‘Flaws in the Payment by Results (PbR) system mean that whole hospital departments could be unfairly closed down as “inefficient”,’ warns the British Medical Association (BMA).
An example of this danger is given in the latest edition of its membership magazine, BMA News.
The government claims its new payments system is supposed to improve NHS productivity and transparency by fixing a tariff for every procedure carried out.
But doctors fear consultants could appear inefficient and their departments appear to be in debt under PbR (payment by results).
Consultant surgeon Mike Davidson writes that the new tariffs do not take into account outpatient procedures performed outside day clinics.
This means 1,000 procedures carried out by his department for Taunton and Somerset NHS Trust and a further 500 for a neighbouring trust were not included in PbR calculations.
Davidson said this made his department appear to be around £300,000 in deficit when its annual turnover was £1.3m.
Initially, he was in favour of Payment by Results: ‘I thought, at least I am going to be recognised for what I do. To my horror I found out that outpatient procedures would not be counted.
‘For a department like ours, this is a potential disaster because a large bulk of the activity that we do will not be recognised.’
Davidson said he expected colleagues in dermatology and plastic surgery would encounter similar accounting problems.
He added: ‘My worry is if we are made to look to be losing such a lot of money, we might be shut down by the time they decide in fact we are not that inefficient.’
• Second news story
JOWELL ‘NOT AWARE’
Prime minister Blair yesterday cleared Culture Secretary Tessa Jowell of breaching the ministers’ code of conduct, because of her claim that her international lawyer husband, David Mills, did not tell her about a $600,000 gift he had received.
In his report to Blair, Cabinet Secretary Sir Gus O’Donnell said Jowell accepted her husband should have told her about it but she had followed the code’s ‘procedures’.
Blair said: ‘In the circumstances, she is not in breach of her obligations under the ministerial code. I have full confidence in her.’
In a statement issued by Jowell yesterday, outlining ‘the facts’ of her personal finances, she deals with the controversial gift which both she and Mills deny came from Italian premier Berlusconi.
Jowell said: ‘Since 2000 we have twice changed our mortgage arrangements on our London home.’
She added: ‘On the second occasion, 20th September 2000, my husband wanted to make an investment, and took out a loan using our London home as security. I signed the relevant papers.
‘My husband has a number of investments and I knew there would be no difficulty in repaying the loan. I knew nothing more about the nature of the investment.
‘I was not aware until recently that the loan had been repaid shortly after it was taken out, so our London home was no longer needed as security.
‘I first became aware in August 2004 that my husband had received in September 2000 a sum of money which he thought he had reasonable grounds to believe was a gift.
‘By the time I became aware of it, he had already agreed with the Inland Revenue that it should be classified as earnings on which tax was paid. I did not therefore consider it necessary to make any reference about any of this to my Permanent Secretary. However, I fully accept that my husband should have informed me, and if he had, I would of course have reported it to my Permanent Secretary.’
