18 February 2005
A pioneering scheme that aims to cut high waiting lists works best when waiting times are low, according to a report this week.
The Fee For Service (FFS) initiative was launched last October in an attempt to cut high waiting times in key disciplines such as orthopaedics.
Doctors and other clinical staff were paid a fee for working overtime and the Department of Health expected the pilot trusts to deliver 8,000 additional operations and 6,000 outpatient consultations by the end of March.
The report, which was commissioned by the department, said the pilots were more successful in attracting consultants when local waiting lists were low.
As fewer patients opted for private care, doctors' private earnings dropped and they sought to augment their pay through additional NHS activity.
'This has important ramifications in terms of the development and timing of any future FFS initiatives,' it said.
Though the review found that the department's targets could be exceeded, the pilots were only a qualified success because some trusts contributed more to the overall total than others.
It said 15 pilots had met, would meet or exceed their targets but 12 would only partially meet them. Others had failed to start their schemes when services firm Serco conducted the review late last year.
However, health minister John Hutton insisted the scheme had made a 'significant impact'. Overall, the pilots would meet the target for outpatient consultations, while it was expected that the scheme would deliver an extra 8,400 operations by March.
He said the initiative would be extended to four more trusts, while a further six would examine its potential in diagnostic services.
'The FFS scheme gives consultants and other NHS staff strong incentives to ensure that more patients are treated more quickly,' he added.
Hugh Phillips, the president of the Royal College of Surgeons, welcomed the increase in surgical capacity but warned the initiative must not encroach on teaching time.
'The target-driven environment of the NHS is not conducive to the provision of quality training for junior surgeons. Surgery is a craft specialty, learnt at the elbow, and it takes time to train.
'Consultants must be allowed sufficient time to train tomorrow's surgeons to guarantee the safety of tomorrow's patients,' he added.
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