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AXA PPP have Withdrawn Recognition of Mr Birch and East Midlands Spine

Correct as of 31/01/18

We have been recently informed by AXA PPP that they will no longer be recognising Mr Nick Birch, or East Midlands Spine Ltd, as a spinal specialist/provider, on their register. We are urgently trying to investigate this matter and apologise to any clients for whom this news may impact.

The correspondence to date appears to concentrate on the Chris Moody Centre and the fact that it is not a recognised hospital facility. The decision to move to this regional leading rehabilitation facility was based upon the access to and the subsequent close working relationship with some of the counties leading rehabilitation specialists. This multidisciplinary approach, which is recognised as the gold standard by all major governing bodies, across Healthcare as a whole, is often what our clients rate most highly about the service they have received at East Midlands Spine. 

We can confirm that AXA PPP's choice to remove Mr Birch from the register IS NOT based upon any medical inadequacies or findings of fault by Mr Birch or East Midlands Spine Ltd. At this stage it appears to be based primarily upon location.

We are continuing to investigate this matter but if you have any concerns or questions regarding your own situation then please do not hesitate to give our secretaries  a call on either 01604 215440 or 01604 215441.

We have anonymised and pasted the correspondence we have, to date, for your own information.

Initial Correspondence - 17/01/18 (from AXA ppp)

Dear Mr Birch
As you know, at AXA PPP healthcare we have a responsibility to all our members to monitor, as much as possible, who we pay for treatment. To enable us to do this, we have developed specific recognition criteria which includes a requirement that clinicians should deliver treatment from a recognized AXA PPP facility.
We have been informed that you do not provide your services at a hospital which is within our directory of hospitals. In view of this we will have to withdraw your recognition with us unless you can confirm that you hold practicing privileges at a recognized AXA PPP facility.
If you believe we have missed something or have been misinformed, and that you do in fact have practicing privileges at a directory hospital, please register and update your details through the Private Practice Register and we will review your recognition based on this information. The Private Practice Register is a third party website run by Healthcode and allows you to update all of your details including things like bank details and change of working location. Any updates made via the site will simply filter through to all the Healthcare Companies registered with the Private Practice Register. If you have any queries related to the registration process, you will be required to contact Healthcode directly on 01784 263 150 or by email:
If we do not receive a response within 3 months of this email, we will assume that the information is accurate and we will withdraw your recognition with us on this basis. While we await your response we will limit the amount of new referrals we make to your practice.
Kind regards

Correspondence 2 - 19/01/18 (from East Midlands Spine)

Dear ..........
Thank you for your email which I received on 17th January 2018 relating to Mr Birch’s practice.
Mr Birch is a fellowship trained orthopaedic and spinal surgeon and rehabilitation expert. He has had an active consultant career in the surgical specialties from 1996 to 2014. During this period, he had a very low conversion rate from outpatients to surgical intervention (5%), as a result of his focus on evidence based treatment for spinal conditions, primarily those that cause pain.
In 2014 he stopped offering any surgical treatment to patients but has continued to offer non-surgical treatment including diagnosis, investigation and non-invasive management.  Given the rehabilitation focus of his practice over more than two decades, that has continued over the last three years since giving up surgical intervention, it was appropriate to move his office into a multidisciplinary rehabilitation environment.  Therefore, in January 2015 his practice was relocated to the Chris Moody rehabilitation and sports injuries centre in Moulton, Northamptonshire.  He has continued his nonsurgical practice at the Chris Moody centre in close collaboration with musculoskeletal and neurological physiotherapists and osteopaths, all of whom are accredited with the major private medical insurers.  Mr Birch refers patients for minimally invasive or invasive treatment as needed, to accredited consultants who are also accredited with the major private medical insurers. The scope of Mr Birch’s practice has not changed except for the cessation of surgical intervention since the end of 2014.  Given his knowledge of the limitations of surgical intervention for spinal conditions and  his present wider understanding of the rehabilitation options, it is clear that he now offers a more cost-effective and clinically effective service to patients as he is more able to manage their spinal pain in a non-invasive way than other more surgically focused practitioners.
He continues to have accreditation with all of the private medical insurers at this point and it would be inappropriate for any of the insurance companies to suggest that accreditation should be withdrawn in the same way that it would be inappropriate for them to withdraw accreditation from a consultant neurologist in  a private practice that did not offer invasive treatment, just because the neurologist did not perform interventions within a hospital.  
I hope this information proves of assistance and helps you to better understand the practice but if we can be of further help please do not hesitate to contact us.

