How do I apply for a DBS check for Bupa?

Physio First members can obtain an enhanced DBS check that will satisfy the Bupa requirements.

We have had really detailed discussions with Bupa and they have agreed, that due to the way that our scheme is administered, Physio First members only have to submit a request to our partner company Due Diligence Checking Ltd (DDC) by email to enable us to tick the box on our Bupa contract renewal application. Just follow the link to DDC's website http://www.ddc.uk.net/physiofirst where you will find details to request an application form to sign up to the scheme and then, Physio First as per the scheme, will request an enhanced DBS check on you.

Once done, you can tick the box on the Bupa contract renewal application, DDC will then contact you to request payment and send an application form directly to you.

This scheme can only be open to Physio First members and DDC will be requesting your membership number and checking against the Physio First website, as being a Physio First member is an intrinsic part of the whole process.

 

The background

The problem has been that Bupa want us to be able to say that we have “applied for an enhanced DBS check before we can apply to renew our contract with them” and it is extremely difficult for us as self-employed practitioners to obtain an enhanced disclosure on ourselves.

The reason is that we as self-employed practitioners need an organisation to endorse us and check our suitability. In researching this (and we have done lots) we did find that there were some umbrella bodies willing to do this – one required applicants to “pretend” to seek employment as part of an employment agency and charged nearly £50 on top of the £44, that has to be paid to the government body (the DBS), to do the checks!

 

Physio First has a formal contractual relationship with Due Diligence Checking Ltd, and we have set up a Physio First Scheme which we, as members, can join to obtain the required Enhanced DBS Disclosure under Physio First administration.

  

The complication

Any umbrella body through whom we apply has to have the ability to manage “positive disclosures” so that suitability to work in a chosen field can be judged fairly, either by an employer directly, or by a third party.

The problem is that this cannot be done by the applicant themselves, and bupa do not act as an employer. Physio First however are able to ensure that, acting as the third party, our members are both suitable to work in a chosen field and judged fairly.

This includes the ability to manage “positive disclosures”, take into account adjudications that may have already been made by, for example, the CSP and the HCPC, so that individuals with a “positive disclosure”, that is not considered a problem, are not unfairly treated.

  

Due Diligence Checking Ltd 

DDC is a large national umbrella body organisation who have been specialising in this area for over 10 years.

We selected them because we wanted to find a partner that would work hard with us to put together a robust system that would satisfy Bupa requirements … quickly!

  

The Physio First vetting & barring scheme

This is what we have set up. We are calling it the Physio First vetting & barring scheme. It is simple, compared to other schemes and combines several processes into one. It is also something that will serve members in England, Scotland, Wales and N Ireland.

One very important aspect of the scheme was that we were specifically able to agree with Bupa, in view of their self-imposed very tight time limits, that upon emailing DDC with our details (i.e. our name, address, telephone number, Physio First membership number and our request for an Enhanced DBS Check) that this is sufficient to satisfy Bupa’s requirement “to have applied for an enhanced DBS check”.

In other words there is no need to wait for any of the following steps that getting an Enhanced DBS check requires before returning our Bupa renewal contracts i.e. getting an Enhanced DBS check involves:

       Sending an umbrella company our details

       Paying them the DBS fee and their administration charge

       Waiting to receive the necessary DBS application form with the special SAE envelope that is to be returned with all of the documents required (e.g. passport, driving licence etc, etc)

       Then the umbrella company will :

o   Check the identity/documents as per their duty to the DBS

o   Forward the application to the DBS in Liverpool (electronically)

o   Return the original documents to the Physio

       Then  the DBS  will :

o   Process it

o   Post the DBS check to the Physio

o   Notify the umbrella company partner of the issue date and number, or confirm that a paper copy is being sent to be evaluated.

       Then the umbrella company will update the database that they hold for Physio First

So if you are applying to satisfy Bupa’s requirement that you have “applied for an enhanced disclosure” then the Physio First scheme is simple – the rest of the above steps can take place later!

 

What if not all physios in my practice are Physio First members?

The Physio First scheme can only be for Physio First members as Physio First is endorsing and checking our suitability.

Physio First is able to endorse members because it is a condition of membership to provide an HCPC number and a CSP number which Physio First checks. Physio First is unfortunately therefore not in a position to offer this service to non-members.

Physio First has had to put in place a system that deals with what is called “positive content” i.e. if any one of us has a criminal record, which could include a caution for a very minor offence when we were in our teens, then this process will disclose it as “positive content”.

This will then be forwarded to Physio First, who will have a panel in place to deal with these i.e. to determine whether the “positive content” is anything that Bupa, the HCPC, the CSP or Society at large ought to be concerned with i.e. with anyone who may be treating a vulnerable adult or a child.

We have taken advice from the CSP who have a similar process for all new students joining, and they advise that most “positive content” is so minor as to be irrelevant, but of course there has to be a process that manages this otherwise the whole process is pointless.

Setting up this process for management of “positive content” was imperative to being able to set up this scheme.

The problem however is that Bupa also require everyone treating their patients to have an enhanced DBS check.

If, for example, self-employed associates are not members of Physio First, then there are 3 options:

1.     They can be asked to join Physio First as full/affiliate members and take part in the scheme. Our office team are standing by for anyone who wants to follow this route – tel. no. 01604 684960 or click ‘join' on this website. 

2.     If a practice principle wants to become the “responsible body” i.e. the person who takes on the responsibility for managing “positive content” as communicated from DDC (or indeed another umbrella organisation) then you can.

