Headlines: July 12th, 2004

Thirty-two NHS trusts are to pilot a new scheme to make extra payments to doctors for delivering extra treatments. The trusts will try a variety of schemes, testing how the NHS can most effectively reward clinicians who do the most for patients.Consultants and other staff will receive bonus payments for operations or other treatments that they perform on top of the work they would normally be expected to carry out. The Fee for Service pilot schemes will involve around 400 doctors and other clinical staff and it is expected that they will mean 8,000 additional operations and 6,000 more outpatient consultations.

Hospitals taking part in the trials will use it to help transform the way patient care is delivered, to improve efficiency and create extra capacity. In one example, a hospital in the West Country will use the scheme to enable it to treat local cardiac patients who currently have to be sent as far as London for treatment. They will use the money spent on sending patients to other areas as an incentive for staff to increase the number of cases treated locally.

Fee for Service will test three model schemes, each of which will define standard levels of activity and then offer additional payments to staff who work in innovative ways to deliver extra activity while maintaining high quality standards. The models are an extended reward scheme, offering payments for staff undertaking an agreed level and type of extra work, a benchmark scheme that will offer payments to those achieving more than an agreed level of work and finally a treatment centre approach that will offer higher payments for staff who achieve greater efficiency by working in radically different ways within NHS treatment centres.

The Fee for Service pilots will cover a range of treatments, including orthopaedics, ophthalmology and general surgery. There will be an evaluation early next year before decisions are made on whether the schemes should be rolled out more widely.