forever be changed and very likely for the worse. 

BUPA approach. The AOO is fundamentally opposed to the approach BUPA have taken in relation to ophthalmic networks as outlined above. We feel that such networks are not in the best interests of patients because of their restrictive nature as far as choice of consultant and hospital and continuity of care are concerned. BUPA have largely alienated the ophthalmic community by their assumption of a role as arbiters of quality and the lack of openness to patients. The AOO is working closely with FIPO (the Federation of Independent Practitioner Organisations) to develop quality audits for cataract surgery as part of our efforts to assess and monitor standards. As BUPA continue to attempt to roll out their networks it is for each individual ophthalmologist to make up her or his own mind whether to join the proposed networks or not.

AXA PPP approach. AXA PPP have chosen a totally different approach. They have purposely excluded consultants from any discussions. In their networks patients as in those of BUPA get referred directly to a hospital. A hospital employee will then decide on a cab rank basis who the patient will see. This is rather like choose and book and will undoubtedly lead to as many inappropriate referrals as in the NHS. One wonders whether patients who pay-directly or indirectly through their employer-a hefty amount for their insurance, should be restricted in their choice. Most patients will not discover that their policy has changed until the time comes to exercise it. The AXA PPP networks will, as with BUPA,  interfere with the doctor patient relationship and distort referral patterns to such an extent that AOO members will have to think carefully if that is the way they would like to proceed.

BUPA hospitals. BUPA hospitals are introducing a centralised appointments system. This means that any appointments at their hospitals can only be made through a call centre, based in Manchester. Referrals will if possible be directed only to network members from the call centre, not necessarily in the patient's best interest or to the doctor they had wanted. This is done on the basis that "patients will be given the earliest appointment possible", no matter who with. Individually you must decide whether you wish to receive referrals in this way or insist, as the insurers are supposed to, that the GP should be the gate keeper and only recognise named referrals by that route.