If you do decide to do this then please note that:

a.     The fee will have to be paid to the umbrella body

b.     You will have to process “positive content” yourself which will include taking action if it proves to be problematic in the context of vulnerable adults and children

c.      You, yourself will still require your own disclosure as you cannot manage your own application – that said if you are a member of Physio First you can do it through this Physio First Scheme.

DDC have their own information on this to help you through this quite different process – please click here for that www.ddc.uk.net.

3.     Otherwise you can get in touch with Bupa for another umbrella organisation that they recognise and with whom they have defined what they will accept as “applied for” because as per the list above, Bupa’s last contract renewal date is on the 5 April 2013 which is approaching.

So to conclude 

       If you are a Physio First member and want to satisfy Bupa’s requirements then click here http://www.ddc.uk.net/physiofirst and inform DDC that you wish to apply for an enhanced disclosure, then you can complete your application to renew your Bupa contract

       If you have colleagues in your practice who want to continue to treat Bupa patients but who are not Physio First members then:

o   If you are a practice principle and want to take on the responsibility for “positive content” then contact DDC (or another approved Bupa Umbrella company) and tell them this – click here for DDC guidance www.ddc.uk.net

 One final complication … and possible solution

An enhanced DBS check cannot be obtained to satisfy more than one organisation so for example if a nursing home or even another private medical insurer were to require an enhanced  DBS check, unless they were to specifically recognise the Physio First scheme, we all have to reapply again, specifically for them!

We would hope however that if another private medical insurer were to make an enhanced DBS check a requirement that Physio First would be able to negotiate that the one that we have just constructed would be acceptable, but we can only try if this occurs.

In closing, I am delighted that we have been able to set this up and I would like thank members of our executive, our office team and individuals from DDC for the tremendous effort, in the very short time frame that it has taken to do this.

As we learn more I will keep you informed.

For more details on the process and to sign up go to: http://www.ddc.uk.net/physiofirst

 

Can I use the Physio First DBS scheme if I work in Scotland/N Ireland?

The answer to this question is somewhat complicated.

Physio First are not being prescriptive about where each member gains their disclosure merely assisting those who require it to navigate the “minefield” in the most expeditious way

It is possible to register with, for example Disclosure Scotland (or the N Irish equivalent) and apply for an enhanced DBS/CRB check and of course all people wishing to sign up for a Bupa contract are free to get their check wherever they wish. It is not quite that simple though!

It is important to remember that it is still not possible (nor should it be) for individuals to check themselves so when self-employed practitioners apply for a disclosure it has to be through an umbrella body who has the capability to filter any “content” that may appear on that disclosure.

Disclosure Scotland (or the N Irish equivalent) are a Scottish/N Irish Government facilities who actually manage the disclosures themselves but hold no judgement role whatsoever.

You can register with them to start the process but if you are an individual they still require to put you in touch with a variety of umbrella bodies to choose from and actually one of these in Scotland is DDC with whom Physio First have forged a relationship. Please see the FAQ under the heading of 'Bupa-latest!' called 'How do I apply for a DBS check for Bupa?'

We have inserted below the excerpt from the Disclosure Scotland website that explains this. As you will see from the detailed e-alert Physio First circulated on 20 March 2013, that Physio First are able to work with the CSP where necessary and will set up the “proper” and robust system for assisting any member who has any “positive content” and manage this appropriately. We have also had extensive talks with Bupa about the variety of different options.

The Physio First scheme is appropriate for all our members in all regions.

Please see excerpt below

Standard & enhanced disclosures

If, because of the nature of your job, you need to apply for a standard or enhanced disclosure, you must do this through your employer or an umbrella body.

Applying through an employer

If you have been asked for a standard or Enhanced Disclosure by your employer or a potential new employer, they will have to manage the application process. Applications for these disclosures can only be processed by Disclosure Scotland when countersigned by an individual registered with Disclosure Scotland for this purpose.

Applying through an umbrella body

An umbrella body is an organisation which has registered with Disclosure Scotland and is able to apply for standard and enhanced disclosures for individuals, for positions which are exempt from the Rehabilitation of Offenders Act, 1974.

More on umbrella bodies

Application process

The application form should initially be completed and signed by the individual. It should then be countersigned by a registered person within the registered body or umbrella body before being submitted to Disclosure Scotland. The registered person is responsible for verifying the identification documentation before submitting the application.

Why doesn’t Physio First campaign for higher fees?

A question that Physio First has been wrestling with for years and which our new strategy takes into account.

It is firstly a question of “who Physio First are” i.e. essentially we are a membership trade association that is run by volunteers who step up from among us and who give up their time and energy for us.

Each volunteer runs his or her own practice but also contributes masses of their own time and energy to doing the best they can for our colleague members, supported of course by our General Secretary and our office team.

In terms of meetings that we have with Bupa, AXA PPP or Nuffield or indeed any private medical insurer or commercial intermediary, these are really quite tricky in that in communicating with them we have to balance informing them of the problems that we as private practitioners face with the reality of their and our marketplace.

Reporting a problem to a private medical insurer or commercial intermediary such as:

Our members do not like the rates that you are offering

we know will lead to the response:

“So what are you suggesting – that we offer your members more than our position in the marketplace requires us to do? You should know that if we were to offer more:

–       We want a marketplace benefit from Physio First members in return

–       A benefit that will save us money or make us money or really help us to improve our brand

–       Unless we get that we would become uncompetitive ourselves!”

