HI: For example, if someone very senior in the company says: 'My GP insists that this is the best consultant', it could be quite difficult to convince them that the reason why the referral is open is because of all the reasons you have said, and that they won’t just think: 'Oh it’s too expensive and we’ve paid all our premiums and now the insurer won’t let me see the top person’. There are also some concerns about employees who have seen a consultant previously and have a recurrence and want to go back to the same person.
NJM: When it comes to recurrence, we would not preclude a member going back to a consultant who they had seen before and who had given then a good result. Continuity of care is really important and we definitely wouldn’t stand in the way of that.
When it comes to your first question, we use Open Referral in our own company, right up our chief executive and board members. We think it’s good enough for everybody at Bupa no matter how senior they are and some of our clients also offer it to everybody in the organisation.
This is not about ‘My GP has said I must see Mr X’, it’s about a discussion and a conversation about who is the most appropriate person for a particular person to see whether they are a junior employee or a very senior employee and if someone is the best person for the senior executive in a business to see then that would be great, we are not going to stand in the way of that. What would be interesting to see is, what is the definition of the top man?
HI: Is there a process whereby clients who don’t want an open referral can appeal? Can there be special arrangements for clients who don’t want to go down the Open Referral route?
NJM: We have arrangements with existing clients whereby they have Open Referral. There is an option for people who want to pay on top to not use Open Referral. We put that in place for one client who wanted it for a particular subset of their employees, which they have done.
If a patient comes to us and says 'this person has been recommended to me', we would look at that. That is what happens all the time and what we have found with individual members is that up to 40% of them facing a shortfall are happy to have alternative suggestions. We are not trying to direct customers to a subset of inferior consultants who happen to be cheaper, or less experienced or less qualified. We are trying to direct people to really great consultants who give evidence-base care.
HI: What would happen if in the consultation the GP said: 'I think the best person for this is this person'? Is the member able to get the open referral but then contact your helpline and say 'is it possible for me to see this person?'?