Terms of Recognition

These Terms of Recognition, together with the details of Your application, the WPA Privacy Policy and the Specific Terms form the entire agreement between You and WPA (this "Agreement"). By submitting an application to become a Recognised Provider You agree to be bound by the terms of this Agreement.

If You were a Recognised Provider on 26 September 2024, You will continue to be a Recognised Provider under this Agreement. This Agreement becomes binding on You if You provide private health care to Our Customers 30 days after the date We notify You of these Terms of Recognition.

This Agreement will also become binding on You if You specifically agree to these Terms of Recognition, including through the PPR.

No contract shall exist between You and Us except as set out in this Agreement, which replaces all prior agreements between You and Us.

No entity associated with any hospital or other healthcare facility, Customer or Patient is party to, nor has the benefit of this Agreement.

You are and remain solely responsible for the provision of Your private medical treatment services to Your Patients.

Our Customers are liable to You for fees for private healthcare treatment You provide to them, subject to Our commitment to them to reimburse any Fees according to their cover with Us. When We pay an invoice for Your Fees We do so on behalf of Your Patient.

You may apply to become a Recognised Provider by completing an application either via Our website or via an alternative registration portal utilised by Us and operated by a third party, such as the PPR or as otherwise specifically agreed by Us in writing.

By submitting Your application, You agree to Your professional details including Your practising address being published on Our website. Such details may include information about You provided to Us by PPR and/or any Booking Portal(s) We use. You consent to Us displaying and using such information as described and on Our website and otherwise for the purposes of this Agreement.

We only consider applications from specialists and therapists who meet Our Eligibility Criteria (as set out in the relevant Specific Terms).

We reserve the right to reject Your application, suspend, remove and/or withdraw Your status as a Recognised Provider on a change of circumstances or at any other time, at Our sole discretion.

Once We have accepted Your application, We will invite You to set up an account within My WPA.

Your status as a Recognised Provider will come into effect on the date of Our written confirmation to You that Your application to become a Recognised Provider has been accepted by Us or upon Our acceptance of Your application through PPR.

On acceptance as a Recognised Provider, Your private medical treatment of any of Our Customers as Your Patient is, as between You and Us, subject to this Agreement.

The following clauses shall survive termination of this Agreement for whatever reason: clauses 1-3, 11-16, 18 and 19.

You agree to:

1. act with openness, honesty and integrity in all Your dealings with Us;
2. operate in accordance with all applicable professional and clinical standards and regulations including those set out in the Specific Terms;
3. limit the scope of Your advice and treatment of Our Customers to the specialism for which You meet Our Eligibility Criteria and have been accepted by Us as a Recognised Provider;
4. promptly notify us (in accordance with Clause 12) of any changes or updates to any of the information We require of Our Recognised Providers, including (without limitation) to Your professional details, eligibility criteria and bank details for payment;
5. hold and maintain professional indemnity insurance for the provision of private healthcare treatment to Patients and provide evidence of this to Us promptly on written request;
6. indemnify Us and keep Us indemnified against all losses or liabilities suffered or incurred and arising directly out of Your breach of Clauses 4, 5 and 7 of this Agreement;
7. process all Patient information and Personal Data as data controller, in accordance with applicable Data Protection Law and in accordance with this Agreement;
8. provide Our Customers with written details of fees and any other costs of diagnosis, treatment and/or care that You intend to charge in advance of their treatment;
9. operate accurate, fair and consistent billing across Your provision of private healthcare services to Our Customers in accordance with Our Specific Terms; and
10. immediately notify Us when You become aware that any formal investigation of You has been commenced or of any sanction, regulatory and/or legal action against You in Your professional capacity, including without limitation: investigation by a regulator or governing body, and any sanction, condition or change applied by the General Medical Council (GMC) to Your GMC registration.

You are responsible for keeping all information supplied to Us accurate and up to date, including (without limitation):

1. the details of any person (such as a secretary) entitled to communicate with Us on Your behalf and give notices under Clause 12;
2. Your contact/practice details; and
3. Your bank details.