So to avoid being regarded as amateurs in a professional business “marketplace” space, Physio First representatives can allude to our member dissatisfaction but cannot yet address their legitimate question as to what Physio First members can do for them in terms of helping them to make money, save money or improve their brand – but we have a plan!

If we are too hostile i.e. telling them how we as private practitioners really detest the way that they do business and that private practitioners would be encouraged to criticise them openly e.g. by implication to their customers (i.e. our patients):

  • At best they will simply refuse to meet us any more
  • At worst remind us that if we were to encourage criticism of them then they would be “asking their lawyers to intervene!”

So again, not really a productive option as without these meetings and an open communication channel with them, we would get no advanced marketplace information that we can publish that helps us all.

So overall, the very best that we can hope to obtain from meeting them (which we do) is to try to persuade them to tell us about what they are intending to do in the future so that we can give everyone a “heads-up” on what to expect and thus enable us as members to factor any marketplace changes that we learn about into our own individual plans.

When meeting Bupa, AXA PPP, Nuffield, Simply Health or indeed any of them, our Physio First representatives really try to walk the line of raising legitimate complaints and in seeking information from them and (occasionally) seeing what we can do “with them” that would benefit us as members or ward off a threat (e.g. the Physio First DBS enhanced checks that as Physio First we set up to satisfy Bupa’s new demand that all private practitioners have to prove they are not a danger to children or vulnerable adults).

So why not just advise us all to simply band together and say “no”?

Essentially in order to “offer a united front”, Physio First as an organisation of like-minded members (like-minded in that we are passionate about what we do and we are self-employed and in business) we have to become really organised. 

To try to present a united front as groups of individual members or as individual businesses e.g. for Physio First to suggest that all members tell Aviva, Bupa, Nuffield or AXA PPP or anyone, that “we will not treat their patients for less than £x per session”, would be to put ourselves in breach of the law and also very likely to shoot ourselves in the foot.

The legal danger is that we would leave ourselves open to being sued by the Office of Fair Trading or indeed any of the private medical insurers or commercial intermediaries directly for trying to adversely affect competition – a subject that we have taken legal advice upon and written tomes about. The OFT makes the point on its website that:

 

“In addition to our own research and market intelligence, the OFT relies on complaints to help us in enforcing competition law. If you suspect that a competitor, supplier, customer or any other business is infringing the law, you may contact us with your concerns”.

The likely outcome of shooting ourselves in the foot outcome comes from the fact that not everyone would agree to unite.

In a free competitive marketplace some of us would regard any attempt by a group of members to band together (to effectively go on strike) to try to protect or improve fees as a major marketplace opportunity to nip in and take the business. Of course we would expect such action to be much more common among non-Physio First member businesses but we were informed of instances of members doing precisely this during the Bupa Blind Tender process in 2009.

All this tells us is that to expect such unity (even if it were legal) in a society that is set up to value competition would be naïve and it would damage to our marketplace credibility.

Bupa, AXA PPP, Aviva, Nuffield or any company we approached where we allow ourselves to say that “our members do not like your fees” would, even if they did not say it to our face, regard us as amateurs and irrelevant and most likely simply ignore us – and rightly so. If we were them would think the same!

Where the new Physio First strategy takes us, is on a continued journey towards marketplace credibility i.e. an expressed understanding that “if” as Physio First we are going to have an impact on the marketplace, we are going to have to create something that marketplace players value!

Please read the article about our Goal 9 in our May 2014 edition of Update for details.

Some of us will remember Physio First projects and initiatives such as:

  • Physio First Clinic Accreditation Scheme i.e. our attempt to provide a quality assurance scheme
  • The Physio First “RehabFirst Scheme” i.e. our attempt to become a commercial intermediary
  • Change of name from OCPPP to Physio First i.e. to create a name that meant something to the public
  • The development of a whole suite of Physio First business courses i.e. to help members develop business skills to meet the changing healthcare marketplace
  • Physio First FAQs on business questions i.e. to answer questions that members frequently ask that can be reviewed quickly and easily and a whole host of other projects and initiatives.

All of these initiatives have helped to improve our business knowledge and skills which have culminated in our Executive’s ability to create our new strategy in 2013 which we are now deploying.

Our past Chairman Sandy Lewis provides lots of details of our new strategy via video and articles on our website.

Our new strategy was born out of a decade of getting ourselves (Physio First) organised along commercial lines – i.e. addressing the 5-key business skills that are needed to take an organisation into what is called “advanced development” i.e.

  1. Positioning – Understanding what is Physio First’s unique position in the marketplace
  2. Advance management tools – Obtaining the best business tools that we can afford e.g.
    • The development of our business training courses which have been attended by our Executive members as well
      The import of our Membership Relationship Management Software
      Professional Performance Management Training for our Office Team 
    • Succession planning – Hard material plans and systems in place to safe guard continuity for every Physio First post to ensure someone becomes the resource to carry on with our journey
  3. Becoming functional – Simply put, becoming as fit for purpose as we can be given our available resources. This has been especially important given that most of our resources are our volunteer member time and energy. We have done this through being really focussed in what we do. We plan everything, we manage our capacity, we have a written down culture (i.e. agreed behaviour), each post has a job profile and our executive are peer reviewed by our Chairman and our office team appraised by our office team manager
  4. Understanding our distribution – “Distribution” simply means being really clear about how we recruit new members and as per our positioning report (details to be sent to all members later in 2014) we understand completely that we, as Physio First, obtain the vast number of our new members from recommendations from existing members – from us!

