NHS doctors bribed to hit targets on smoking

GPs offered £100 to say patients have quit. Outrage at 'corrupt, demeaning scheme'
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Health Service managers are offering family doctors cash bribes worth thousands of pounds to meet Whitehall targets, an investigation by The Independent on Sunday has revealed.

Health Service managers are offering family doctors cash bribes worth thousands of pounds to meet Whitehall targets, an investigation by The Independent on Sunday has revealed.

GPs are being given a £100 payment for each smoker they say has quit in the most stark example yet of how targets are leading to the abuse of public funds.

Doctors simply need to take a patient's word that they have not smoked for four weeks to pocket the cash. The patients are entered into a prize draw to win holidays and gift vouchers with the same lack of checks.

Patients' groups and doctors leaders united to voice their anger yesterday at the scheme operated by Brent Teaching Primary Care Trust in north London. Dr John Reid, the Secretary of State for Health, faced calls for an immediate investigation into the "ridiculous" inducements.

Dr Lise Llewellyn, the trust's chief executive, wrote to GPs and trust staff last month offering the cash. "For Brent to improve its star rating we need to increase the number of smokers quitting smoking," she wrote on 24 February.

"We will pay you a Hundred Pounds [sic] for each smoker you help to quit between today and March 31," she added in bold type.

Some of those receiving the letter reacted with dismay to the initiative. "The scheme demeans me as a professional," said Dr Stephen Nickless, a sessional GP. "Offering me this bonus shows contempt for what motivates me. It is corrupting of my professional values. It is an unwelcome intrusion into the doctor and patient relationship and it is a waste of public money."

Dr Hamish Meldrum, deputy chairman of the British Medical Association's GP committee, agreed. "Doctors are keen enough to help their patients give up smoking without being offered a £100 bribe in a Mickey Mouse scheme like this.

"It sounds like something that was dreamt up in a late-night brain-storming session in the bar - only it seems this one saw the cold light of day." Dr Meldrum said that, while it was not unusual for GPs to be offered incentives to tackle particular health problems, doctors would be appalled at the explicit linking of a payment to a trust's star rating.

Managers in the health service are under increasing pressure to meet Whitehall targets in order to win financial bonuses and independence. Of nine targets set last year, Brent PCT failed only one: smoking. Because it was judged to have "significantly underachieved" on the target the trust missed out on being awarded the highest star rating.

Managers were determined to improve their performance this year. In addition to the £100 incentive offered to doctors, smokers attempting to quit are being entered in a draw. Prizes include a weekend in a health farm, £250 in gift vouchers for a bicycle or "one of 10 step-o-meters".

Anti-smoking campaigners warned that the lack of checks might mean that the quitters recruited in the scheme could not be counted towards the trust's target in any case.

A copy of the incentive guidelines as well as a "client monitoring form" make clear that staff can claim their cash on the patient's word alone.

Deborah Arnott, director of anti-smoking campaign ASH, said: "Department of Health guidance states that to count in the figures, smokers should have attended the stop-smoking service for at least the first four weeks of a quit attempt and that the staff providing the support should have been trained for their role. From the letter Brent PCT sent out it does not appear that they are making sure that this is the case."

Ministers distanced themselves from the scheme. A DoH spokesman said: "We certainly do not recommend or encourage incentive schemes of this type. We were not aware that Brent PCT were running such a scheme and we are sure that the local strategic health authority will want to look into this further."

Dr Llewellyn defended the scheme: "Smoking is the biggest health problem facing Brent. Thirty per cent of the adult population in Brent smoke and last year 18 per cent of all deaths were smoking related. The trust asked its staff to encourage their friends and family to stop smoking using our smoking cessation services. As an incentive we offered £100 to each member of staff whose smoker remained a 'quitter' after four weeks. The scheme was funded from the existing smoking cessation budget and we believe it is a very cheap and effective way of tackling smoking."

Coming on the eve of the Irish ban in smoking in public, the shortcomings of the UK efforts to tackle the habit are sure to be embarrass British ministers. Dr Reid is due to order a crackdown on the way that the £138m of taxpayers' money earmarked to reduce smoking rates is being spent. The money is supposed to help PCTs to meet an overall national target of getting 800,000 smokers to quit over the next three years.

A recent report on public health by Derek Wanless, commissioned by the Chancellor, Gordon Brown, was sharply critical of the policy, however.

The former bank chief identified "urgent areas for better management if resources are to be effectively used".

"Management information is very poor at the national level and the local level," Mr Wanless reported on smoking cessation programmes.

But it was ministers' use of targets in general that came under fire last night as the Conservatives called for an inquiry into the Brent scheme.

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