Bonus plan to cut NHS waiting lists

Individual NHS doctors and nurses will pocket bonus payments worth hundreds of pounds for carrying out extra operations, health minister John Hutton announced today.

The radical new fee-for-service scheme could see clinical teams divide up bonuses of ?250 a session for treating more than a benchmark number of patients, while nurse specialists could take home ?400 a month bonuses on top of their pay for exceeding a target number of cases, as a variety of pilot schemes are set up at 32 NHS trusts.

Four fast-track surgery centres, dubbed NHS Elect, have already begun fee for service pilots in which doctors were paid a minimum ?100 a case for each operation carried out over and above what they would have been expected to do within their core hours, the Department of Health said.

The fee for service system was signalled in the NHS improvement plan published by the health secretary, John Reid, last month as a further extension of the payment by results financial system being introduced in the NHS, which will mean hospitals being paid per patient treated.

But extending the scheme to individual staff is likely to spark anger among the unions, which have resisted individual bonuses in the past. The announcement also comes at a delicate time with the proposed new Agenda for Change pay system for 1.3m staff.

Unions will ballot on whether to accept Agenda for Change in October, but the fee for payments scheme could be seen as cutting across its system of salary bands and payments for out of hours work, which was designed in part to protect the NHS against equal pay employment tribunal cases. The Department of Health confirmed it had not consulted unions nationally.

The fee for service pilots will initially involve around 400 doctors and other
clinical staff. the Department of Health said it would lead to 8,000 additional operations and 6,000 extra outpatient consultations being carried out.

They will cover a range of treatments, including orthopaedics, ophthalmology and general surgery.

The fee for service schemes aim to boost efficiency and create extra capacity, with one hospital in the West Country intending to use the scheme to enable it to treat local cardiac patients who would previously have been sent as far as London.

The trust will use the money that would otherwise have been spent
on patient transport as an incentive for staff to work more efficiently and increase the number of cases treated locally.

Three different models will be piloted, all of which involve defining standard levels of activity and then offering extra payments to staff who work in innovative ways to deliver extra activity while maintaining high
standards of quality.

Mr Hutton said: "New NHS pay contracts are already incentivising frontline NHS staff to become more and more innovative in improving patient care. The fee for service scheme builds on these reforms by giving consultants and other NHS staff even stronger incentives to ensure that more patients
are treated, more quickly.

"Just as the new system of payment by results and patient choice will drive NHS trusts to improve waiting times and achieve more efficient use of resources, so fee for service will apply the same incentives to the front-line staff who deliver these benefits for patients."

An evaluation will be carried out early next year before any decision is taken on whether to extend the schemes.