Of course we still have to improve each of these five skills but having developed them so far we now have our reason for existing and 9 goal five year plan. So it is now worth turning to goal 9 as this is where we think the solution to the question lies i.e. the question “how do we as Physio First have an impact upon the marketplace?

 

Our executive’s explanation of goal 9

Goal 9 – Investigate so that we are able to understand, explain and judge the:

  • Potential impact of cooperatives (i.e. Physio owned/controlled business entities)
  • Elements of real branding (that incorporate measured quality and competence) 

… and as said above, please read the article about our Goal 9 in our May 2014 edition of Update for details.

May 2014

What is our relationship with Bupa?

In our communications with Bupa over the last year or so we have reported in Update and on our private Physio First LinkedIn forum that there is a palpable cultural shift within Bupa.

The shift has not been to make our lives easier by simply agreeing to raise our fees which have remained unmoved for a number of years. This of course would be nice, but naive to expect. But there is definitely a palpable willingness to collaborate that echoes with our own vision.

We will continue to talk to Bupa as we feel that is important, but for now here are a few reflections upon developments within Bupa that have come to light during our communications with them in the run up to this, Bupa’s contractual renewal process.

No GPs

Bupa have already followed through on a point that they relayed to us in a late December i.e. that they there is no longer a need to refer a patient back to their GP for an onward referral to a consultant.

Bupa are engaging more with consultants and of course their overall direction of travel will be around reducing costs through being able to identify the “overall cost” that a referral to a consultant means (i.e. see “consultant dashboards” in  1) The Bupa contract renewal process” and below) but it does demonstrate Bupa’s engagement with data collection and the power that this affords around “cost efficiency”.

The pendulum however does swing in our favour too and it will be through the evidence provided by Bupa’s data collection that will enable Bupa to decide that GPs are no longer a “cost effective” way of having their customers referred to us and it will be through our own Data for Impact collection that we will be able to help demonstrate our value to Bupa and indeed the public at large.

Advanced practitioners

Bupa gave us a lot of information about their thinking around “advanced practitioners” which is communication that is most welcome.

These communications are partly an expression of “trust” – the essential ingredient to any form of collaboration – but see more about this in the section entitled “trust” below.

Bupa’s interest in “advanced practitioners” is about their desire to move towards identifying those who have “extended scope roles” that might prove more “cost effective” to them than other marketplace providers such as Consultants.

With Bupa we talked about “injection therapy” and Bupa’s comments were “why would we not use a Physio with extended scope if, overall, they proved more cost effective?” The pay-off for them being less referrals to consultants – if we private practitioners can use our skills to avoid the need for that onward referral.

Currently the business case is not yet made as regards “injection therapy” as there are only about 100 Physios who would be qualified and that is not enough for Bupa’s requirements. But if the demand grows then so will the suppliers.

Bupa have also made the point that, in private practice, there seem to be people who appoint themselves as consultants. Bupa are obviously anxious to be able to recognise what they call “advanced practitioners” and have said that they will welcome feedback from Physio First about how to identify MSK experts.

This is something that as Physio First we intend to follow up on with Bupa as we feel that whilst many of us have the skills, “proving our worth” is the challenge.

In addition, we have made the point to Bupa that it is also a “chicken” and “egg” situation i.e. any marketplace stakeholder requiring such a specialism would have to develop or demonstrate a need for it to encourage practitioners to want to have it!

So we fully intend to explore with Bupa both the business case for us to develop the niche “advance practitioner” and our desire to help define what that means. To their credit Bupa do seem to have taken these on-board.

We have also talked to Bupa about our already developed asset i.e. our Physio First Data for Impact project which is now permanently alive and available to any of us to join at any time.

As will be announced in our March Update, later this year Data for Impact contributors will have the ability to receive individual clinician data that each of us can compare with the Physio First national data. We have said to Bupa that this, combined with the implementation of our new Physio First education strategy, would enable us to work with them in helping to define this.

In addition, our own thoughts are that we might even be able establish and monitor the standard, but only as far as private practice is concerned.

Again, and as an aside, Bupa is not the only private medical insurer to contemplate the idea of “advanced practitioners”!

Bupa, for their part, have said that:

  • They are very interested in Physio First’s strategic journey towards our Intent and Goal 9 and to that end would like to meet to discuss matters at a “strategic level” which we welcome very much
  • In the future they are looking to help define and model care around the idea of an “advanced practitioner” so that they get a one stop shop around it
  • They are very interested in just how our Physio First Data for Impact collection might be able to assist.

Bupa finder service

Bupa also referred us to their Bupa “finder service” that appears on their website where they say that practitioners can go to and see the data recorded against us saying that “the data is mainly contact data but clinicians are able to update their practice profile and include links to websites, pictures of the practice, etc”

They have said that they felt that “the more information that is recorded against the practitioner the better for them as their finder service gets 3,000 hits a week”. Quite how valuable it might prove we will have to wait to see, but we will find out more about this as we communicate with them.  

 

The development of dashboards

Bupa referred us to the development of something they are calling “a dashboard”.

So far this has been developed for consultants and is due to be launched in March. The purpose is to demonstrate, from all of the information that they have upon a consultant, what “an overall cost of treatment” of a patient who is treated by them represents.

