The London Consultants' Association has called on doctors to refuse to sign contracts with insurance companies that limit their clinical freedom and management.
The move is a reaction to attempts by BUPA and the Private Patients Association, both providers of private health insurance schemes, to exercise greater control over their work. At the end of last month, BUPA announced that, in future, consultants will have to get prior approval from the company before they can carry out hysterectomies (3 July, p 9).
BUPA said that the introduction of the "preauthorisation" process is aimed at reducing the number of unnecessary operations. But consultants view it as a step too far down the road of managed care and the "Americanisation" of health care in Britain.
"This is the thin edge of wedge," said Geoffrey Glazer, chairman of the association, at a special meeting held in London to discuss the future of private practice. Founded eight months ago, because of concern over insurance companies' attempts to control patients' treatment and curb consultants' fees, the association has been steadily increasing in numbers and now has 350 members.
Members claimed it was only out of fear that many consultants had signed recent contracts with BUPA, PPP, and other insurers limiting them to named hospitals or "preferred providers."
Dr Derek Machin, chairman of the BMA's private practice committee, said that forcing consultants to work only in certain hospitals, in unfamiliar surroundings, and with unfamiliar staff was a "recipe for trouble." However, he thought that consultants could challenge the development on clinical governance grounds.
Mr Glazer, pointing out the irony that managed care was being promoted in the United Kingdom at a time when it was being proved not to work in the United States, said: "Clearly all of us have to work together. We have to unite."
John Randle, a hospital management consultant, suggested that members write to insurers refusing to participate in preferred partner schemes. "Unless you write, you will be on the thin end of a very thick wedge," he warned.
