Plans are being drawn up for surgeons to receive performance-related bonuses, linked to mortality, infection and cost-effectiveness. The proposal is being discussed by Imperial College Healthcare Trust in London which runs five hospitals including Charing Cross, Hammersmith and Queen Charlotte’s.
Patient groups expressed concern that such bonus schemes could deter doctors from carrying out complex operations or taking on high-risk patients such as the elderly. Dr Jonathan Fielden, chairman of the BMA’s consultants committee, described the scheme as “too simplistic” and commented: “The quality of data collected on clinical outcomes remains poor and, although improvements are being made, it is not reliable or accurate enough to be used meaningfully.
“The outcome of an operation is based on multiple factors, including the severity of the illness and the relative health of the individual. Other members of the medical team would also have fundamental roles in the care a patient receives and the outcome achieved.”
He added that private sector companies with contracts to provide NHS care are able to cherry-pick the easier, routine NHS operations, leaving the more complex and high-risk patients to NHS consultants. “If pay is crudely linked to outcome then defensive medicine will be the detrimental result,” he pointed out.
The Royal College of Surgeons also commented that it was “offensive to suggest that surgeons would do better if paid more,” adding that the proposals would “undermine the doctorpatient relationship.” Furthermore, given the vital role played by many healthcare professionals in the care of each patient, the College considered it “invidious to pick out one member of that team for extra award.”
