Surgeons will get 'survival bonus' every time they save a patient's life

Britain's largest hospital trust is planning to pay doctors every time a patient survives the operating table or leaves hospital without picking up an infection.

Patients groups reacted with horror to the proposals, warning they would deter doctors from carrying out complex operations or taking on high-risk patients such as the elderly.

A measure of success: Plans are being drawn up for surgeons to receive performance-related bonuses

The proposal is being discussed by Imperial College Healthcare Trust in London which runs five hospitals including Charing Cross, Hammersmith and Queen Charlotte's.

The trust has started measuring the performance of its doctors ready for the scheme which could start later this year.

'We are looking at a pilot scheme for a particular operation which will measure the improved functionality of the patient and we are looking at linking certain performance-related bonuses to that,' a spokesman for the trust said.

'At the moment we are in discussions with the surgical team.'

The Trust refused to say which operation would be involved, but said it was chosen because it had 'very clearly defined' indicators that made it suitable for testing.

The payments would be linked to mortality, infection and cost-effectiveness.

'It's about rewarding excellence,' the spokesman added.

But Katherine Murphy, from the Patients Association, said there was a danger that complicated cases would be overlooked because they would not guarantee the best results.

'Doctors already have a duty to provide high-quality care,' she said. 'I think good doctors would be insulted by the idea that they will only do their best on the operating table if there is extra money in it.'

Her comments were echoed by Professor Ellis Downes, a consultant gynaecologist at Chase Farm hospital in north London, who described the idea as 'offensive' and ' incredible'.

'As a highly-trained professional, I do my very best for my patients and I do not need financial inducements to persuade me to operate even better,' he said.

'All our patients deserve the highest level of surgical care we can give them. It's a bit like saying to an airline pilot, if you don't crash your aeroplane we will give you more money.'

The British Medical Association said the scheme was 'too simplistic'.

Dr Jonathan Fielden, chairman of the BMA consultants committee, said: '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.'

A Department of Health spokesman said that while the London pilot scheme was not government-controlled, under the Clinical Excellence Awards Scheme bonuses could be awarded for procedures such as hip operations, after which patient mobility could be measured.