BUPA, Britain’s biggest medical insurer, has declared war on surgeons who charge too much and are not as good as they think they are.

It plans to set up networks of approved surgeons, first in ophthalmology and later in orthopaedics and ear nose and throat surgery, have angered surgeons, the British Medical Association and the Royal College of Ophthalmologists.

But BUPA, which has more than three million members in the UK and a 40 per cent share of the market, has rejected the objections. It said that its own research revealed huge variations in the price and quality of eye operations carried out in private hospitals by surgeons who also work in the NHS.

Premiums for private medical insurance have been rising at 12 to 15 per cent a year, pricing many people out of the market. BUPA claimed that some surgeons charged four times as much as the NHS price for operations. It also said that the standards varied greatly.

Its own networks of “approved” surgeons are designed to reverse these trends. Policy-holders who choose to go elsewhere will find that their costs are not reimbursed in full, if at all.

BUPA has insisted that it needs to provide its premium-payers with the highest possible quality of care, but the surgeons argue that it was more interested in narrowing choice for patients and driving down costs.

Natalie-Jane Macdonald, medical director of BUPA Health Insurance, denied this charge. She said that BUPA’s research so far had shown that there were indeed big variations in the quality of eye surgery provided by private hospitals.

“Consultants were very resistant to us looking at it at all. But we found that clinical standards and auditing of results were very patchy. Doctors are not really very willing to be held accountable.

“We found that clinical guidelines were hardly used. Only half of ophthalmologists use their own Royal College’s guidance for measuring the effectiveness of operations,” Dr Macdonald said.

“If you point this out, they say ‘Oh, you know . . . and brush it aside. It’s very hard for a lay person even to know what questions to ask. We’re acting as experts on their behalf and our prime purpose is a really high standard of care.”

BUPA’s review of ophthalmology found that almost a quarter of facilities did not routinely monitor two important complications of cataract surgery. It also found weaknesses in auditing services and the outcomes of surgery, which were both important if services were to be improved.

“All facilities where our members receive treatment and the consultants who treat them meet Healthcare Commission and General Medical Council standards,” Dr Macdonald said. “However, it is worrying that there is such variation in clinical practice for no apparent reason.”

The survey also found huge variations in the prices charged by private hospitals. The NHS tariff for a cataract operation is between £702 and £1,015. But in some cases BUPA was being asked to pay £3,500 for an operation in the private sector.

These prices have a direct effect on premiums. BUPA said that a typical policy-holder, aged 32, who was paying £655 a year for medical insurance cover in January 2004 will be paying nearly £867 by January.

But the Federation of Independent Practitioner Organisations, which represents surgeons and anaesthetists, claimed that far from improving care BUPA was introducing a “dysfunctional” system from the United States that would break the link between the patient and the consultant.

Doctors sign up to chambers plan

More than 300 surgeons have signed up to a new organisation designed to improve their bargaining power with medical insurers such as BUPA.

Alliance Surgical aims to become a barrister-like set of “chambers” for surgeons, with listed shares. It plans to negotiate with insurers, private hospitals or with the NHS to deliver surgery at valuefor-money prices. The advantage for the surgeons is that they will have an organisation to bid for work on their behalf, saving them time and effort.

They will also be able to acquire shares in the company, which could have a monetary value if it is successful. When they retire, they would be able to sell these shares.

Paul Howlett, the businessman who founded Alliance Surgical, also believes that surgical standards would be raised by by strict adherence to medical protocols and procedures, and more vigilant regulation. In the past year the group’s members have completed about 80,000 surgical procedures, a spend of about £200 million in the private healthcare sector. It plans to acquire the services of up to 450 surgeons and to quadruple the number of procedures over the next two years.

The company is controlled by a medical directorate, led by Ged Byrne, Dean of Clinical Studies at South Manchester University Hospitals and a cancer surgeon. He said: “Alliance Surgical is my chance to become a stakeholder in the delivery of the highest possible standards of private practice."

Mr Howlett said that his company was “group practice without the hassle” and that he aimed to make it the premier provider of independent surgical services in Britain. Insurance companies and private hospitals would be able to negotiate with a single point of contact for medical services across all disciplines, he added.

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