Kind regards

Correspondence 3 - 23/01/18 (from AXA ppp)

​Good morning,

Thank you for your email.  I would just like to confirm that the wording in my earlier email may have been misleading – it is not because Mr Birch doesn’t work in a hospital as such, it is because he does not work in a facility (clinic, hospital, medical centre etc.) that is recognised with AXA PPP Healthcare and nor is it because he does not offer invasive treatment.
As The Chris Moody Centre is not a recognised facility with AXA PPP Healthcare, this means Mr Birch no longer satisfies our recognition criteria so I will have to withdraw his recognition with us. 
If anything changes in the future, please do let us know and he can re-apply for recognition via The Private Practice Register (
Kind regards,

Correspondence 4 - ​23/01/18 (from East Midlands Spine)

Good afternoon
Mr Birch has seen your email and he has responded as follows:
“There are multiple therapist practitioners at the Chris Moody Centre who are recognised by the insurer, therefore why have they taken a unilateral decision not to recognise my practice, since it is equivalent to those other practitioners i.e. non-invasive diagnostic and therapeutic clinical management of spinal conditions?  This is not only perverse, but it may contravene relevant legislation, so unless the correspondent is prepared to reverse her decision, I will seek an immediate legal opinion and consider appropriate action."

Kind regards

Correspondence ​5 - 23/01/18 (from AXA PPP)

Good afternoon,
Thank you for your response.  As part of our recognition criteria, to be a recognised Physician or Surgeon, whether they do surgical and invasive treatment or just outpatient treatment, they must all fulfil the following:
               • Full registration with the General Medical Council (GMC) and whose current position is either:
                               ○ A substantive appointment as a consultant in their specialty within the NHS or Armed Forces.
                               ○ A substantive appointment as a Senior Lecturer, Reader or Professor in the medical faculty of a UK University awarding a primary registrable qualification under the Medical Acts, with a concurrent appointment as an Honorary Consultant in that specialty in the NHS.
                               ○ An independent practitioner, working solely in private practice, who can provide evidence of a previously held substantive appointment as a consultant in their specialty within the NHS.
               • Whose name is currently held on the Specialist Register of the GMC in a specialty which we recognise for benefit under our plans.
               • Whose practice is not subject to any special conditions, restrictions, warnings or a requirement for supervision or further training.
               • Who retains current professional indemnity insurance for the treatments they provide.
               • Has practicing privileges at a hospital/facility in our directory of hospitals/facilities.
All of our requirements are published online.
As Mr Birch no longer fulfils the entirety of our recognition criteria then we are unable to continue to recognise him.
I cannot comment on other individual practitioners at The Chris Moody Centre, as they may work from a facility AXA do recognise as well or they may be recognised as a different type of specialist, for whom we have different recognition criteria for.
Kind regards,

Correspondence 6 - 29/01/18 (from East Midlands Spine)

Good afternoon
Thank you for your email dated 23 January 2018.
Mr Birch has asked if you could clarify what criteria does a “recognised facility” need.
When Mr Birch stopped undertaking invasive treatments in November 2014 to concentrate on a purely diagnostic role and follow-up patient management, it was decided that his practice no longer needed to be in a hospital environment. 
The decision to move to the Chris Moody Centre, a regional leading rehabilitation facility, was based upon the access to and the subsequent close working relationship with some of the County’s leading rehabilitation specialists.  This multidisciplinary approach, which is recognised as the gold standard by all major governing bodies, across healthcare as a whole, is often what our patient’s rate most highly about the service they have received at East Midlands Spine.
At the time of relocation, over three years ago, you were informed along with all the other major health insurance companies of this move to ensure that it was accepted as a suitable venue and you did not object at that point. 
Given all of the above, Mr Birch would like the opportunity to discuss this matter with you directly and he would be grateful if we could arrange a mutually agreeable time.
I look forward to hearing from you.
Kind regards

