Peer Raises Questions Over Private Medical Insurers - GP advice being ignored, says former chairman of GMC

The Government has been urged to look at restrictions some private medical insurers are imposing on their new policies that deny patients the advice of their GPs, and the impact this is going to have on healthcare in the UK.

Lord Walton of Detchant, former chairman of the General Medical Council, has tabled two parliamentary questions in the House of Lords. The first asks whether the Government has assessed “restrictions placed by BUPA and other private medical insurers on the choice of consultant or hospital to which insured patients can be referred, irrespective of the advice of their general practitioner, and their impact on healthcare in the United Kingdom”.

This follows BUPA’s introduction of its open referral process which means that when private medical insurance (PMI) policies come up for renewal the terms and conditions will change. As a result, instead of referring patients directly to a consultant, GPs complete an open referral form provided by the insurer simply outlining the nature of the condition or procedure, but without naming a consultant. Patients then contact BUPA to gain pre-authorisation and, provided this is covered by their policy, will be given a short list of BUPA approved consultants whom they may see.

BUPA claims that it can deliver this process, which has been devised by its managing director Dr Natalie-Jane Macdonald, because it “has an unparalleled level of information to assess both specialists and hospitals”.

But this statement, made in BUPA’s patient booklet on open referral, is in direct contradiction to the findings of the Office of Fair Trading (OFT) who in its market study into private healthcare clearly states:

“In their submission to the OFT market study PMI providers indicated that they did not possess sufficiently detailed information on the quality of care offered by consultants recognised by them and were in most instances unable to advise patients beyond information relating to the consultant speciality and location.”

Geoffrey Glazer, chairman of the Federation of Independent Practitioner Organisations (FIPO) takes up the argument and points out how the patient will suffer. He says:

“BUPA has made several claims about the variation in clinical practice between specialists, but has never been able to produce hard data to support the contention that this leads to better outcomes. The implication that the ‘BUPA approved consultant’ is of a higher quality is entirely unsubstantiated. In fact, only those consultants who have agreed to BUPA’s scale of fees will be on the list of approved consultants, thereby actually restricting patient choice.”

Independent research also reveals that PMI policyholders are unhappy with the open referral process. Of the 31 per cent of people who have PMI questioned in a recent Comres study of more than 2,000 individuals, a massive 74 per cent confirmed that they would rather see a consultant recommended by their GP than choose one from a list provided by their private medical insurer. In fact, nearly three quarters of those with BUPA policies took this view.

Half of those with PMI also said that they felt an open referral process directly threatens patient choice including 49 per cent of those who actually held BUPA policies.

This view is supported by the Private Patients Forum which champions choice. Its executive director, Don Grocott says: “Open referral is simply jargon for a system in which the insurance company decides which doctor and which hospital you go to - not the patient or the GP. It means that we may see someone our GP doesn’t know and may have to go to a hospital further away from either home or work. That takes away choice - the very reason most folk opt for private medicine.”

Patients who decide to change PMI provider and move away from BUPA, are also likely to lose out because a new insurer may not cover a pre-existing condition. This was the issue that Lord Walton’s second parliamentary question addressed. He asked what assessment the government has made of “the degree to which BUPA and other private medical insurers exclude pre-existing conditions from their cover, and its impact on healthcare in the United Kingdom”.

So what advice is there for people with PMI policies from BUPA? Geoffrey Glazer suggests: “When the policy comes up for renewal, check the terms and conditions very carefully. If you are not sure of anything then ask your employer if you are a member of a corporate scheme, or if you have a personal policy talk to your broker – who would have negotiated the policy – to explain it to you. Patients should not throw away their choice of consultant, have the opinions of their GP discarded, or be restricted in their cover in this fashion.”

The ComRes Omnibus poll was carried out on behalf of PIELLE Consulting as part of its research for several clients. ComRes interviewed 2046 GB adults online between 11th and 13th November 2011, of which 629 (31%) stated they currently had or have previously had private medical insurance. Of these 629, 60% received their PMI through their employer.

Data were weighed to be representative demographically of all GB adults. ComRes is a member of the British Polling Council and abides by its rules (www.britishpollingcouncil.org)

Data tables can be found at www.comres.co.uk

The Federation of Independent Practitioner Organisations (FIPO) represents professional independent medical organisations and specialist groups in Britain. It provides guidance, policies and co-ordination to membership organisations, acting on behalf of the profession to advance the cause of independent health care. FIPO promotes the highest standards of health care provision, achieved through robust clinical governance and audit, as well as expert, consultant advice for best patient care and clinical outcomes, based on professionally developed guideline..

Royal Colleges, the GMC and the Patients Association have signed the FIPO Charter for Patients and their Doctors, reaffirming their commitment to high-quality patient care. Outlined in the Charter is the ethos that governs each doctor’s duties to their patients, the patient’s rights and the principles inherent in best medical practice, such as the GP to consultant referral pathway.