When I talk to hospital doctors, and especially consultants, I am aware of their apathy at best, and hostility at worst in relation to management issues. However, there’s one subject guaranteed to perk up their interest: money. Doctors are highly ‘calculative’, i.e. what’s in it for me?
It is obvious that if we can align the doctors’ personal interest with the organisation’s interest we will be more likely to succeed. Usually the NHS provides no financial incentive for doctors, or worse provides perverse incentives. Here are some practical ways that Incentivisation for NHS consultants could work:
- Fee-per-case work. This doesn’t fit easily with the NHS’s nationally negotiated consultant contract, so usually falls at the first hurdle. However, it can be made to work but needs determined leadership
- Separate contracts are the easiest way to achieve this, for instance extra work is paid via a distinct contract so all the restrictions of the consultant contract don’t apply. I have first-hand experience of the astonishing increase in productivity this produces
- ‘bonus’ cases paid fee-per-case over and above normal, expected activity
- Linking Clinical Excellence Awards (CEA) to performance. This is again difficult as these are assessed according to national criteria that local hospitals have little influence over.
- Paying annual bonuses for reaching pre-determined standards
Bear in mind that most NHS activity is now paid to hospitals on a payment by results (PbR) basis, but the workers who actually do the work are paid a fixed salary. If a fee-per-case system is introduced it must be linked to the ‘tariff’ paid for that procedure. 5-10% of the national tariff is about right since it is sufficiently high to attract high-performing consultants and sufficiently low to require decent volumes to be done whilst leaving plenty of margin.
That such schemes are virtually, if not totally, absent from the NHS gives testimony to the outdated ‘socialist’ mentality still prevalent, and the power of vested interest ‘trade’ unions, like the BMA (of which I am a card-carrying member for over 20 years!)
I am hoping over the next few months to pilot a scheme in my local Trust. Watch this space!