The logic, Bupa say, is that many consultants do not realise the overall cost associated with their treatment of a patient and that this varies enormously e.g. the cost of blood tests, MRI scans, etc. So now, as part of how they recognise consultants, they are looking at “the overall costs”.

Bupa say that with “the dashboard” data they will be able to go to consultants and show them what the overall cost of patient treatment is, which will of course tell the consultants what the other costs are associated with their hospital services, which in turn will have an impact upon them!

Bupa also say that they will be collating the information that they have on Physios too to create a “physio dashboard” later in the year. Again this is something that Bupa have confirmed is something that they will speak to Physio First about, but part of that context, we feel, should be the value that private practitioners can bring to a patient’s treatment. If patients can avoid more expensive interventions through private practitioner intervention then this needs to be evaluated and reflected there too.

Data for Impact as a basis for future business discussions with Bupa

Bupa define their customer base as “Small to Medium Enterprises” (SMEs i.e. up to 500 employees) and corporates (i.e. over 500 employees)

During our recent communications with Bupa, they confirmed that they do not have information about how much time off work their Bupa customer has and were intrigued that our Physio First Data for Impact collects this information!

We know from our data i.e. how much time off our patients have had and how long it took to return to work is data that could be of huge added value to Bupa in their endeavour to sell policies to their customer base and if we are able to help them sell policies, then we have a basis for negotiation with them. Something that we feel Bupa would welcome – for context see the Bupa Managing Director’s Prescription for Growth publication.

So, the “marketplace value” of our Data for Impact collection is beginning to have some effect both in terms of giving us as Physio First a possible negotiating position but also in terms of our individual businesses!

Trust

In Update we have written a lot about “trust” – the new currency of business.

Banks have mortgaged theirs and will suffer, the internet is exposing others who are two-faced or dishonest and culturally we are becoming as a society much less forgiving of those who do not honour their word and of businesses that do not “add value”.

Funnily enough Physio First too is now starting to have these conversations with Bupa that is about “trust”. Again referencing Bupa’s Managing Director’s publication Prescription for Growth,the message from him is that there is a severe lack of “trust” in the healthcare sector and to enable us all to work collaboratively towards “an evidence based cost effective” and thus financially more viable future, we need to address this!

Obviously we have confirmed that we would like to have a “strategic” discussion with Bupa and to that end we expect to meet them later in 2015.

We have already shared Physio First’s new vision and our 9 Goals with them and the fact that it involves our endeavour to produce a private practitioner owned network that will enable us to “Champion evidence-based, cost-effective private physiotherapy with Physio First members in the changing healthcare marketplace”.

… so to conclude

Based upon discussions to date, we do think that Bupa share a great deal of our vision and that when Physio First and Bupa do get a chance to speak at a strategic level we will find out more fully whether it may be possible to look for ways to begin to trust each other … whether that essential ingredient for collaboration can actually exist?

From Bupa’s point of view, if Physio First and Bupa can develop this mutually advantageous position then we will see if it is possible to build a marketplace position that will serve our mutual benefit and that of the public who are our customers and our patients – which is who we work for anyway!

Of course the casualties in all of this, if we succeed, will be those business’s that exist exactly because of the previous lack of trust i.e. commercial intermediaries. They came into existence precisely because private medical insurers feel that they cannot trust healthcare providers … but then we would have to give some credence to the question “could we really be trusted?”

Now at least, as a group of private practitioners belonging to Physio First that exists to “Champion evidence-based, cost-effective private physiotherapy with Physio First members in the changing healthcare marketplace” we at least have a vision that important stakeholders in our marketplace regard as worth a second look and through our goal 9 – through our desire to build a marketplace disrupting self-owned business entity that will enable private practitioners to define and ensure the delivery of quality – we have a means by which to deliver it.

So, this contractual renewal process should prove interesting but perhaps subsequent discussions with Bupa will prove more so!

To join us on our private Physio First Linked-In Forum – click here

To view 1) Bupa contract renewal process click here

February 2015

How can I protect myself against the financial collapse of a commercial intermediary?

Having clear terms and conditions can be very helpful when it comes to disputes with patients over paying for treatment but they are not the panacea or the silver bullet to cure all problems over non-payment for treatment fees.

The recommended terms and conditions below have been drafted in direct response to the collapse of the commercial intermediary, Remedy Matters in November 2008, which left a large number of members with unpaid invoices that could only really be pursued against Remedy Matters (who went into administration and for all practical purposes had no money to pay) rather than directly against the patient who had received the treatment.

Please note that any business coach, bank manager or accountant will tell you that cash is king and moving away from the patient paying for the treatment that they receive either before or immediately after they receive it is never a good idea unless there are no alternatives.

Please do not justify any move to allow third parties rather than the patient to pay for their treatment on the basis that if asked patients would prefer me to bill a third party e.g. a private medical insurer, rather than pay me as this is akin to if asked people would like free money the answer is always predictably affirmative.

If however any one of the following reasons apply to you, you will find yourself having to bill a third party i.e.

  • If I do not bill a third party, the evidence that I have gathered about my customer base supports the view that they will prefer my competitors over me please note the word evidence.
  • My business plan has led me to conclude that I need to be a preferred provider of particular private medical insurers or a commercial intermediary and to do so I am required to bill them directly or run the risk of losing this status without which I cannot treat patients insured/referred by them.

So below is a first draft of terms and conditions that you could use. Please remember that having terms and conditions in place is only the first step. If a patient or third party does not pay then enforcement of this contract is a whole new process that involves the following steps:

1. Writing the 3 debt collection letters that Physio First recommends one uses (see your Members Manual) to try to persuade the person or organisation to pay.

