BMA apologises to Bupa after allegations of market-fixing

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The BMA is locked in a bitter row with Bupa, the private health insurer, over the price and location of private treatment. Jeremy Laurance, Health Editor, examines the year-long dispute that culminated in Bupa issuing a writ for libel last month.

It was, so far as Bupa was concerned, a step too far. The British Medical Association claimed in its house journal BMA News Review last month that any consultant who signed up to Bupa's new Consultant Partnership risked being struck off the medical register for accepting financial inducements that could affect his or her clinical judgement.

Bupa, Britain's largest health insurer, demanded a retraction and, when that was not immediately forthcoming, issued a libel writ. The BMA reluctantly backed down and has written to its 20,000 consultant members withdrawing the allegations and is to publish an apology.

The dispute has its origins in the state of the private health-care market which has been in the doldrums since the recession of the late 1980s. Bupa has seen its share of the market slip as competition from rival companies has intensified. The Consultant Partnership is a scheme to hold premiums down - and thus attract new business - by capping consultants' fees and tying them into a network of private hospitals which charge preferential rates. In return, consultants who sign up get a 5 per cent bonus at the end of the year.

Four thousand have done so since the scheme was launched in April last year, in defiance of the BMA, which urged consultants to boycott it. The association argues that in addition to limiting doctors' private earnings - Bupa fees have not risen since 1992, it says - the scheme infringes their clinical freedom. James Johnson, chairman of the BMA consultants' committee, said: "It's a bad deal for consultants. It puts them in a position where they are increasingly working for an insurance company rather than the patient."

Although there are more than 15,000 consultants who do some private practice, the 4,000 already signed up account for more than half the total private work carried out. The BMA fears that if Bupa succeeds in drawing in a majority of the major players it will have control of who does the work, where they do it and how much they get paid. Their choice of hospital will be restricted to the 170 in the Bupa network out of the 800-plus NHS and private hospitals in the country and, ultimately, it fears Bupa may dictate what treatments are provided.

Mr Johnson said: "When the biggest private health insurance company is trying to tie up the hospitals, the consultants and the prices they charge, I think that is worrying." Bupa said in exceptional circumstances the scheme would allow consultants to charge higher prices or refer patients to hospitals outside the scheme.