You warrant that the information You have provided in Your application, via Booking Portals, throughout the claims and billing processes and otherwise for the purposes of this Agreement is accurate, not misleading and complete.

We will be entitled to rely on the information You provide to Us directly or via a third party portal including PPR which We reasonably believe to be accurate and/or up to date. We will not be liable for any losses incurred where We make a reimbursement of Fees in reliance on such information.

We may use provider finder/third-party booking portal(s) such as that operated by Doctify to enable Our Customers to book appointments with You (Booking Portals). We will share the information You provide to Us including Your name, contact details, practicing address, speciality and GMC number with any such Booking Portal. We may also share information about You which is available through a Booking Portal with Our Customers to enable them to choose a provider and to make a booking.

Our Customers are required to follow Our relevant claims processes when making a claim on their policy or scheme provided or administered by Us.

You agree to:

1. complete all documents presented to You by Our Customers or by Us as part of Our claims process;
2. provide Our Customers/Your Patients with written details of fees in advance of treatment taking place (as mandated by the Private Healthcare Information Network (PHIN));
3. provide Us, on request, with a copy of the Customer's GP referral letter and/or Your clinic letter;
4. provide Us in a timely manner with all information We (either directly or through the relevant hospital) reasonably request about a Customer's medical history, condition, prognosis, and previous and proposed treatment and care in order to determine the eligibility of their claim for pre-authorisation for Our reimbursement of Fees;
5. provide any such information requested in a full, complete and accurate manner, without omitting relevant information. You also agree not to charge Us or our Customer for providing such information; and
6. notify Us and keeping Us fully notified and updated on any non-standard fees or treatment combinations before the relevant treatment of Your Patient takes place.

You agree to comply with Our Specific Terms on Billing Practices and Invoice Specifications.

When You submit an invoice to Us for reimbursement of Your Patient's Fees for treatment, We will review it in line with the terms of the Customer's scheme with Us and Our Agreement before deciding to make any payment to You on their behalf.

You can submit Your invoices for reimbursement of Fees to Us via My WPA or via Healthcode.

We do not accept postal invoices or handwritten receipts.

Your invoices must be submitted within 6 months of the relevant treatment date. It is Your responsibility to submit invoices to Us in accordance with this Agreement. If You fail to submit a valid invoice for reimbursement of Fees in time, You forfeit the right to subsequently approach Our Customer for direct payment of such Fees.

Once Your invoice has been processed by Us, We will not accept top-up invoices.

As part of Our due diligence checks on clinical procedure(s) carried out and the theatre consumables used, we may request copies of the relevant Customer's operation notes and anaesthetic records from You and You agree to provide these to Us or to use Your best endeavours to procure that the relevant hospital provides them.

We will only reimburse fees for consultations and procedures up to the fee maxima published in Our Fee Schedule and in accordance with the CCSD Coding Principles (other than where We specifically agree a complexity uplift).

It is Your responsibility to check the extent to which Our Customer has cover and may be entitled to reimbursement of Fees from Us to You.

We will only pay any Fees to You on behalf of Our Customer to the extent We have an obligation to indemnify Our Customer for, or otherwise to pay those fees to or on behalf of Our Customer, and provided that those fees have been correctly incurred, and communicated to the Customer in writing, and invoiced by You or on Your behalf, in each case in accordance with this Agreement.

We aim to process properly presented invoices within seven working days of receipt of Your valid invoice.

We will make any payments to You via BACS Direct Credit transfer to Your designated bank account.

An itemised Payment Advice listing all the invoices which are included in the payment will be sent electronically. You can also view these via Your My WPA account for up to 12 months from the date of the Payment Advice.

If We make a payment to You in error, We are entitled to recover all or part of the amount of the payment. We are entitled to offset overpayments made to You against other amounts payable to You under future invoices.

