About the campaign
What is the campaign?
As the leading membership organisation representing Independent medical practitioners in the UK for both specialists and general practitioners, we are responsible for supporting our members to address key concerns and issues.
Independent doctors have reported that private medical insurer (PMI) involvement in care pathways, fees and derecognition procedures are driving inequalities and sub-optimal standards in the quality of care they can provide patients. PMIs are limiting the free choice of professionals to provide clinically recommended care and of patients to select their care provider.
To address these concerns we have launched this doctor-led, patient-focused national media and political campaign where we are hoping to encourage collaboration between independent doctors, private hospitals and PMIs to find a resolution suitable to all that continues to prioritise patient care and outcomes.
Why is it happening?
The UK healthcare system faces a number of capacity, staffing and treatment-availability challenges that impact the achievement of population health targets. The private healthcare sector has been identified as a key tool for addressing these challenges and contributes to the operation, performance and efficiency of the UK healthcare system alongside the NHS, especially in the response to health crises. Private medical insurance is now the most common method of payment for private healthcare and 2023 saw a record number of procedures performed. An estimated 11% of the UK population, around 7 million people, use some form of private medical insurance.
The health of the UK population is reliant on a private medical insurance service that is efficient and effective at facilitating high-quality treatment. However, the independent doctors responsible for patient care have been constrained in their abilities to deliver the treatment that is, in their expert professional opinion, most appropriate, utilise appropriate specialist healthcare professionals, and even receive patients due to the policies of private medical insurers (PMIs) which do not prioritise individualised patient care and choice and clinical expertise.
What issues have been identified?
01.
Derecognitions
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Derecognitions/de-prioritizations reduce the choice of specialist that policy holders have and often prevent GPs from making the referrals that they would recommend. Other options should be pursued before derecognitions/de-prioritizations occur.
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The communication with doctors about the rationale behind derecognitions/de-prioritizations is poor, with many feeling that they were not given sufficient time to amend the necessary practices or derecognized unfairly without an opportunity to appeal this decision.
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Where derecognitions are based on compliance with fee structures, many doctors feel that the communication of this to policy-holders implicitly undermines their capability as a practitioner.
02.
Power imbalance and fee schedules
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The fee-schedules are not increasing in-line with practice costs. This means doctors are often struggling to bill for their time fairly and provide certain treatments. If becoming an independent doctor is no longer an attractive option for younger doctors, the supply of quality specialists will be reduced potentially compromising safety.
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Doctors have to commit significant time and financial resources to applying for fee uplifts and addressing the administrative burden of receiving private medical insurance patients
03.
Pathways
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Many patients have reported being referred to doctors who do not specialize in their condition or have been placed on sub-optimal treatment pathways (against clinical recommendation). Inherent to the insurance product that a consumer purchases is the care pathway that they receive when they claim. Given the expectation of consumers and the ‘consumer duty’ obligations under the FCA, these pathways should be personalized to their needs and offer the most appropriate treatment solution. Referral and treatment decisions should be consultant-led in partnership with the patient and potentially independently clinically regulated.
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Patients have had to do their own research to find relevant specialists or to verify the PMI-recommended doctors. Non-expert consumers should not have the responsibility of dictating their care pathway to this extent.
What do we want to change?
To secure the top level of care and outcomes for patients, we want to secure meaningful change in the following areas
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We want to ensure that doctors are being fairly treated by PMIs, especially on matters of representation to the policy holders and reimbursement.
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We want to enable doctors to be able to treat their patients to the best of their ability, in line with their clinical expertise and requirements of the GMC.
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We want to work on addressing the grievances of patients and doctors to show the independent healthcare sector to be an attractive and effective alternative choice to NHS healthcare and position private healthcare as a viable solution to alleviating many of the problems in the NHS.
A successful private health and private medical insurance sector could have a significant impact on the effectiveness of the UK health system as a whole.
Whether a member of the Independent Doctors Federation or not, we want to hear about your experiences with private medical insurance.
Get in touch with us if
You are a patient who has experienced a poor level of care due to the actions of your insurer
You are an independent doctor who wishes to support the campaign or share your experience with us
You work for a businesses that provides private medical insurance to their employers and their experience of the service
You are a stakeholder involved in the independent health sector who wishes to contribute to the campaign in any way