2. If these fail, then using the Physio First members Debt Recovery Assistance Service to try to persuade payment (again see www.physiofirst.org.uk) for details.

3. Issuing proceedings through the Small Claims Court brief details of which are that:

  • One has to pay a fee to initiate often 30 - 50
  • Is designed to keep lawyers out of the process to make it less expensive
  • Does require your time to:

Read and understand how it works

Complete the necessary forms

Possibly attend a hearing

  • You will not be able to claim anything for the time that you spend using this process, so there comes a point where most people have to decide (and this is best done before you start) whether the time and aggravation investment is worth it.

Conclusion

So to get to step one, it is helpful to have terms and conditions and they are infinitely better than nothing!

Having these in place may have alleviated the problem caused by the collapse of Remedy Matters in that Physio First members who have terms within their terms and conditions that require the patient to agree that they will be directly liable for treatment fees not paid by the third party, would mean that the Physio First member has a case that could be pursued in the Small Claims Court if necessary.

But even with terms and conditions in place, there are still obstacles to over come is it worth the time and aggravation (e.g. as each individual amount due for patient treatment fees will be relatively small); might a claim be defended (even if the defence ultimately fails) or does the patient have the money to pay?

Finally, with the exception of the demise of Remedy Matters the incidence of non-payment for patient treatment is relatively rare within the private physiotherapy sector. This is not to say that individuals have not had significant problems in obtaining payment for large amounts but that as a sector the non-payment of treatment fees (or bad debts) as a percentage of annual turnover, is not a major sector wide problem at the moment.

That is not to say that as things change within the sector that this will not change, but just an observation. If you find yourself with significant non-payment by patients then you may need to seek the advice of your accountant or the Physio First General Secretary (for details please contact the administration office 01327 354 441) as there is something rare about how you practise.

Please note that these recommended terms and conditions:

  • Have been drafted in plain English so that Physio First members can explain them to patients who want them explained and legalese has where possible been avoided.
  • Are the first draft of recommended terms and conditions by Physio First and will be updated from time to time and members will be notified by Physio First e-alert when they are. Please ensure your email address is kept up to date via www.physiofirst.org.uk or by notifying Physio First in writing.
  • Should not be used as the basis for any arrangement that is likely to generate very significant treatment fees (e.g. over 5,000) as such cases should be dealt with much more formally and will require greater legal input.

 

Terms and Conditions

These are the terms and conditions of [Business Name].

I/We the patient(s) who have signed these terms and conditions (below) agree with [Business Name] (hereinafter referred to as the business) that :

1. A Physiotherapist from the business may provide treatment for me.

2. I am personally liable to pay the treatment fees of the business and any surcharges incurred (e.g. as a result of a failure to attend an appointment where I have failed to give the business at least 24 hours notice).

3. If the business does agree by prior arrangement with a third party to invoice and seek payment from that third party (e.g. a Private Medical Insurer or a company who has referred me for treatment) and allows them some additional time to pay, then I agree to pay the business upon it demanding payment of me by letter within 7 days of being asked to do so. I understand that this is only likely to arise if the third party ceases to trade for any reason or fails to honour an agreement to pay the business within a specified timescale (and that this may occur whether or not the third party has reimbursed me as the patient or has agreed to do so).

4. The business accepts no responsibility or liability for any indirect, special or consequential loss or other damages howsoever caused or any liability arising from the services or treatment provided or made available to me except in the case of personal injury or death caused solely by negligence of the business, its servants or agents.

5. I or the business may terminate this contract by mutual agreement or by either I or the business giving the other immediate notice of termination in writing to the last known address.

6. Where this agreement (and/or a termination notice under 5 above) has been signed by a person on my behalf, that the person so signing warrants to pay all charges incurred up to the date of termination (unless already paid).

7. The business shall not be liable to me or be deemed to be in breach of this agreement by reason of any delay in performing or any failure to perform any of its obligations in relation to services or treatment if the delay or failure is due to any Act of God.

8. If the whole or part of any of this agreement shall be held void or unenforceable by any Court or competent authority then any such term or condition or the relevant part thereof (as the case may be) shall be deleted and the remaining terms and conditions (or part or parts of such terms and conditions shall continue in full force and effect.

9. A person who is not party to this agreement (including any employee, officer, agent, representative or sub-contractor of either party) has no right under the Contracts (Rights of Third Parties) Act 1999 to enforce any part of this agreement. This does not affect any right or remedy of a third party which exists or is available to that person apart from that Act.

10. We agree that any dispute arising from this agreement will be determined in accordance with English Law and will be deemed for all purposes to have arisen within the jurisdiction of the County Court.

I the patient, or the person signing on behalf of the patient, agree to these terms and conditions which I have read and understood

Signed

Name

Date

These Terms & Conditions can be downloaded - Click here.

[February 2009]

What is the advice regarding slow paying commercial intermediaries?

Slow payment can be symptomatic of financial problems. The advice therefore is to monitor this with the intermediary you are working with and try to avoid allowing non or slow payments to build up.

If you have particular and regular problems please do contact follow the Phyios First debt collection service procedure.

In addition, where we identify a pattern of non or slow payment from a particualrly internediary, we will write to the party concerned and try to establish the reasons. The advantage of doing so is that if asked directly, the directors could be in trouble (acquire some personal liability) if they say they are liquid when in fact they are not.

