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The more lives they save, the more they earn
But performance-pegged pay means surgeons could spurn high-risk operations

LONDON — :In radical plans being drawn up by hospitals across Britain, National Health Service (NHS) surgeons are to be paid bonuses based on the number of lives they save.

For the first time, they will receive performance-related pay according to the results they achieve on the operating table, with levels dependent on how well patients recover.

Leading surgeons, critical of the proposals, said that this could deter doctors from taking on higher-risk patients — such as the frail and elderly— and from carrying out complex operations.

Patients’ groups said those facing surgery would be “horrified” by the proposals, and questioned why doctors should be paid a premium for fulfilling their basic duty.

The Government intends to link doctors’ merit payments to patient mortality and other measures, such as rates of infection, readmission and post-operative mobility.

Britain’s largest hospital trust is already preparing a pilot scheme that will link surgical outcomes to bonus payments. Imperial College Healthcare Trust has begun measuring the performance of its doctors, and Prof Stephen Smith, its chief executive, said that it intended to use the data on mortality, infection and the cost-effectiveness of its consultant teams to reward the best-performing doctors.

The pilot scheme will concentrate on rewarding surgeons for the degree of mobility that patients enjoy after their operations.

The London trust’s own surgeons admitted to risks if the plans were not handled carefully. A consultant, Mr Justin Vale, who is the programme group director for surgery and cancer, said: “We have got to ensure we don’t create a dangerous precedent, that the surgeons doing the big, complex cases aren’t discouraged from taking them on.”

Mr Ben Bridgewater, of the Society for Cardiothoracic Surgeons, said that he would be very cautious of using data on a consultant and his team as the basis for bonus payouts.

“Surgeons would be quite anxious about using these measures in this way,” he said. “They wouldn’t be confident the data is robust enough, or that it reflects the mix of patients and activity that they deal with. I don’t think surgeons will buy into this.”

Ms Katherine Murphy, from the Patients Association, said: “Patients will be horrified. There is a real risk that the most complicated cases, as well as the patients in real need, will be forgotten because they don’t get the best outcomes. Doctors already have a duty to provide high-quality care. I think a good doctor would be insulted by the idea that they will only do their best on the operating table if there is extra money in it.”

In the north-west part of Britain, 24 trusts are piloting a scheme that will pay bonuses to the 20 per cent of hospitals with the lowest rates of deaths, complications and other clinical standards linked to five common operations. Managers will be able to pass the bonuses on to doctors and nurses.

In December, the Government will publish a set of indicators to measure the quality of treatment at every NHS hospital.

THE DAILY TELEGRAPH