If Your fees correctly incurred and notified in writing to Your Patient/Our Customer in advance exceed the Fees We reimburse to You on behalf of Our Customer, then Your Patient will be responsible for any such shortfall in payment to You. We are not responsible for and will not assist You in recovering shortfalls from Our Customers. You may only recover any shortfall from a Customer if You are not a Fee Agreed Recognised Provider (see Clause 10).

Our Fee Agreed Recognised Provider status denotes those Recognised Providers who have agreed not to charge Customers fees that exceed the rates published in Our Fee Schedule (other than where We specifically agree a complexity uplift in writing).

Becoming a Fee Agreed Recognised Provider

You can confirm that You charge no more than the rates published in Our Fee Schedule on initial application or, after acceptance as a Recognised Provider, through Your My WPA account, the PPR or otherwise notifying Us in accordance with Clause 12 of this Agreement. Your status as a Fee Agreed Recognised Provider will be recorded on Your My WPA account.

In becoming a Fee Agreed Recognised Provider, You agree:

• not to charge Our Customer fees that exceed the rates published in Our Fee Schedule other than where We have specifically agreed a complexity uplift; and
• not to seek payment of any shortfall or top up fees above Our fee maxima from Our Customer once We have paid Your invoice for their treatment on the Customer's behalf.

We may indicate which of Our Recognised Providers are Fee Agreed Recognised Providers on Our website and via the Booking Portals We may partner with.

Withdrawing as a Fee Agreed Recognised Provider

You can opt-out from being a Fee Agreed Recognised Provider through PPR or by contacting Us by phone.

You agree not to charge fees that exceed the rates published in Our Fee Schedule to any of Our Customers who booked a consultation and/or procedure with You and/or received pre-authorisation for any of Your fees prior to Your notice to Us of withdrawal as a Fee Agreed Recognised Provider.

We reserve the right to terminate or suspend Your Recognised Provider status and/or this Agreement by written notice at any time without cause, effective on the date of service of such notice.

You may terminate this Agreement at any time by providing written notice in accordance with Clause 12.

On termination or suspension of Your Recognised Provider status We will only reimburse You for Fees due for treatment:

• which has already been received by the Customer before suspension/termination and is correctly invoiced and accepted by Us; and/or
• which We have pre-authorised in accordance with this Agreement, and which is subsequently provided to the Customer.

You agree to promptly advise any Patient of the termination or suspension of Your Registered Provider Status and to inform them that WPA will not provide reimbursement for Your Fees from the date on which You cease to be a Recognised Provider, or during any suspension.

All notices under this Agreement must be in writing and are considered effective on the working day of delivery as long as they are delivered before 5:00pm on a working day, otherwise the notice is considered effective on the following working day.

Communications to and from Us about this Agreement including written notice to update Your information held by Us or notice of termination or suspension may be given by email through Your My WPA account or by post. If You are registered with PPR, You may also update some of Your information via PPR.

We may also send notices or communications to the practice address which You have provided to Us.

Notice of legal proceedings or threatened legal proceedings may not be given via My WPA, PPR or any other third party portal and must be sent in writing by post to Our registered office, Rivergate House, Taunton, TA1 2PE.

You agree in the first instance to raise any dispute about Us with Our Individual Provider Services by phoning 01823 625170 or using Our contact form available here. If Your dispute is not resolved within 10 business days of being referred to Individual Provider Services You may escalate it to an Executive Director.

We reserve the right to immediately suspend or withdraw Your Recognised Provider status, seek to recover any costs incurred and to report You to the relevant hospital and/or the appropriate authorities where We have reasonable grounds to suspect that We have been deliberately misled; information We would reasonably expect to be disclosed in the interest of good faith has been withheld from Us or Our Customer (during Your application or otherwise during the term of this Agreement) and/or there has been fraudulent or misleading behaviour.

We may also refer to any relevant hospital and/or to any relevant regulatory or law enforcement agency body any concerns We have about Your professional conduct.

