A hospital trust is to trial a “performance-related” pay scheme that will reward the most successful surgeons.

Imperial College healthcare trust in London, the largest NHS trust in the country, will run the scheme to reward doctors financially for an as yet unspecified operation.

Managers are currently discussing the proposal with the surgical team responsible with a view to rolling it out in the next few months.

But patient watchdogs fear the most at-risk patients will be disregarded as surgeons look to treat cases with the best chance of success.

A spokesman for the trust said: “We are looking at a pilot scheme for a particular operation which will measure the improved functionality of the patient and we are looking at linking certain performance-related bonuses to that.”

Similar schemes are used in other countries, the spokesman added, and the trust was keen to test new approaches that will raise standards.

The government already offers cash incentives based on measures such as post-operative mobility, outlined in the recently published NHS Next Stage Review.

A Department of Health spokesman said: “Quality indicators such as complication rates and patient feedback are already used in specialities where they are available.

“As such measures become more widespread and robust, they will become increasingly influential in determining who gets awards.”

Katherine Murphy of the Patients Association warned the plan would provoke anger from its members.

“Patients will be horrified,” said Murphy. “There is a real risk that the most complicated cases, and the patients in real need, will be forgotten because they don’t get the best outcomes.”

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