At the end of August doctors from around Britain will meet in London to pursue their battle against the introduction of locally determined performance related pay within the NHS. According to the BMA no other issue since the start of the reforms has aroused such a consistent and united response from ordinary doctors working in hospitals and community trusts. Why the anger, and what are the principles at stake?

The move towards performance related pay was heralded in the Citizen's Charter, which promised that public sector workers' pay would be more closely related to performance. Earlier this year the Department of Health suggested amending the terms of service of all NHS staff to allow an element of pay to be determined locally on the basis of individual performance. Since then negotiations have continued, but the government has asked the Doctors and Dentists Review Body to make only a minimum award next year, to leave room for local supplementation; and it has told all NHS employers to establish mechanisms for local pay bargaining by next spring.

Doctors' concerns are twofold. Firstly, they fear the threat that local pay bargaining poses to a national health service. Secondly, they question the benefits of systems that tie pay rises to a formal appraisal of how an individual has met certain performance criteria. Their concerns cover both matters of principle and the practicalities of measuring performance. But they also reflect the underlying rift in the NHS between political- managerial priorities and clinical ones.

Firstly, …