On acceptance of Your application to become a Recognised Provider We will hold and process the Personal Data You provide to Us in Your application or afterwards in connection with Your activities under this Agreement in accordance with applicable Data Protection Law and in accordance with this Agreement.

We will update information We hold about You as a Recognised Provider (including bank details and other information We may rely upon in processing Patient claims) when asked to do so by any person We reasonably believe to be acting with Your consent and on Your behalf (such as Your secretary).

We will process all Customer Personal Data included in the Patient information You provide to Us as an independent data controller in accordance with applicable Data Protection Law.

As a Recognised Provider You will hold and process the Personal Data of Your Patients as an independent data controller in accordance with applicable Data Protection Law and in accordance with this Agreement. You agree to take any steps We may reasonably specify to protect the security of Customer Personal Data which is shared between including in relation to how that data is transferred.

You shall, at no additional cost, make available to Us reasonable evidence of Your compliance with the obligations set out in this Agreement, and on reasonable notice allow for and contribute to audits, including physical inspections of relevant records (including without limitation billing, clinical data and information about standards of care), processes and systems, conducted by WPA, its representatives or regulators. You agree to assist Us with such audits, including providing relevant financial records and medical notes.

We may modify, add or remove any part of this Agreement at any time.

We will give You written notice of such changes by e mail or post, or We may update the Specific Terms by updating the relevant online page. We may not provide specific notice to You of these changes to the Specific Terms. Any changes will come into effect immediately on expiry of any specified notice period or on the date on which the change is made to the relevant online page.

Anti-bribery and corruption

You agree to comply with all applicable laws relating to the detection and prevention of financial crime (including, without limitation, the Bribery Act 2010) and shall have in place adequate policies and procedures to procure compliance.

Modern slavery

You agree to comply with all applicable anti-slavery and human trafficking laws, statutes, regulations and mandatory codes from time to time in force including but not limited to the Modern Slavery Act 2015.

Rights of third parties

This Agreement is not intended to confer rights upon any third party except You and WPA and the Contracts (Rights of Third Parties) Act 1999 does not apply.

Force majeure

Neither party shall have any liability for any failure or delay in performance of this Agreement to the extent the same results from any event beyond the reasonable control of that party. The party affected by such event shall promptly notify the other party in writing when such event causes a delay or failure in performance and when it ceases to do so. If such event continues for a continuous period of more than three months, either party may terminate this Agreement by written notice to the other party.

Governing law and jurisdiction

This Agreement is governed by the laws of England and Wales. You agree to submit to the exclusive jurisdiction of the courts of England and Wales for resolution of any dispute arising under or in relation to this Agreement.

In this Agreement, the following words and expressions shall have the following meanings unless the context implies otherwise:

Customer

Our insured individual Customer or Scheme Member, who is also Your patient for private medical treatment.

Data Protection Law

1. all applicable data protection and privacy legislation in force from time to time in the UK including the General Data Protection Regulation ((EU) 2016/679); the Data Protection Act 2018; the Privacy and Electronic Communications Directive 2002/58/EC (as updated by Directive 2009/136/EC) and the Privacy and Electronic Communications Regulations 2003 (SI 2003 No. 2426) as amended;
2. all other legislation and regulatory requirements in force from time to time which apply to a party relating to the use of Personal Data (including, without limitation, the privacy of electronic communications);
3. the guidance and codes of practice issued by the relevant data protection or supervisory authority applicable to a party; and
4. references to "Data Controller/Controller", "Data Subject", "Personal Data", "Process", "Processed", "Processing", "Data Processor/Processor", and "Supervisory Authority" shall have the meanings set out in, and will be interpreted in accordance with the Data Protection Law.

Doctify

Doctify Limited.

Fee Agreed Recognised Provider

A Recognised Provider who has agreed to charge our Customers no more than the fee maxima set out in Our Fee Schedule.

Fee Schedule

WPA's published fee maxima for surgical procedures and consultations as updated from time-to-time and set out in the Specific Terms.

