Reforming the consultant contract again?: Fees for service have been in effect for some time

doi:10.1136/bmj.329.7478.1343-a

BMJ 2004;329:1343 (4 December), doi:10.1136/bmj.329.7478.1343-a

Letter

Reforming the consultant contract again?

Fees for service have been in effect for some time

The first 150 words of the full text of this article appear below.

EDITOR—I am somewhat bemused to read an article by thechair of my NHS trust employer that proposes introducing feesfor service—particularly when they have been in effectin his own hospital for several years.¹

Payments for waiting list initiatives are fees for service thatseem to provide no incentive whatsoever, for increasing patientthroughput or activity with existing resources. They can evenseem to reward inactivity.

The authors speculate on the impact of such personal financialincentives but they do not provide any evidence of benefit.They acknowledge that Germany and France wish to abandon feefor service payments because of their cost. I'm sure our ownfinance manager would wish the same fate for waiting list initiativepayments in York, which have had no effect on reducing the overallwaiting list. They also undermine NHS efficiency and createdisharmony, with differential pay rates for different employees.

. . . [Full text of this article]

R Skilton, consultant anaesthetist

Anaesthetic Department, York Hospital, York YO31 8HE Roger.Skilton@York.NHS.UK