THEY SAY A PICTURE IS WORTH A THOUSAND WORDS, and as I have a large picture (the map) for you to look at this month and a thousand-word limit, I won’t be writing as much this month. Please spend the time you would normally spend reading a thousand words looking at the map and considering its implications.
Sales of pet insurance premiums are static yet according to the ABI, pet insurers paid out 15% more in claims for 2014 than in the previous year – £602 million or £1.65 million a day.
Rising claims costs over recent years are now threatening the sustainability of affordable pet insurance provision. To address this, RSA has created a network of referral practices.
The map shows the current distribution of practices on the RSA referral network. If you have a client who has insurance with RSA (i.e. More Than, Tesco, M&S, John Lewis, Argos and Homebase pet insurance) and you, as their primary vet, want to refer a case, you need to send it to somewhere on the map or if you do not the client will have to pay an additional £200 on top of excess. This map does not show different types of centre; most are multidisciplinary but not all.
I want you all to ponder this really from the point of view of fairness to the client and patient with respect to simple geography. And I am writing here about RSA, but this is a concept that needs to be considered for any policy regarding referrals and veterinary services.
Have a look at the map and see what you think about pets insured with RSA policies who need referral and live somewhere like West Wales, or North Devon, or Cumbria, Lincoln… you get the idea. Their first opinion vets there will have existing relationships with local referral centres in these areas, some remote (e.g. West Wales), some just remote to the RSA network (e.g. Lincoln).
How can it be fair that these patients and clients are penalised £200 for not living near an RSA centre? This map is just the overall plot of centres. If we narrow it down further, let’s look at the south-west where I live as an example. The only centre is St David’s for orthopaedic only. If you drop a line south from Weston-super-Mare there is not a single referral centre on the network other than one orthopaedic centre.
If a vet in Bude in North Cornwall wants to refer a chronic eye case to the Diploma holder in South Devon (one hour-ish away), the client will now face a £200 penalty to do this or have to go to Bristol (three hours away).
Similarly a vet in Truro may usually send a non-emergency heart case to the peripatetic service in Wadebridge (one-hour drive) – their client now will have to pay £200 extra to do this or face a drive to Bristol (three to four hours).
This is another case of a human medicine model (or indeed car accident repair model) being forced on the veterinary infrastructure. I have a lot of sympathy for RSA wanting to control costs (as do most primary care vets), but why a simple maximum price per procedure framework isn’t used I do not understand.
This system of penalising clients for using the “wrong” centre and intervention into existing referral relationships (between first opinion and referral vets) does not seem to me to be the right way to do it.
I put this to RSA and I will quote some of their reply below:
“Once the Preferred Referral Network has been completed, we will issue a map, fully detailing where our partners are. That said we are aware that for regions such as West Wales and Cumbria there are far fewer referral centres, so customers could see extended travel times in these regions, but again we are happy to review on a case by case basis, taking a pragmatic approach, with our customers at the heart of our final decision. You mention specific geographical gaps and we recognise that this is an excellent example of where the case by case basis would apply until the successful appointment of a network partner… we will discuss this directly with the customer on a case by case basis and apply a pragmatic approach to decide whether the customer may need to pay towards the referral practice bill.
“We note your comments on price per procedure and it is possible that in the future, like human private medical care, this may become the industry standard. However, we wanted to work within the current models of pet insurance offered by us and our competitors, so our customers can continue to make a direct comparison about the value of the insurance they are purchasing, which is why we chose the option of a preferred referral network instead. This approach also has the added benefit of insurance not standing in the way of the development of medicine and treatments by capping available funds.
“Existing customers will be made aware of the changes as and when their policy reaches its renewal. We are not making any changes mid policy. We have kept the FCA fully up to speed throughout our Network roll-out with regular updates.”
Open to negotiation
If you do live in one of the gaps on the maps, please be aware then that the RSA may be open to negotiation about the £200 fee with the client. Also none of this refers to emergency referrals. Many non-RSA referral centres have also told me that they will refund the £200 to the client anyway – that will really help with overall claim inflation…
Thanks to colleagues who responded to my e-mail on this earlier in the month. Let us hope that one prediction from our old friend Disgruntled from Staffordshire does not come true:
“They are trying to treat sick pets like damaged cars. I am just wondering when they are actually going to start to tell the under insured clients to consider euthanasia? From their point of view it’s the next logical step. Writing off what cannot be fixed and minimising losses.”