Fees

Fees due to You from a Customer which We may agree to reimburse You for on our Customer's behalf.

Healthcode

Healthcode Limited.

My WPA

A secure area hosted by WPA through which Recognised Providers can view their practice, contact and billing information, invoice activity and can communicate with WPA.

PPR

The Private Practice Register portal operated by Healthcode.

Patient

A Customer of WPA who You provide private healthcare services to.

Recognised Provider

A private healthcare provider granted recognition status with WPA.

Specific Terms

The specific terms applicable to this Agreement, as referred to at the end of this Agreement and as amended and updated by us from time to time. If there is a conflict between the Specific Terms and these Terms of Recognition, these Terms of Recognition shall take precedence.

Specialist

A medical practitioner holding a licence to practise whose name appears on the current GMC Specialist Register and is certified as a specialist by the appropriate college or specialty body providing a regulatory function.

Therapist

A treatment provider fully registered with the appropriate professional body.

Us/Our/We/WPA

Western Provident Association (WPA) Limited Rivergate House, Blackbrook Park, Taunton, Somerset, TA1 2PE and all subsidiaries of WPA.

WPA Privacy Policy

Our privacy policy (as amended from time to time) and as applicable to Your Personal Data and the Personal Data of Our Customers.

You/Your

The individual healthcare professional named in the relevant application to become a Recognised Provider, who provides treatment/advice to their Patient who is also Our Customer.

The Specific Terms applicable to this are listed below, or can be viewed using the links provided:

A. Eligibility Criteria

Specialists

To be recognised with us, specialists must be on the GMC Specialist Register with a current licence to practice, without any restrictions on or supervision of their practice.

Therapists

Therapists must meet one or more of the following criteria.

Are a registered member of the:

• Health and Care Professions Council (HCPC)*
• Association of Child Psychotherapists (ACP) and hold (or have held) a post as a child Psychotherapist at Grade A in the NHS with at least five years' experience after qualification
• General Chiropractic Council (GCC)
• General Osteopathic Council (GOC)

Or are an accredited member of the:

• British Association for Counselling and Psychotherapy (BACP)
• Faculty of Homeopathy as a Customer or Fellow
• British Association of Behavioural and Cognitive Psychotherapists (BABCP)
• UK Council for Psychotherapy (UKCP)
• National Counselling Society (NCS)
• Association of Christian Counsellors (ACC)
• British Medical Acupuncture Society (BMAS)
• British Acupuncture Council (BAC)

* We recognise those on the registers of Art Therapists, Chiropodists/Podiatrists, Dieticians, Occupational Therapists, Physiotherapists, and Speech and Language Therapists.

B. Clinical Standards

You agree to practice in line with the guidelines published by the relevant organisations, including but not limited to the GMC, National Institute for Health and Care Excellence (NICE), the Royal Colleges and your professional body (e.g. HCPC).

C. Invoice Specifications

Any invoice You submit to Us for payment must be typed on headed paper and contain the following information:

• Details of Recognised Provider providing treatment
• Patient details (name, address & date of birth)
• WPA Customer Number
• Claim Authorisation Number
• Invoice number and date
• Treatment date(s)
• Details of the treatment provided (inc. CCSD code(s), as appropriate)
• Detailed Unit cost
• Clearly receipted, if already paid

D. Billing Practices

You agree to invoice accurately, in line with the CCSD guidelines, and only for treatment that has taken place. Our expectations regarding unacceptable combinations, multiple procedures and multiple specialists are set out here.

We may update or amend Our billing practices from time to time by providing You with 14 days' notice of any material changes via Your preferred method of contact (as previously notified to Us).

E. Fee Schedule

We publish Our fee maxima for consultations and procedures within in Fee Schedule. As the industry standard, WPA endorses and applies the CCSD Coding Principles and We routinely update Our Fee Schedule to reflect updates published by CCSD (i.e. changes to the narrative, unbundling and the addition/removal of codes).

F. Website Terms of Use

You can access the terms of use of the WPA website here.