A trial giving medical teams financial rewards and bonuses for successful operations will soon start in the UK’s largest hospital trust. Imperial College Healthcare NHS Trust in London intends to pilot a scheme with the amim of “rewarding excellence”. This follows in the wake of Health Minister Lord Darzi’s NHS review, which emphasised quality.

A spokesman for Imperial told BBC News that the trust was considering the bonus awards for specific procedures with clearly definable and measurable outcomes. "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. At the moment we are in discussions with the surgical team." The likely timescale for introduction is within the next few months.

A spokesman denied that surgeons may receive any performance-related bonus or financial reward if their operations were judged particularly successful.

Controversy over rewards for surgeons
A range of figures have expressed their concerns about the scheme. Prominent health economist Professor Alan Maynard of the University of York, writing for Health Policy Insight website, pointed out that “The trouble with incentives is that they work, but they may produce changes in behaviour that are at once welcome and perverse”.

Dr Jonathan Fielden, chair of the British Medical Association's consultants committee, also said it would be "far too simplistic" to reward individual surgeons according to the outcome of operations.

He 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."

Meanwhile, Katherine Murphy from the Patients Association outlined concerns that ‘payment for success’ schemes could make clinicians reluctant to take on the most complicated cases, because of the likelihood of outcomes that would fail to trigger the payments. Murphy said, "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."