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Incredible! Doctors pay to be based on ratings and review of patients

July 2, 2013

The Public Accounts Committee (for non-UK readers, this is a cross-party group which checks whether the public gets value for money) has released a pretty scathing report about the shambles that is the (lack of any) link between the pay of hospital consultants and their performance or productivity.

Of course the current government blames the last government – but what are they actually going to do about it, more than merely try to score political points with a frankly jaded and cynical public?

This is actually a chance to be big and bold, empower the public and bring together a number of truly innovative patient-facing initiatives across the NHS.

A key part of the the report’s criticisms is that ‘Clinical Excellence Awards’, meant to award exceptional performance, are actually given to the majority of consultants and the system of awarding them is opaque with no clear link to quality or performance. They didn’t even mention the fact that once a doctor is given an award, then it is her’s for life (and life means life, it is added to the pension as well) – however good or bad her performance in the following years.

Now don’t get me wrong, I’m all for rewarding excellence – but this should be transparent and, in a public system, based on clear metrics that are a) obvious to and understood by the public, b) linked to great clinical outcomes, c) dependent on continuing excellence.

If the government really wants to solve this problem, turn their words about a “patient-centred” NHS into real action, show what transparency means (other than an election slogan), and do something meaningful to meet the demands of the Francis enquiry, then here is how to do it:

1. Excellence awards should be 100% based on ratings and reviews given by patients
2. To be eligible doctors must get more than a minimum number of reviews from patients, say 10/month
3. Only those whose scores are in the top 20% for 4 consecutive months get the award, and it is awarded only for the following year
4. To maintain the award, they have to hit the same target for 3 months in the following year, or it lapses
5. If they are in the top 20% of their peers for five years in a row, then the award becomes life-long.

For vast majority of clinicians it would be simple to incorporate this system into the Friends and Family test, where every patient in an NHS hospital is being asked to feedback anyway – and boy would that ensure every doctor suddenly took an interest in this.
At same time, it is aligned with Robert Francis recommendation that the voice of the patient moves to the heart of healthcare.
And added bonus, this becomes the feedback the GMC uses for meaningful revalidation (rather than the meaningless “20 pieces of feedback every five years” that is the current mess).
Evidence is clear that patient feedback predicts safe, high quality care so – for the first time ever – these excellence awards would actually have a clear link to quality and performance = transparency in action.

Of course, only those whose feedback was fully, openly published on the web would be eligible for any award. Shock – gives the public insight and useful information!

Many doctors are already dedicated to continuously giving their patients an excellent experience and the very best clinical outcomes – and ask every patient to rate and review them. Aren’t these the sort of doctors the public want to reward, isn’t that the focus and ambition we want for the new generation of professionals – rather than relying on an out-dated opaque, old-boys club where rewards are decided in some smokey-bar or a golf club?

Dan Poulter, the junior health minister and once a hospital doctor, claims the last government was “absurdly naive” negotiating contracts with doctors, so here is your chance Dr Poulter to be “absurdly” bold and effective. What will you prescribe?

(As an NHS clinician of nearly 20 years I’m aware that there are a minority of specialities where this system would not work – getting feedback from patients is hard for even the most empathetic and caring pathologist – so we’d need to find alternatives for them.)

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