Published: 17/02/2005, Volume II5, No. 5943 Page 10

There is one point all medical directors appear to be agreed on: payment by results is at last making some sense.

Described by one medical director last June as 'dumbfoundingly' complex, there was a fear that only the most on-the-ball clinicians would appreciate its implications.

But what a difference a year makes. 'I have set up a special commissioning group with a consultant from every specialty. Now some of these people understand the [payment by results] system better than anybody else in terms of how work is commissioned and paid for because they can see the importance of guaranteeing that income is recovered, ' said one medical director.

'For medical staff, It is something they really understand and look forward to the implementation of, ' said another.

'Everyone believes they work very hard and very efficiently and can only make great advances with payment by results. I think the medical profession quite likes payment by results because it has a degree of clarity which wasn't there with the previous financial arrangements.

'I think most consultants have private practice where they are paid on a fee-per-service basis and That is what payment by results is all about; It is just that the fee goes to the trust.' However, others did identify some problems. 'I think it is a good system for creating incentives for doctors to improve their services in terms of quality and efficiency.

[But] if you implement payment by results too slowly they will not see these improvements so quickly and so they become disengaged, lose interest.' Another added: 'The issue is that with payment by results you can get a wide range of complexity in a healthcare resource group and get easy and difficult cases attracting the same payment.

'There is a danger that complex work will go to the teaching hospitals and they will not be able to cover the full cost of taking those cases.

A specialist top-up has been announced to deal with that factor but we do not know how it is going to play out yet.'