DOCTORS fear that plans by BUPA, the private health insurer, to set up a network of “approved” eye specialists could undermine existing regulations for hospitals and surgeons.

The Royal College of Ophthalmologists and the British Medical Association (BMA) accused BUPA of setting itself up as a medical regulator — displacing the General Medical Council (GMC) and the Healthcare Commission — when it had no actual competence in the field. They said that the real object was to force prices down.

The insurer said that it simply wanted to get the best value and best quality treatment for its policyholders.

BUPA has given ophthalmologists and hospitals until June 19 to sign up to its proposals. Those who do not sign up would be assumed not to want to do work for BUPA, and their recognition would be suspended, the insurer has said.

This could mean that patients would be confined to consultants in BUPA’s approved ophthalmology network.

The BMA and the royal college have urged their members and fellows not to join the network. But doctors who do a great deal of work for BUPA risk losing part of their livelihoods. Doctors protesting against the network believe that it may be followed by others.

But Paula Franklin, the deputy medical director of BUPA Insurance, said that no decision had been taken to extend the model to other specialities. She said that the insurer had two aims: to assure the quality of service and to avoid nasty surprises in terms of cost.

To achieve this it had asked ophthalmologists and hospitals to fill in forms detailing their qualifications and standards of service. From the replies BUPA would create a list of approved practitioners and premises. The doctors claim that it would then cut costs by paying surgeons and anaesthetists less.

Brenda Billington, the president of the Royal College of Ophthalmologists, questioned whether it was appropriate for an insurer to make judgments.

She said: “Regulation is the GMC and the Healthcare Commission’s job. Surgeons are on the GMC’s specialist register, go through annual appraisal, and are registered for continuing professional development. How can a questionnaire, even if honestly answered, add anything to that?”

She was concerned that the scheme would mislead patients, because there was no way of validating the results, and that patients’ choice could be severely limited if 50 to 60 per cent of specialists did not sign up.

Derek Machin, a consultant surgeon and the chairman of the BMA private practice committee, is one of eight signatories of a letter sent to doctors urging them not to join the scheme, saying: “A robust united front will defeat it.”

Mr Machin said: “I think it’s all about price, not quality. The quality issues are a complete façade. BUPA got away with it when they set up a network for MRI scans, forcing prices down, and we are already hearing of people getting scans done by unqualified people and getting reports of the results that are wrong. They have forgotten they are an insurance company, and are trying to become a regulator of everything.

“The GMC is not good enough for them, the Healthcare Commission is not good enough. They’ve got delusions of grandeur.”

Dr Franklin did not deny that cost was a consideration. She said: “There are opportunities for efficiency gains in the way medicine is delivered. The problem is that we are in a situation where doctors have nothing to gain by working in a more efficient manner. They get paid a fee regardless of how efficient they are.

“If private medical insurance is to continue it is essential to differentiate the product. The quality of the entire patient experience is very important — and if you have information about the quality of service, you can pay accordingly.”

Last night, BMI Healthcare, the largest operator of private hospitals, distanced itself from the BUPA proposals. Paul Murphy, its chief operating officer, said: “We have declined to participate in the proposed BUPA ophthalmology network, particularly in the light of the advice of the BMA and others.”

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