The dangers of naming and shaming specific companines are that Physio First, like everyone else, would receive a writ which it would have to defend, but surveying commercial intermediaries regarding payment terms etc, is something we are working on.

Sept 2009

How do I respond to referrers who want to inspect my practice/CPD?

Commercial intermediaries or PMIs seeking practice visits or CPD portfolio reviews

We have had a number of enquires from our members expressing concern about requests from commercial intermediaries or private medical insurers (PMIs) who want to "inspect" our practice or "view" our CPD portfolios.

When faced with a request of this nature, it is natural to feel defensive or to question what the "real" motive might be. We therefore thought that it might be helpful to provide a little perspective.

Any organisation - commercial, membership (such as Physio First) or Government agency (such as the HCPC) has limited resources.

In private practice terms think about the limits of the resources that each of us has in terms of how we run our own business i.e. money and time (which is money too).

It is in an attempt to manage the time (and money) resource that the HCPC, for example, limits the number of physios that it calls to submit CPD portfolios - if the HCPC want to be "sure" that everyone was compliant with CPD, they would want everyone's and would like to inspect clinics as well - but they simply cannot afford it, so they take a "snap shot" and request a few.

If anyone were to tell the HCPC that their process was "not good enough" and that they should do more, they would say, "well we will need to drastically increase our costs" which of course would go down with everyone (Government as well as us) like a lead balloon - so no one does.

Now - if a commercial entity is going to spend the resource in sending people (who have to be paid a salary as well as expenses for attending), it will be for a purpose. Speculating upon what that purpose may be is interesting:

  • Might they want to see our CPD portfolio, when it is technically our responsibility to keep it up and the HCPC's job to police it? Unlikely!!
  • Might they want to see our premises, to make sure that it is tidy enough, or compliant with Health & Safety? Also unlikely!!
    • Might it be "a reason" to explain a new way of doing business that:
      • Requires us as suppliers to charge less??

And/or

  • Helps them to save money by making the processes more efficient, e.g. submit reports electronically, accept payment electronically, etc?   

The answer is of course "very likely"!!

So what to do? The answer is really common sense:

  • Try to find out what they really want. Ring them up and ask or ask someone you might know from the organisation seeking to inspect, who is not necessarily one of the people involved in the inspection - this may give you background.
  • "Refuse to allow an inspection on grounds of "principle" - Of course we could if we wanted to, but what would be the point?

At the end of the day what we decide to do is up to us and what is the final determinant is how important the organisation seeking the inspection is to our business. If they send one or two patients a year and expect us to put ourselves out for little reward, we may well be justified in saying "no" and to fully expect all further referrals to dry up.

If however they represent 10% plus (or the potential for more referrals) then we may well roll out the red carpet.

So in closing, such overtures by commercial intermediaries or PMIs should not be viewed as a personal or professional affront but as "business as usual". How we respond should also be "as business people". 

If they are offering value (more referrals) or if we could ameliorate a threat (avoid losing referrals) then our reaction might be to welcome them with open arms - if they offer no real value, then folded arms and a cold shoulder may prove to be the order of the day.

Eric Lewis 

7 July 2010

What are personal independence payments (PIPs)?

Personal Independence Payment (PIP) is a benefit for people with a long-term health condition or impairment, whether physical, sensory, mental, cognitive, intellectual, or any combination of these.  It is paid to make a contribution to the extra costs that disabled people may face, to help them lead full, active, and independent lives.

The benefit is not means tested and is non-taxable and non-contributory.  This means that entitlement to the benefit is not dependent on a person’s financial status or on whether they have paid National Insurance contributions.  PIP is not restricted to people who are out of work.  It can be paid to those who are in full or part-time work as well as those who are out of work.

PIP will replace Disability Living Allowance (DLA), which has become outdated and unsustainable.  The Government say that the introduction of PIP will ensure a simpler, fairer, more transparent and more objective assessment, carried out by Healthcare Professionals.

PIP was introduced in April 2013 for claimants aged 16 to 64 years.  It applies to new claims from April 2013; and to reassessment of existing DLA awards on a rolling programme.  The peak period of reassessment will now start in October 2015.  The intention is that by the end of 2017 all eligible DLA claimants aged 16-64 will have been reassessed for PIP.  DLA claimants aged under 16 and over 65 will not be affected.

 

The structure of PIP

PIP has two components:

The Daily Living component – intended to act as a contribution to the extra costs disabled people face in their day-to-day lives that do not relate to mobility.

The Mobility component – intended to act as a contribution to the extra costs disabled people face in their day-to-day lives related to mobility. Both components are payable at a either a standard rate or an enhanced rate, depending on a claimant’s circumstances.

Entitlement to PIP is determined by a DWP Decision Maker – known as a Case Manager in PIP – who acts on behalf of the Secretary of State.  The HP does not make decisions regarding the award of payment

When an individual makes a claim for PIP, DWP gathers basic information about the claimant and their health condition or impairment.  DWP then issues a claimant questionnaire (How your disability affects you) to gather more information about how the individual’s health condition or impairment affects their day-to-day life.  This stage is skipped if the individual is claiming under the special rules for terminal illness, where the case is instead referred directly to a provider and dealt with as a priority.

