Productivity in NHS has been seriously neglected, meeting hears

BMJ 2011; 343 doi: (Published 09 December 2011) Cite this as: BMJ 2011;343:d8035
  1. Zosia Kmietowicz
  1. 1London

Consultants in the United Kingdom are among the best paid and least productive in Europe—a situation that is unsustainable in the current environment of financial constraints, a meeting heard this week. One way to increase productivity might be to introduce an element of performance related pay into doctors’ salaries, one commentator has suggested.

Mark Britnell, global lead on healthcare at the consultancy firm KPMG, said that the gap between the productivity of the private sector and that of the NHS is getting wider. Although most industries expect to increase their productivity by 2% a year, the productivity of the NHS has fallen by 10% over the last 10-15 years despite “a very safe environment where we have had seven years of feast [under the Labour government].” He was commenting on presentations at a meeting on 8 December organised by the healthcare think tank the King’s Fund entitled, “The NHS in an age of austerity: a workforce fit for the future.”

Other industries have had to move a lot quicker and a lot smarter than the NHS in response to the current economic climate, said Mr Britnell.

A report for the European Union on pay and productivity of healthcare staff across Europe by KPMG to be published shortly shows that UK consultants are in the upper quartile for pay but in the lower quartile for productivity, he said.

“I have got to say we are in trouble,” he said. “It is alright to cap pay [of the NHS workforce] at 1%, but we should be differentiating performance of the 1.4 million people who work for the NHS. Evidence from Europe suggests that having 20% of pay related to performance seems to motivate and hold people to account.”

Karen Bloor, senior research fellow at the University of York and also speaking at the meeting, commented that while performance related pay “probably does work, it probably does not have to be huge to work.”

Candace Imison, deputy director of policy at the King’s Fund, also speaking, said that despite the fact that the NHS workforce consumes 70% of the health sector budget there was only one mention of it in the recent NHS Operating Framework for 2012-13 (BMJ 2011;343:d7712, 29 Nov, doi:10.1136/bmj.d7712).

Productivity as an outcome goal of the NHS has been badly neglected, agreed the speakers. Variations in productivity among consultants are both large and impossible to explain, said Dr Bloor. Consultants’ productivity seems to increase through their 30s and then gradually fall, but women see between 10% and 20% fewer patients each year, she said.

The question is how to improve productivity. Dr Bloor believes that trusts could be using doctors’ contracts more effectively to get the best out of key members of staff. They should also be sharing information on productivity more effectively—both on their own staff and that of other trusts.

Dr Bloor also called for the abolition of the consultants’ clinical excellence awards, whose allocation she described as “pretty hopeless.” A better incentive might be to introduce a new senior consultant grade to recognise those doctors who have provided a sustained contribution to the NHS.


Cite this as: BMJ 2011;343:d8035