UK
An initiative to reward doctors and other staff for carrying out extra work in NHS
By Ashwin, UK Correspondent
Feb 16, 2005, 16:06

An initiative to reward doctors and other staff for carrying out extra work is to be rolled out further across the NHS, Health Minister John Hutton announced today.

It will mean new ways of working, leading to thousands of NHS patients having their operations more quickly and help the NHS work towards the 18 week referral-to-treatment target, Mr Hutton said.

The Fee for Service scheme involves consultants and other staff receiving bonus payments for the operations or other treatments that they perform on top of the volumes they would normally be expected to carry out.

Mr Hutton also said the scheme would be piloted for the first time in the diagnostic sector to help speed up diagnostic tests.

Fee for Service has been piloted in 32 NHS Trusts from last October. The pilots involved 400 doctors and other clinical staff and set a target of 8,000 additional operations and 6,000 outpatient consultations. A report undertaken for the Department found that the scheme is expected to deliver these targets by the end of March 2005 and � in the case of inpatient activity � to exceed the target by delivering over 8,400 additional operations.

Mr Hutton announced:

* funding of ��m to the most successful pilot sites to spread best practice as part of a drive to extend successful Fee for Service models throughout the NHS;
* a further group of sites to be included within the pilot programme � namely North Middlesex University Hospital NHS Trust, Royal Orthopaedic Hospital NHS Trust, North Tees and Hartlepool NHS Trust, and East Elmbridge and Mid Surrey PCT; and,
* identifying six sites to pilot Fee for Service in diagnostics during 2005/06 with the possibility of extending this further at a later date.

Hospitals participating in the scheme are using Fee for Service to help transform the way patient care is delivered, improve efficiency and create extra capacity. The scheme covers a range of treatments, including orthopaedics, ophthalmology and general surgery.

For example, Medway NHS Trust � one of the pilot sites � is using the scheme to facilitate the provision of an in-house dermatology telemedicine service. Although the clinical model of telemedicine was already established within the Trust, FFS was used to incentivise dermatology staff to undertake additional elements of work and further improve delivery of a quality service.

The individual projects in the Fee for Service Programme have identified incentive structures that fit their individual needs. In some pilots, clinical teams received a fixed sum of money for each additional operation completed while in other pilots bonuses were paid to whole teams and the funding was used to purchase extra equipment.

John Hutton said:

"The Fee for Service scheme gives consultants and other NHS staff strong incentives to ensure that more patients are treated more quickly.

�The initial evaluation of the pilots shows that the new ways of working has made a significant impact in helping reduce waiting times. That is why we will now be going further and faster in extending these new approaches to rewarding additional additional activity throughout the NHS, including a new wave of diagnostics.

�This will benefit both patients and front line staff and will play an important role in helping us achieve the 18 week referral to treatment target.�

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