Correspondence 7- 29/01/18 (From AXA PPP)

Good afternoon,
Thank you for your response.  To be honest I don’t know what criteria there is to become a recognised facility with AXA PPP as this isn’t something I would look into in my department.  Hospitals, clinics and centres can apply to be recognised facilities with AXA and to be in our directory of facilities.  If this is something that you wanted to look into, you can contact
With regards to the time of relocation – it may have been that at that time our recognition criteria was different.  I know that our recognition criteria did change in March 2017 including the fact that all specialists must be working from a facility that we have in our directory.  That might be why it was fine for the past few years to be there, and why we have recently contacted you about it as we do get regular reports from our customer services team if for example a specialist has retired or is no longer working at a certain hospital etc. We then action these and contact the specialists to gather the correct information and action appropriately.
My working hours are 08.30 to 17.00 Monday to Friday and I would be happy to speak to Mr Birch whenever suits him. This week I will not be available on Wednesday 31/01/2017 between 08.30 and 14.00 but I am free from 14.00 until 16.30.  I am also not available on Friday 02/02/2017 all day.   Otherwise this week I am available anytime between 08.30 and 17.00. 
Kind regards,

​Correspondence 8 - 30/01/18 (from East Midlands Spine)

Thank you for your helpful email.   If the criteria for registration of a medical facility by AXA PPP changed in March 2017, it would have been very helpful to have been alerted at that time.  However we have now contacted Provider Operations as you have suggested, requesting information regarding how to proceed with the process of enabling The Chris Moody Centre to become a recognised facility so that Mr Birch (East Midlands Spine Ltd) can continue see patients insured with AXA PPP. 
In the meantime, could you please defer your decision that he should not see AXA PPP patients cannot be seen at the Chris Moody Centre until we have had a response from them?  There are a number of patients insured with your company that are in the process of being investigated and treated by Mr Birch who will be medically disadvantaged by AXA PPP taking a decision to not recognise the Chris Moody Centre and so prevent them from completing what has until now been an authorised programme. 
Kind regards

Correspondence 9 - 30/01/18 (from AXA PPP)

Good afternoon,
It is not the criteria for medical facilities that changed – apologies if I didn’t make this clear.  It is the criteria for specialists as individuals that changed in March 2017 – this is published on our website.   The Chris Moody Centre has never been a recognised facility with AXA, but I would assume patients were allowed to go there as it was on an outpatient basis (they are usually allowed to go to most facilities if it is for outpatient only obviously depending on their policy etc) and providing the specialist they were seeing was recognised as an individual with AXA (as Mr Birch was). 
The reason I withdrew Mr Birch’s recognition is because he didn’t work from a facility we recognise, which is part of the individual specialist’s recognition criteria.  Please see the link to our website which outlines what criteria must be met to become recognised with us.
By withdrawing Mr Birch’s recognition, this only means our patients cannot see Mr Birch, it doesn’t mean that patients are not allowed to attend The Chris Moody Centre to see other specialists that work there (obviously again dependant on if the specialist is recognised, what type of specialist this is, the patients policy restrictions and whether this has been authorised by the patient’s customer services team) as mentioned, patients may be allowed to go to a facility that isn’t recognised with us if it is on an outpatient basis and the specialist is recognised with us.
Does that all make sense?
I will speak to my manager tomorrow regarding Mr Birch’s recognition and see if there is any way I can re-instate his recognition.  However, please note this is not a guarantee of anything. 
Kind regards,

Correspondence 10 - 31/01/18 (from AXA PPP)

Good morning,
Further to my email yesterday I have discussed this with my manager.  I wouldn’t be able to re-instate Mr Birch’s recognition with us as he no longer fully satisfies our recognition criteria.  If anything changes in the future he can apply for recognition via The Private Practice Register run by Healthcode.  We will then look at his application and if he satisfies all of our recognition criteria we would be able to re-instate him.
Kind regards,

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