Milliman comes to the UK
Update – July 2007
Despite some misgivings from the profession BUPA Insurance has announced that it will embrace these American care plans. In an announcement in April 2007 Dr Natalie J Macdonald of BUPA Insurance said; “We’ll use the guidelines to equip our clinical staff with information to ensure decisions to fund treatment are clinically sound, consistently delivered and sufficiently flexible to recognise variation in individual patient circumstances.”
October 2006
The Seattle based American company Milliman has come to the UK. Some details about the parent company and the UK offshoot can be found at these sites:
This giant company has many interests but is famous for having introduced detailed clinical care plans for many medical and surgical conditions. UK doctors are concerned that these Care Guidelines (which have been licensed for use by BUPA) will impinge on clinical decisions and take these out of the hands of doctors and place this in the hands of the insurer.
A recent article in The BMA News (November 4th 2006 - Page 7) attempts to give a balanced review of Milliman. There are claims on one hand by US based critics that this has lead to “cookbook medicine” and reductions in hospital care and on the other hand by the company who claim that they merely offer a guide to best possible practice.
There are many critics of Milliman as can be seen from an article in Hospital Doctor:
A defence of the guidelines has been made by the Editor in Chief Dr Schibanoff who denies that these will be imposed and that they will assist in delivering high quality care.
Dr Natalie J Macdonald of BUPA Insurance stated that “these guidelines would be used to equip staff (BUPA) with information to ensure that decisions to fund treatment are clinically sound, consistently delivered and sufficiently flexible to recognise variation in individual patient circumstances”.
There is some concern that these guidelines are being considered by one or two NHS Trusts.
The response of the profession has been one of suspicion that this will lead to greater control of medical practice by the insurer with adverse effects on medical standards. Furthermore, there is bound to be an increase in bureaucracy as every patient and their medical attendants will need to constantly justify the need for treatment to a insurance clerical officer. In addition, there are already many UK care plans and guidelines developed by British professional groups such as Royal Colleges and specialist organisations.
The FIPO position is clear on this issue. The profession accepts that cost-effective practice is a vital consideration and doctors must be careful with resources. Care plans and guidelines are to be used judiciously with the best interests of the patient foremost in the doctors’ mind. These can never be slavishly adhered to, as medicine cannot be practiced in a rigid fashion. There are British guidelines, which are best suited to British patients and hospital systems. These should be interpreted and employed locally by consultants. Local clinical governance committees should review all clinical work and there are robust systems in place for this to be done in the Independent Sector. This is not the job of an insurer whose role it is to facilitate care for their subscribers not to prescribe it.
A review of current audit practice for ophthalmology in the UK