IDF announces campaign to address PMI restrictions on patient care

Tuesday 19th March 2024

We are pleased to announce a partnership with RPP Group, a leading healthcare-focused public affairs agency, to address the limitations imposed by Private Medical Insurers (PMIs) on the ability of independent doctors to deliver the highest standard of care to their patients.

Campaign aims to gather evidence and create path for improvement

This initiative marks a significant step in our ongoing efforts to advocate for fair treatment of independent doctors and ensure patient choice is not compromised. The campaign will focus on gathering evidence about the following key issues:

• Limited treatment options: PMIs often dictate which treatments they cover and the associated reimbursement, potentially restricting doctors' ability to provide the most appropriate care for their patients.
• Reduced patient choice and derecognitions: Disagreements over fees can lead to derecognitions, where a doctor is no longer recognised by a PMI, limiting patient choice and potentially creating a two-tier healthcare system.
• Lack of transparency and accountability: The current system lacks transparency around PMI fee structures and decision-making processes, raising concerns about fairness and patient well-being.
• Stagnant PMI fees: PMI-assured fees have not kept pace with inflation, decreasing since the 1990s. This, coupled with rising practice costs and administrative burdens, puts financial pressure on independent doctors, potentially impacting the quality of care provided.

Mr Andrew Roche, Chair of the Specialist Committee at the IDF, adds his experience: "I have been working as a consultant orthopaedic surgeon in the NHS and private sector for over 10 years. In that period, I have seen private patients' access to treatment gradually being reduced with insurance companies determining more and more who patients can see and in some cases what they can have done based on absolutely no clinical reasoning.

Fee reimbursement by the insurance companies to doctors in the UK has remained stagnant or even reduced in that entire period with insurance companies deciding to pay some doctors more and some less for exactly the same treatments, introducing huge inequalities. The companies also threaten or indeed do remove doctors from their provider lists if doctors try to put their fees up, even in line with inflation. This then removes patient choice over which doctor they want to see.

The IDF action has been long overdue and I am delighted to see the approach they are taking which will hopefully end up with a far more transparent, medically regulated system with patients able to choose whomever they wish to treat them and doctors able to be reimbursed equitably and fairly."

 Seeking change through collaboration

We are committed to working with all stakeholders to find solutions that address these concerns and improve the patient experience.

“We cannot ensure that insurers will respond positively to the campaign,” said Ken Mackness, Managing Director at the IDF, “however, we are hoping to work together to find a solution to the current issues.”

We want to emphasise that their goal is not simply to raise PMI fees. Our priority is ensuring patients receive the best possible care. To achieve this, we are proposing a multifaceted plan. Firstly, we want to see fair and sustainable fee structures implemented. This means PMI fees need to be regularly adjusted to account for inflation and rising practice costs. Secondly, we are calling for an independent body to oversee PMI policies and fees. Finally, we want to highlight the importance of clear and objective derecognition protocols. These protocols should include a fair appeals process managed by an independent body.

Dr Philip Batty, President of the IDF, stated: "We believe that excellent care requires doctors and patients working in partnership to explore evidence-based treatment options, and continuity of care. Our members and their patients report increasing restrictions, poor triage and frustration with PMIs. It is time to challenge systems that compromise excellence."

Patient and Doctor input crucial

We are committed to working together with all stakeholders to improve the patient experience. This includes gathering crucial input from both doctors and patients through surveys. The surveys are open to all independent doctors in the UK, not just IDF members.

To help us understand and evidence the impacts of actions taken by PMIs on patients and independent doctors, please complete the following surveys – Doctor Survey and Patient Survey.

For more information or to get involved, please contact the IDF campaign leadership team at pmi@idf.co.uk.

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