OFT Inquiries into Medical "Chambers & Partnerships"

The Office of Fair Trading (OFT) has received a complaint from an unknown source that certain anaesthetic groups around the country are allegedly setting fees for their services in breach of the Competition Act. This matter has been reported in the national press.

The reports in the Financial Times also quote Dr Adrian Bull of PPP whose argument is that the patient is "under duress" when the anaesthetist visits pre-operatively because they have no way of making a free choice of their own anaesthetist.

It is obvious that anaesthetists are often called upon in emergency situations and that PPP's concept of a patient asking for several different consultants to visit before making a decision (presumably based on price) would be impractical and quite contrary to good clinical practice. The fact that surgeons work with specialist anaesthetists and within regular teams is, of course, part of good clinical practice and this arrangement should not be disrupted.

These points were made in a letter published in the Financial Times (click here) by Geoffrey Glazer, Chairman of the Board FIPO, Derek Machin, Chairman of the BMA Private Practice Committee and John Wedley, Chairman of the Independent Practice Committee of the Association of Anaesthetists (all three directors of the Federation of Independent Practitioner Organisations).

A side issue to this whole dispute was the allegation that anaesthetists are requesting parity of fees with surgeons in the private sector. This has been denied by Dr John Wedley, Chairman of the Independent Practice Committee of the Association of Anaesthetists who has issued the following statement.

All Consultants in the NHS are paid the same. The situation in Private Practice has always been different. As anaesthesia has developed there has been an approximation of fees and in recent years developments in post operative pain relief has increased the role of the anaesthetist. Current demands for preoperative assessment and consent for anaesthesia have lead to anaesthetic outpatient clinics in the NHS for major procedures. If the same standards are to be applied to the Private sector then anaesthetists will have to be able to see patients before major surgery, which will be reflected in the anaesthetic fee. This is an entirely separate issue and has been introduced into the present discussions about partnerships to drive a wedge between anaesthetists and their surgical colleagues. Unfortunately unguarded quotations from some anaesthetists have fed the media, even though they have been subsequently denied. It is the declared intention of certain sections of the Private Health Insurance industry to isolate anaesthetists from their surgical colleagues and drive them into employed status as they have done for radiologists and histopathologists. It is essential that all consultants realise the dangers involved. FIPO provides a unique protection against the tactics of the Insurance Industry to take control of the profession to the detriment of patient care, which is the overriding concern.

The final outcome of the OFT inquiry into the various groups of anaesthetists practising together is now sub judice. However, there are clearly advantages to such arrangements for doctors who can provide cover and specialist backup for our of hours surgery. Such arrangements are becoming known as "Doctors in Chambers" and the legal basis of doctors working in chambers or partnerships is clearly of interest to many consultants around the country. Such arrangements are commonplace in general practice and in other professions.

In order to clarify some of these issues the London Consultants' Association, in conjunction with the London Clinic who are sponsoring the event, will be holding a meeting at the King's Fund, Cavendish Square, London W1 on Thursday 25th April. The meeting will be devoted to the clinical, legal, financial issues and is intended members of the medical profession only. For further information click here

SUNDAY TIMES REPORT.

RELATIVE VALUES REVIEW

BUPA Insurance and other insurers reported to the Office of Fair Trading (OFT)

The Relative Values Review (RVR) carried out by BUPA Insurance and several other major insurers (apart from PPP) has been going on for 2 to 3 years and is discussed elsewhere on the LCA website (click here). The reasoning behind the review was the general acceptance that current fee reimbursements to patients for medical services are anomalous in many respects and of course have not changed substantially in the last 10 years. This review by Newchurch has not been implemented despite repeated requests from the consultants. The delay has been due to many factors.

However, there is now considerable doubt that this RVR will ever be implemented because PPP has reported the matter to the OFT claiming that this new fee structure would represent a national tariff or cartel. The matter is therefore under investigation. It remains to be seen if BUPA Insurance and the other insurers will make any interim offer to raise the patient's reimbursement for consultant fees whilst the OFT considers the position.

BUPA Insurance Shortfalling patients.

The failure of BUPA Insurance to satisfy patient's costs was reflected by a quote in the Sunday Times (27th January 2002) from Dr Natalie Jane Macdonald of BUPA Insurance who stated that 40% of BUPA Insurance patients are facing shortfalls on consultant fees. This figure strongly suggests that the BUPA Insurance remuneration for patients' medical fees has not keeping up with inflation, premium rises or hospital charges. All consultants regret shortfalls that patients may face and FIPO and the other medical organisations are doing their best to persuade BUPA Insurance to increase patient remuneration and thus reduce the incidence of shortfalls.

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