Department sends doctors' productivity data to trusts in value for money bidBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7558.62 (Published 06 July 2006) Cite this as: BMJ 2006;333:62
Trusts throughout England have this week been sent statistics from the Department of Health, which show the most and least productive doctors in five surgical and five medical specialties in their hospital.
The potentially controversial data have been compiled by academics at the University of York's department of health sciences. In an article published in this week's Health Service Journal (2006;116(6013):18-19) researchers Karen Bloor and Alan Maynard point out that, between 2001 and 2005, the basic starting salary for NHS consultants increased by almost 50%.
“In most industries, employers would expect pay increases to be accompanied by improvements in ‘productivity,’” they state. “Although this is less usual in public services, the Department of Health must demonstrate to the Treasury and to voters that the new contract has delivered value for money, and in the case of consultants that the potential benefits of the contract are realised.”
But Jonathan Fielden, deputy chairman of the BMA's consultants committee cautioned against over-reliance on the data and warned that it might merely be used to cut costs: “There may be many reasons why a surgeon's performance varies,” he said.
“Some procedures are more complicated or the patient may have other risk factors which will affect the length of an operation. The surgeon may have trainee doctors working alongside which can also alter the length of procedures. There may be administrative or system delays in getting the patients into theatre on time.
“Consultants are keen to explore ways of measuring their performance and improving care for their patients, but managers must work with consultants to ensure data is accurate and used positively. Unfortunately, with the present financial climate where many trusts are still struggling to balance their books, there is a danger that it will become an exercise of cutting costs rather than improving quality.”
Charts showing the performance of consultants in 10 specialties are being sent to the NHS trust in which they work. The charts will indicate consultants' individual performance, including those working in general surgery, cardiology, and paediatric medicine. The information is based on finished consultant episodes, with the output adjusted for case mix. The data is based on the annual national hospital episode statistics for 2004-5, the most recent available.
Although the trust is able to identify individual consultants by their GMC numbers, which are incorporated in the charts, this information will not be available to the general public. The information will be sent to the medical director and chief executive of each trust.
A Department of Health spokesperson explained that, after taking into account consultants' other responsibilities, it would be possible for each trust to identify the highest performing consultants “and the working practices and techniques that are enabling high performance, and spread best practice within the trust to improve productivity and patient care.”
“It's not giving answers,” said Professor Maynard, “it's about asking questions. And it is not about quality—it is about differences in activity.”
According to the Department of Health, a recent report by the NHS Institute for Innovation and Improvement found that completed procedures and admissions per consultant varied by more than 100% between trusts. This is certainly confirmed by York University's study for the department.
“All charts illustrate considerable variation in activity rates between individual consultants,” the researchers wrote. “This variation needs careful local investigation as to its cause. Although data accuracy is improving all the time, there may still remain data problems including trust failures to assign correctly episodes to the correct consultant and specialty.
“Other causes of variation include the variable responsibilities of consultants, including their outpatient, administrative, teaching or research responsibilities, which would justifiably cause variation in patient contact. In addition, consultant characteristics (eg, age), hospital characteristics (eg, availability of operating theatres, size of consultant support teams) and patient characteristics (eg, catchment population, case mix) necessarily cause variation.
“The local management challenge is to know who is doing what, and to consider and validate each individual consultant's location in the national distribution.”
Health minister Andy Burnham added, “The quality of patient care is increasing, but we still need to get more value for money from the record investment that's going into the NHS. Increasing productivity is the answer to both good patient care and good value for taxpayers' money.
“Consultants have quite rightly seen increases in pay for the work they do, but we need to ensure we're getting value for that money too.
“This is not a big stick with which to beat consultants. It's a positive tool to help consultants make the best use of their time.”