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Letter to all consultant ophthalmologists and anaesthetists - proposed BUPA approved ophthalmology network

12 June 2006

Dear Doctor

We wrote to you on 25 May 2006 regarding the latest developments with BUPA Insurance Limited’s proposals to implement an approved ophthalmology network. We informed you that BUPA Insurance Limited had agreed to extend their deadline for the completion of the quality assessment document, until the 19 June, and that they had agreed to engage in further discussions with us. We advised you not to complete, or allow your name to be included in, any of the documents until these discussions had concluded.

The British Medical Association, Royal College of Ophthalmologists, Association of Ophthalmologists, United Kingdom and Ireland Society of Cataract and Refractive Surgeons, Association of Anaesthetists of Great Britain and Ireland, the Federation of Independent Practitioner Organisations, British Ophthalmic Anaesthesia Society, and the Independent Doctors Forum have now held discussions with BUPA to express our shared concerns. Unfortunately, BUPA Insurance Limited has decided not to withdraw the network at this moment but have suggested further talks with the implication that they may reconsider their position if the profession is able to further develop the quality assurance and cost effective practise proposals that we have put to them. Set out below are our concerns with the initiative:

• The accreditation of consultants is the role of the Royal Medical Colleges, Post-Graduate Deaneries and the GMC, and not that of a medical insurer.
• Private medical insurers should not be regulating healthcare facilities, which is the remit of the Healthcare Commission.
• Quality guidelines are drawn up by the profession and Royal Medical Colleges. The quality criteria documents that form part of BUPA Insurance Limited’s ophthalmology network procedure have misrepresented guidelines issued by the Royal College of Ophthalmologists.
• Audit assessment of consultants is a local hospital governance issue, and not the remit of a medical insurer.
• The network is detrimental to patient choice, as only a limited number of consultants will be BUPA Insurance Limited “approved” and it is likely that BUPA Insurance Limited members will be preferentially directed to ‘approved’ rather than ‘recognised’ consultants.
• The network may interfere with the existing doctor-patient relationships.
• The network could result in a reduction of fees paid to ophthalmologists and anaesthetists, as it is the overall cost of treatment that is assessed for BUPA ‘approval’. It is likely that private hospitals will offer ophthalmologists and anaesthetists a set fee for undertaking work. The network will therefore give hospital providers control over consultants.
• The contractual relationship has always been and should remain between the patient and their doctor and not between the insurance company and the doctor and the proposed network will interfere with this
• BUPA Insurance Limited has not consulted its members/subscribers about any of these restrictions to their policies.
• We have concerns that this initiative will be followed by similar networks in other clinical specialties and believe this misguided initiative should be terminated.
• Any decision to continue with this initiative would be against BUPA Insurance Limited’s stated intention to work in co-operation with consultants.

In light of these concerns, we would advise you not to take part in the initiative, and to write to BUPA to explain why. It is important that you do so, because BUPA Insurance Limited is saying that if you do not take part, they will derecognise you. Template letter A you may wish to send to BUPA is available above.

If you have already indicated to BUPA that you would be interested in the Network, we would advise you to withdraw. Template letter B which you may wish to send to BUPA is also available above.

We are sorry that so far we have been unable to persuade BUPA Insurance Limited not to go ahead with this network, but we are willing to work with BUPA to find an alternative solution to their expressed anxiety about quality assurance and cost effective practise. A robust united front by ophthalmologists and anaesthetists, and all other consultants in rejecting the proposal will defeat it. In the past BUPA Insurance Limited attempted to control hip and knee surgery, but this initiative was successfully defeated by the profession.

We will keep you informed of progress, and updated information will appear on the websites of the organisations set out below. The BMA has created a form for you to register your decision so a running total can be kept. Note - the form is no longer live.

Yours sincerely

Massoud Fouladi Tristan Reuser
Association Of Ophthalmologists

David Whitaker
Association Of Anaesthetists Of Great Britain And Ireland

Derek Machin/ Rhodri Daniel
British Medical Association

Tony Rubin
British Ophthalmic Anaesthesia Society

Geoffrey Glazer
Federation Of Independent Practitioner Organisations

Patricia Wilson
London Consultants’ Association

Paul Rosen
Uk & Ireland Society Of Cataract And Refractive Surgeons

Kevin Harrington
Independent Doctors Forum

Copied To:

Royal College Of Ophthalmologists
Royal College of Anaesthetists
All Speciality Associations