Claimants will also be encouraged at this stage to provide any supporting evidence that they already have that they feel should be considered alongside their claim information – for example, from a health or other professional involved in their care or treatment.  Members of Physio First may be asked to submit reports about an existing patient at this stage of the process.  It is unclear whether there will be any payment for these reports

When the claimant questionnaire has been returned to DWP, the case is referred to a provider along with any additional evidence provided.  The provider then conducts the assessment, gathering any additional evidence necessary before providing an assessment report to DWP.

The two main providers are Atos and Capita who have been awarded the two contracts to be the main providers and who have two separate business models to do so.  Capita are directly employing a network of assessors and Atos is subcontracting to several networks e.g.  IPRS, Premex

The PIP assessment

The assessment for PIP looks at an individual’s ability to carry out a series of key everyday activities.  The assessment considers impact, not diagnosis.  Benefit will not be paid on the basis of having a particular health condition or impairment but on the impact of the health condition or impairment on the claimant’s everyday life.

The activities for the PIP assessment are:

Daily Living (10 activities): preparing food taking nutrition managing therapy or monitoring a health condition washing and bathing managing toilet needs or incontinence dressing and undressing communicating verbally reading and understanding signs, symbols and words engaging with other people face to face making budgeting decisions

Mobility (2 activities): planning and following journeys moving around

Each activity contains a series of descriptors, which define increasing levels of difficulty carrying out the activity.  A numeric score is allocated to each descriptor.  Claimants will be allocated a descriptor (and score) for each activity in the assessment.

The health professional

The PIP assessor is a Health Professional (HP) with specialist training in assessing the impact of disability.  They must have 2 years of post-grad experience.  The contract holders will be providing training for HPs but it is unclear in what amounts and who will pay for this training.  It will differ from situation to situation.  The training claims to carry 35 CPD points after 40 hours of e-learning and a residential course.  This content has been accredited at Derby University in the case of Atos and Cardiff University for Capita.

The key elements of the role of the HP in PIP are to:

  1. Consider information in the claimant questionnaire and any supporting evidence provided along with it.
  2. Determine whether a claim can be assessed on the basis of a paper review and provide appropriate advice.
  3. Determine whether any additional evidence needs to be gathered from health or other professionals supporting the claimant.
  4. Carry out face-to-face consultations as required.  This is expected to be in 85% of cases approximately.
  • Having considered all the information and evidence of the case, produce a report for DWP containing information on the claimant’s circumstances and recommendations on the assessment criteria applying to the claimant
  • The report to the Department should include a detailed history of the claimant, including information on any health condition or impairment present, their history, functional effects, current medication and treatment
  • Advice on the appropriate assessment descriptors for the claimant, based on consideration of the evidence on file and (if appropriate) the evidence that the HP has collected during the face-to-face consultation
  • Justify the advice explaining the evidence used to inform the advice on descriptor choices
  • Advice on the likely prognosis of the case
  • Advise if the claimant may need additional support to comply with future claims processes.

The HP may also be asked to provide advice to the case manager on a range of other aspects of a claim

At the time of the assessment, the claimant can be accompanied by whomever these choose and in the early stages, there are reports of up to 12 people accompanying a claimant.

The DWP estimate that each assessment and report will initially take 2 hours to complete reducing in time to just over an hour.  There are no reports of any experiences to date. 

The amounts paid to HPs per assessment are also unclear and should be negotiated in full by each practitioner at the time of considering the contract.  Other issues to be considered may be:

  • The business case for taking on these assessments as part of your practice
  • Cost/or payment for training
  • A DNA rate
  • What the appeals process may be and the likelihood the HP will be further involved at this stage
  • The space available to accommodate accompanying adults.

For more information go to https://www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers

July 2013

What is a “back to work” assessment and am I qualified to do this?

All experienced physiotherapists understand musculoskeletal conditions however those working in occupational health also concentrate on how these conditions or disabilities impact on an employee’s ability to cope at work, allowing them to assess an employee’s functional capabilities and any barriers that may impact on their ability to work. A back to work assessment is also termed a functional capacity evaluation.

Functional capacity assessments are specially designed for employees with health problems or disabilities who may be struggling at work, on restricted duties, returning to work after sickness absence or looking at re-deployment.

What is involved in a functional capacity evaluation?

  • Reviewing the employee’s medical and employment history
  • Gaining an understanding of the employee’s work role and how well they are coping at work
  • Clinical musculoskeletal examination and functional capacity testing following evidence based models
  • Detailed task analysis of the employee’s work
  • Assessing the employee’s capacity and performance to undertake individual tasks
  • Assessing the employee’s overall capacity and performance at work
  • Assessing the barriers to retention at or return to work, taking into consideration both psycho-social and organisational issues

As well as providing verbal advice to the employee and manager at the time of the assessment a physiotherapist would provide a detailed report highlighting all relevant issues and recommendations such as:

  • Nature of the condition, including prognosis, and functional limitations at work
  • The impact of work on the condition, including possible causation
  • Recommendations on how the condition may be managed at work including possible phased return, restricted duties, workplace adjustments or redeployment
  • Would the employee benefit from further treatment or consultant referral

Some commercial intermediaries such as IPRS and rehab works may request these assessments from private practitioners.  Whether to participate in these contracts would depend upon;

  • Whether you had previous training/experience/CPD so would be working within your scope of practice
  • Whether the contractor was providing training to support the assessments they required
  • Whether you had formed a good business case for accepting these assessments based on time, cost, payment (including DNA rates), the possibility of an appeals process etc.

Keep an eye on e alerts and the Education programme at www.physiofirst.org.uk for any further help that may be offered in the future

July 2013