Independent Practice Committee Update
Competition Markets Authority
As many of you will know the AXAPPP challenged the findings of the CMA supporting the use
of Anaesthetic Groups and LLPs. The AAGBI and the BMA supported the CMA in defense of
its findings through to the Competition Appeals Tribunal. At the tribunal after two days of legal
argument the CAT decided to uphold the CMAs initial findings. This is extremely good news
for Group practice particularly as AXAPPP did not follow up with an appeal to a higher court.
This should finally cement Anaesthetic Group practice for the future. There is one further
appeal outstanding on the CMAs judgments, that being FIPOs challenge to the fees remedy
around limitations on the ability to charge top up fees. This should receive judgment later this
year. FIPO are hopeful of a judgment in their favor but did lose their previous appeal on the
same matter but on a split judgment.
http://www.bma.org.uk/support-at-work/private-practice/competition-and-markets-authority
However there are still pitfalls for the unwary to fall into. A large group of Ophthalmologists
were fined after breaching competition law earlier this year. In essence they were all partners
in an LLP and as such set a fee scale for their partnership, a legally acceptable thing to do
but were then also practicing outside of the partnership individually using the same fee scale
and it was this that breached competition law. Please see below a link taking you to more
detailed advice on this matter
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/481620/Private
_medical_practitioners_-_information_on_competition_law.pdf
https://www.gov.uk/government/publications/medical-practitioners-advice-on-competitionlaw/private-medical-practitioners-information-about-fees
Private Medical Insurers
Members are still reporting difficulties with the PMIs in regards to recognition requirements.
Whilst we understand the frustration this causes and did make up part of our initial
submissions to the CMA, the CMA did not find this to be limitation on Competition that
disadvantaged the consumer; this has enabled the PMI to continue this practice.
We meet with representatives from BUPA at the end of 2015 and this made up part of our
discussions at that meeting, in particular the practice of derecognizing a Consultant who had
not billed for some time and then only accepting them back onto the books on new terms, this
particularly affects Consultants returning from sabbaticals overseas or those returning from
maternity leave. Their representative agreed that this was unreasonable and undertook to
take it back to BUPA giving us an undertaking that where Consultants fore warn BUPA that
they will be away from practice for a period they will not lose their recognition. BUPA also
have a chain of local representatives who will help consultants deal with issues such as this.
We also had discussions around fees and mechanisms to reflect the complexity of a case
with regards to co morbidities, but also around the benefits of some additional anaesthetic
procedures and input with regards to length of stay. Tim Woodward undertook to take our
thoughts back to BUPA but with particular questions around the fee envelope. I am
disappointed but not surprised to say that despite some time having passed I am yet to hear
any further from them.
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BUPA did also concede that in some parts of the country they were noticing that fewer new
Consultant Anaesthetists were entering the market, we argued that this was a reflection on
private practice becoming unprofitable with newer entrants choosing to undertake additional
NHS practice either in their own trusts or in the private sector with the decreased costs
incurred by the practitioner. Indeed in my own institution several of the more recently
appointed Orthopaedic Surgeons are only undertaking NHS work in the Independent sector!
Many members will have received letters from AVIVA concerning benefit payable for cataract
surgery; again we have taken this up in discussion with AVIVA as it would appear that
anaesthetic involvement with any patient would have had to be paid for by the surgeon! We
highlighted that in the private sector many cases are booked at short notice limiting the ability
of practitioners to gain preauthorization for anaesthetic involvement, potentially putting
patients at risk or being subject to delays in their surgery whilst agreement for anaesthetic
involvement is obtained. We were reassured that this was not their intention but they
struggled to see that when in the NHS the vast majority of cases of cataract are now handled
by the surgeon with topical anaesthesia, this is not reflected in private practice. Where
possible they will be seeking for us o gain authorization as in their letter but accept that this
may on occasions not be possible however if this was ‘not possible’ on many occasions by an
individual they would reserve the right to look at this further.
E-billing
This is becoming the norm amongst insurers, we have put it to BUPA that our contract is with
the patient and hence the bill should pass that way but we have received advice that legally
insurers may require submission in this way to maintain recognition. We have sought to get
the process of data input improved with for example simplifying the disability codes to allow
anaesthesia as an input and simplifying the discharge date to the same day as anaesthesia
was given, my office manager assures me that the process has become easier but also that
once the backlog of cases was cleared payment has become much quicker. With regards to
shortfalls BUPA in particular are informing their client, our patients directly if there is a
shortfall to be paid by the patient.
Dr Paul Barker
AAGBI Independent Practice Committee, Chair
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