BUPA Insurance Ltd : Ophthalmology Approved Network
Comments from consultants and letters to BUPA
We are trying to gauge your opinions. If you have any questions, comments or copies of letters sent to BUPA or elsewhere about the proposed network for Ophthalmology then please email these to FIPO at firstname.lastname@example.org. Please let us know clearly if these are for publication on this website. All data will be anonymised and no one will be identified.
Letters and Comments received so far
Letter sent by representatives of Moorfields Eye Hospital to BUPA...
15 June 2006
Dear Miss Gooding,
Re. BUPA Approved Ophthalmology Network
We are writing on behalf of Moorfields Eye Hospital NHS Trust and the Consultant Staff at Moorfields. We understand that you are currently taking part in talks with the Royal College of Ophthalmologists and the British Medical Association, on several issues related to the proposed network. We are aware that many other providers and professional groups have expressed concerns about the proposal, and we share those concerns.
It should be absolutely clear that we want to continue to treat all patients at Moorfields, whether clients of BUPA or not, and therefore would wish to retain recognition by BUPA; not only for our facility, but also for all our Consultant Ophthalmologists and Anaesthetists.
We have decided not to pursue the current application process, pending the outcome of your discussions with the BMA and the Royal College. We would wish to engage in a constructive dialogue with BUPA once these have concluded.
Thank you for helping to organize this response, along with the BMA, RCOphth, AOO etc. When BUPA announced this initiative, I felt a deep unease and assumed that there would be a widespread rejection from the profession. It has taken a few weeks for this to happen, but the response thankfully now seems unanimous. I was interested to see that even today (13th June), BUPA sent me another email, part of which read as follows.
“We also wish to reiterate that any hospital or consultant that does not submit their documentation by 19th June will be signalling that they no longer wish to treat BUPA members and BUPA will suspend their recognition for ophthalmology once the Approved Network is launched.”
I think that this communication from BUPA was remarkably (and unnecessarily) aggressive, given the recent statements from all the major organizations over the past few days.
This email was sent to BUPA after the consultant received an email from BUPA that claimed that it was not their intention to interfere with consultant independence or fee charging.
Unfortunately you do not seem to have addressed the concerns I have raised. As you say the vast majority of consultants will agree that there should be good quality work done in the private sector. I strongly suspect that most, if not all, believe that this is what they already provide. That there should be suitable vehicles for audit in place few would complain of; however what we do not think appropriate is that this is done in any way by an insurance company. Many of the things I would regard as part of quality cataract surgery, for example correction of astigmatism and use of multi-focal lenses, you do not currently pay for any way.
In relation to the matter of independence and fee setting, you say that there will be no change. Presumably you mean for those that you choose to "recognise" rather than those who are "approved". The price of independence and therefore recognition will mean only being able to see a very small proportion of BUPA patients. I understand that this status of recognition will disappear within a short time to leave only those "approved" who will be inextricably tied to BUPA. They thereby will have lost their independence, as the accolade of "approval" will necessitate an agreement with BUPA and the "team" which will control fees.
Apart from improving the financial position for BUPA and increasing your very substantial profits, I do not see in what way we, as members of the medical profession, will gain in any way. The reimbursement for cataract surgery for example has not been increased for 13 years. At current prices this makes it worth £200 at 1993 prices. That some of us have felt the need to put up our fees reflects the fact that in the real world most costs go up year on year. I have never heard of rents going down and mine in London are going up by 50% this year. I would be very interested to hear your comments on the further points I have raised.
This email was sent to BUPA by a hospital provider.
Dear Mr Hardman,
Thank you for your email. I'm afraid that I have to tell you that I cannot accept that BUPA is acting in good faith over the issue of quality versus price in this matter. It is clear also that BUPA is no longer taking medical advice and appears to be keen to repudiate its founding principles, as outlined on its own website:
" BUPA began... in 1947 to preserve freedom of choice in health care. It believed that with a National Health Service being introduced a year later, there would still be a need for a complementary service enabling people from all walks of life to afford the benefits of choice on where, when and by whom they are treated."
Insofar as you have not spelled out to your subscribers the implications of this proposed network, any more than you did in the case of the MRI one, it is clear that BUPA is once more seeking to mislead its subscribers. I think that you ought to know that there is a very wide perception amongst providers that BUPA is being intentionally deceptive to subscribers, consultants and hospitals.
Under these circumstances, it is wholly to be expected that our Ophthalmologists are opposed to BUPA's Ophthalmology network proposal. BUPA has no standing in the monitoring or the regulation of quality. Eleven professional bodies have stated their opposition to what BUPA is seeking to do. BUPA's professed aims are to maintain quality and to contain premiums; these objectives could readily be achieved by the setting of maxima in reimbursement ( and allowing patients to "top-up") and ensuring that the HCC recommendations are met. Nothing else is required.
This Hospital will not be putting in a submission for all these reasons.