British Association of Otorhinolaryngologists - Head and Neck Surgeons
Royal Society of Medicine, 3rd May 2001

The British Association of Otorhinolaryngologists - Head and Neck Surgeons devoted a whole day to the issues of private practice at the Royal Society of Medicine in London on the 3rd May 2001. This was an interesting day with a variety of talks and presentations, which exposed some of the difficulties prevailing in private practice. The first speaker Dr. Tim Evans PhD, Executive Director of Public Affairs of the Independent Healthcare Association, spoke about the history of private practice in the UK and looked at the macroeconomics of taxation and government expenditure. Following this Mr. Geoffrey Glazer, Chairman of the London Consultants' Association and the Federation of Independent Practitioner Organisations spoke of FIPO, a new organisation and discussed some issues relating to private practice. He was clear to point out the problems of Managed Care and the dangers being posed to the independence of consultants.

A debate followed entitled "This House believes we should all withdraw from the BUPA Insurance Partnership". There was a vote of those attending the meeting in favour of withdrawal from the BUPA Insurance Partnership. For this to become official Association policy however would require a ballot of all members. The BAO-HNS had initially advised members not to join the Partnership but after considerable thought removed the objection and advised those members who wished to join, to do so en masse. It is unclear what percentage of ENT surgeons, or indeed other consultants, are in the Partnership but the general consensus was that the rewards were small and there was extreme difficulty in obtaining payments and bonuses as laid out in the BUPA Insurance Partnership agreement.

In the afternoon there were presentations by Mr. Mike Hughes, CEO of the Nuffield Hospital Group, Mr. Julian Stainton, CEO of WPA, Dr. Natalie MacDonald of BUPA Insurance and Dr. Adrian Bull of PPP.

Mr. Hughes of the Nuffield Group gave a short review of the provider issues. Mr. Julian Stainton of the WPA held strongly to the care, consideration and quality issues in private practice. He felt that new insurance products would be necessary and also a change in attitude on the part of the patient, who have to recognise that insurance refunds were a contribution to fees and that they might well be responsible for more excess payments and shortfalls in the future.

Dr. Natalie MacDonald, from BUPA Insurance, spoke on the RVR exercise, which she said would be implemented in some months time. No details of costs were given but she did state that RVRs might become the yardstick for fee charging. Whether this is strictly legal is another question but the overall impression was that BUPA Insurance were trying to control fees and all aspects of patient care as opposed to the rather more freewheeling and liberal WPA approach.

Dr. Adrian Bull came under some attack because of the current inefficiencies in PPP with payments and he apologised for these. He again stuck to the PPP line of "usual and customary" which on the face of it sounds reasonable but there are considerable difficulties in the application. He stated that PPP would not budge from their stance that radiology and pathology fees should be negotiated by the consultants with the hospitals and this is clearly going to be an issue for further negotiation.

In discussion there was evident frustration expressed from the audience about the insurers' stance. Mr Glazer pointed out that the philosophy of the insurers are quite different with WPA holding to a line of consultant independence and choice on one side and then the BUPA Insurance Partnership and Managed Care scenario at the other end of the spectrum with its objective of trying to control all aspects of consultant practice. This is clearly something that the profession needs to consider with the insurers.

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