'Pay for performance' could be next, says NHS medical director

Management of the programme has been awarded to the Healthcare Quality Improvement Partnership, a new consortium made up of the Academy of Medical Royal Colleges, the Royal College of Nursing and the Long Term Conditions Alliance. It is the fifth home for the programme in the last 10 years.

In an interview with HSJ, NHS medical director Sir Bruce Keogh said: "The new organisation has to deliver because if it does not, then of course questions will be asked again about where it should lie."

He said the decision to award the contract to run the National Clinical Audit and Patients' Outcomes Programme to professional clinical and patient-focused organisations demonstrated the Department of Health's commitment to engagement with clinicians and to make clinical audit part of the mainstream.

He said in future clinical audit would play a greater role in clinicians' revalidation. He added: "As voluntary audits get better and their value is recognised, I think the regulator will take a keen interest."

He urged managers and clinicians to work together to improve data collection and share information.

"Doctors work off their own audit data, which is not always freely shared with the managers, when you end up with different people making decisions on different parallel pieces of information.

"Doctors and other clinicians need to accept that they have a moral and professional duty to ensure that they know what they are doing and how well they are doing it and we need objective measures of that, which should be underpinned by accurate collection of data."

Sir Bruce revealed that effective clinical audit could pave the way for a move towards "pay for performance" schemes, where clinical units are rewarded for doing work of a higher standard.

"In this country we have payment by results, where you get paid according to how many cases you do. The next step is that we pay you for how many cases you do, but we also look at the quality of what you have done," he said.

The consortium will also support the new National Clinical Audit Advisory Group, which has been set up to provide advice and guidance on the programme, especially proposals to begin or discontinue particular audits. It is chaired by Professor Nick Black, who has been instrumental in championing the potential to make use of patient-reported outcome measures.