Despite a relatively cautious assessment in an independent report, the government has said it is to extend an incentive programme that rewards NHS staff for carrying out extra work.

Health minister John Hutton said that pilot trials of the "fee for service" (FFS) scheme had led to more operations being carried out.

But a report by Serco Health, commissioned by the Department of Health, said the experiment had only been a "qualified success".

There was also a warning that the government's latest reform programme could have limited impact on reducing health service waiting lists.

The FFS scheme involves consultants and other staff receiving bonus payments for the operations or other treatments they perform on top of those they would normally be expected to carry out.

"During the course of the review it was noted that FFS seemed to be more successful at attracting consultants from specialties experiencing low waiting times," the study said.

"This is likely to be because private practice had declined in these specialties as paying for a procedure through private healthcare became less attractive to patients as waiting times shorten and consultants become amenable to augmenting salaries through additional NHS activity.

"The irony is that whilst one of the key objectives of the FFS initiative was to reduce waiting times, FFS may in fact work best in an environment of low waiting times.

"This has important ramifications in terms of the development and timing of any future FFS initiatives."

Data quality

Serco found there had been "no discernable adverse impact on quality and no adverse events" as a result of the pilot schemes.

But it cautioned that data on quality improvements was "generally poor".

"The finding of the review is that the programme of fee for service pilots undertaken by the department has been a qualified success," added the report.

"A range of approaches were adopted and approximately half the sites have met, or are likely to meet, the objectives they set themselves including approximately 8,400 additional inpatient procedures and 6,000 outpatient procedures."

The review said that the pilots had demonstrated that "well managed, highly motivated successful organisations, in the NHS as elsewhere, will make the best of the opportunities which are available to them".

"Meanwhile for organisations which are less successful, the offer of cash incentives to staff is not enough in itself to improve performance and may be counterproductive."

Roll out

With the test programme leading to a greater output, Hutton said it would now be rolled out further.

The scheme will now be piloted for the first time in the diagnostic sector to help speed up diagnostic tests.

"The fee for service scheme gives consultants and other NHS staff strong incentives to ensure that more patients are treated more quickly," said Hutton.

"The initial evaluation of the pilots shows that the new ways of working has made a significant impact in helping reduce waiting times.

"That is why we will now be going further and faster in extending these new approaches to rewarding additional additional activity throughout the NHS, including a new wave of diagnostics.

"This will benefit both patients and front line staff and will play an important role in helping us achieve the 18 week referral to treatment target."