Extracts from Issue Two of the LCA Newsletter, March 2000

PPP Good News
Following complaints from members about PPP's failure to approve payments for second or third consultants providing additional specialist opinions or care to inpatients, the LCA took this matter up with Dr Adrian Bull. We have obtained agreement that inpatients who require further secondary specialist treatment will receive reimbursement from PPP for consultant's fees. The insurance company is keen to promote pre-authorisation and has voiced commitment to improving their Helpline during working hours. They accept that out of hours emergencies will have to receive retrospective authorisation. The LCA believes that justified referrals to specialist colleagues is an essential aspect of good practice and is pleased that this matter has been resolved.

PPP New Difficulties

Cardiac Surgery
A very recent problem brought to our attention is the fact that PPP are now not routinely intending to reimburse patients for their cardiologist's fees when they undergo cardiac surgery. Cardiologists will be expected to share the operative fee reimbursement with the surgeon. The LCA would like to discuss this at the AGM on 14th March and in the interim we would like to hear what is considered normal practice during and after cardiac surgery. Please send us your views before the meeting.

Post operative Consultations
We have also received copies of letters to several members informing them that, "PPP healthcare considers that the fee for an operation should include all the usual pre- and post-operative care for that procedure and management of common complications". In effect PPP are refusing to reimburse patients for follow up consultation fees after operations, something that they honoured previously. The LCA believes that this amounts to a "bundling" of fees. The matter is particularly serious because PPP are telling patients not to pay any shortfall to the consultant. Whilst we agree that routine in-patient care after surgery is part of the operative fee, the LCA have informed PPP that consultants are fully entitled to charge a proper fee for any consultation whether emergency or not and whether pre-operative or a post-operative follow up. We will be advising our members to take this line, probably under some general LCA umbrella action that will be discussed at the AGM. The LCA continues to challenge PPP and we are taking advice on what further steps can be taken.

Consultants pressure in Guildford
There has been some good news recently from Guildford where the MAC Chairman of the two private hospitals which had been asked by PPP to tender for a place in their network, joined together to protest with the support of all their colleagues. Their actions forced PPP into a climb-down and now both hospitals are included in the network. Such examples of cohesive, concerted action prove that the voices of consultants do count and can make a difference.

The BUPA Insurance Hysterectomy Issue
You may well be aware that all gynaecologists received a letter from BUPA Insurance which states that all consultants must obtain permission from the insurance company before proceeding with hysterectomy for patients. The issue is a vital one for the future independence of consultant practice, not just for gynaecology but for all specialties. BUPA Insurance is now extending this process of clinical preauthorisation to other procedures, such as wisdom teeth extraction, with the next on the list likely to be ENT surgery and grommet insertion.

The LCA is working to co-ordinate the action of gynaecologists and ENT surgeons so that no individual need feel threatened by BUPA Insurance. We have circulated all consultants in both specialties in London seeking their views and support. The response has been extremely encouraging with over 100 gynaecologists pledging support. We have taken this matter forward to BUPA Insurance and have reiterated that the LCA consultants will adhere to accepted guidelines and governance (and be prepared to audit indications within a professional grouping) but do not accept any insurance companies' interference with the normal doctor/patient clinical relationship.

We await their response...

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