The news that the ABI and British Medical Association (BMA) agreement on GP report (GPR) fees has broken down will usher in a period of uncertainty.
I also find it difficult to believe that simply going for access to full medical records via customers will turn out to be a viable solution in most circumstances.
First, it is worth remembering why the agreement exists at all.
The BMA have suggested a moral case – that it is in the public interest. This argument may have merits but it is not the original basis of the agreement. In fact, that an agreement is possible at all is due to competition law.
Normally such an agreement would constitute price fixing and be illegal. An exemption applies because GPs hold a monopoly on patient records. That is why the agreement does not apply to medical examinations not carried out by a patient’s own GP.
So what has changed? The move towards patients holding their own records electronically and the proposals to allow patients to register with more than one GP do set a trend towards diversity in routes to obtaining medical records but currently this diversity is not prevalent.
So, for now, insurers are largely stuck with obtaining information from a patient’s own GP – either direct through the GPR route or via their patients.
Second, we have been here before. The agreement did break down ten years ago. During the hiatus, GPs and local medical committees gradually increased their fees and insurers paid up.
After a couple of years the situation spiralled out of control and insurers had to go back to the negotiating table. The end result was a big hike in fees. This may happen again if the situation is allowed to drift.
Third, accessing full medical records still has big risks in the case of genetic and family history information. Inevitably more genetic information will get passed on to insurers. They will ignore it but customers may make assumptions that ratings and test results are linked, triggering dangerous disputes.
Family history is even more risky. The danger here is that information on a patient’s relatives that a patient is unaware of may be passed to insurers. Apart from the ethical dimension there would be data protection issues.
Fourth, the timing of this breakdown in negotiations could not be worse. Relationships between insurers and the BMA are already pretty fraught in the PMI sector as an indirect result of the referral of private hospital pricing to the competition commission. While in this case insurers are likely to be seen by most as the good guys, the BMA will not see it that way.
The two issues are likely to be linked as far as the atmosphere between the two sides is concerned. In addition, the ongoing progress on electronic medical information was a great opportunity to open a dialogue on an alternative access route based on convenience for all and sound ethical standards – as happened for e-GPRs some time ago.
There is a danger that, instead, the BMA will take a highly defensive and political line on this development with the ultimate risk that the government may legislate against insurers accessing data this way. The current controversy over the NHS reforms and ‘privatisation’ will add to this danger.
Finally, information has a value. Whether to GPs, insurers or customers. Insurers who save money by going via patients for information should pass the savings on to their customers.
Sooner or later the two sides will have to come to an accommodation but what that will look like is very uncertain.
Richard Walsh is a director and fellow of SAMI Consulting
Research by Zurich
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