Surgeon bonus plan 'too simplistic'

The professional organisation for doctors added its voice to other critics of proposals to extend NHS cash reward schemes to reflect performance against a number of quality indicators such as mobility after surgery.

Dr Jonathan Fielden, chairman of the BMA's consultants committee, said: "The BMA has, for many years, been calling for improved high quality data to properly inform patients and doctors. It would be far too simplistic to reward individual surgeons according to the outcome of operations."

Dr Fielden continued: "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."

Dr Fielden said 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 said.

"Outside the relatively small area of overall health care that surgery represents, data collection and translation is even more difficult. We must focus on removing barriers to high quality care, not rushing to simplistic solutions that create further hurdles to the excellent care we all wish to deliver," he added.

The Government paved the way for linking cash incentives to measures such as post-operative mobility in the recently-published NHS Next Stage Review. It stated that the current Clinical Excellence Awards Scheme, which gives consultants financial rewards for excellence, will be strengthened to reinforce quality improvement.

According to the review, new awards, and the renewal of existing awards, will become more conditional on clinical activity and quality indicators.

A Department of Health spokesman said: "The Advisory Committee on Clinical Excellence Awards makes recommendations for awards on the basis of applications from consultants, who are required to produce objective evidence of excellence. Quality indicators such as complication rates and patient feedback are already used in specialities where they are available. As such measures become more widespread and robust, they will become increasingly influential in determining who gets awards."