Papers

Discrimination in the discretionary points award scheme: comparison of white with non-white consultants and men with women

Aneez Esmail, president ^a, Peter Abel, research assistant ^b, Sam Everington, vice president ^a. 

^a Medical Practitioners Union, MSF Centre, London EC1V 8HA, ^b Rusholme Health Centre, School of Primary Care, University of Manchester, Manchester M14 5NP

Correspondence to: A Esmail aneez.esmail{at}man.ac.uk

The discretionary points award scheme is one of the main mechanisms for rewarding consultants beyond their basic salaries in England, Wales, and Scotland. Half of all consultants have received awards. Together, the discretionary points and distinction awards cost the NHS about £251m ($410m; 380m) each year. Each discretionary point is worth £2645, so a consultant with the maximum of eight discretionary points earns £87 280.

Department of Health guidance for awarding points instructs employers to ensure that consultants are treated equally regardless of colour, race, sex, religion, politics, marital status, sexual orientation, membership or non-membership of trade unions or associations, ethnic origin, age, or disability.¹ We assessed whether any disparity between the discretionary points awarded to consultants in England and Wales and in Scotland is associated with ethnic origin and sex.

	Methods and results

Top Methods and results Comment References

We used data for 2000-1 from the Advisory Committee on Distinction Awards for England and Wales and the Scottish Advisory Committee on Distinction Awards. These disaggregated data included date of birth, sex, ethnic origin, specialty, level of award or number of discretionary points held, and the year the awards or points were granted.

We categorised the ethnic groups Bangladeshi, black African, black other, Chinese, Indian, and Pakistani as non-white and compared these groups with consultants who described themselves as white. Consultants classified as from any other ethnic group and those who did not give their ethnic origin were excluded. We divided the number of consultants with discretionary points by the total number of consultants who did not receive distinction awards, as consultants without awards are eligible for discretionary points. We compared the proportion of consultants with discretionary points between white and non-white consultants and between men and women (table).

In England and Wales, white consultants had 1.37 (95% confidence interval 1.31 to 1.44) times as many awards as non-white consultants, and men had 1.25 (1.21 to 1.30) times as many as women; in Scotland the ratios were 1.34 (1.08 to 1.66) and 1.36 (1.23 to 1.51). The ratios increased with increasing level of award (table).

	Comment

Top Methods and results Comment References

Non-white and female consultants may be disadvantaged under the discretionary point award scheme. The non-response rate of 16% (3597/22389) in England and Wales may have affected the results. To negate the differences, all the consultants who did not give their ethnic group and received awards would, however, have to be non-white. Non-white consultants are older when appointed, and, therefore, their period of eligibility for discretionary awards is less than for white consultants. Non-white consultants may also be concentrated in specialties which are less likely to receive awards. ^{2 3} The reason for differences in the number of points awarded to men and women is unclear, but differences could be due to discrimination.⁴

Points are awarded by local decision making groups which usually consist of three non-eligible consultants and three managers. The deliberations of these groups are not usually open to scrutiny. The lack of published data on the scheme locally and nationally is a continued source of concern. Employment tribunals have already found in favour of consultants who have alleged racial discrimination.⁵ Without effective monitoring, it is impossible to judge whether the scheme is operated fairly and without discrimination.

	Acknowledgments

We thank Chris Roberts for statistical advice.

Contributors: AE planned the study, supervised the analysis, and wrote the paper. PA obtained the data, carried out the analysis, obtained the background information, and commented on drafts of the paper. SE suggested the idea for the paper and commented on drafts. AE is guarantor.

	Footnotes

Editorial by Raftery

Funding: No additional funding

Competing interests: AE and SE are members of the Medical Practitioners Union, which is opposed to distinction awards and discretionary point awards.

	References

Top Methods and results Comment References

1.	Department of Health. Consultants discretionary points. London: Department of Health, Dec, 1995. (Advance letter (MD)6/95; Annex B modified December 1999.)
2.	Esmail A, Everington S, Doyle H. Racial discrimination in the allocation of distinction awards? Analysis of list of award holders by type of award, specialty, and region. BMJ 1998; 316: 193-195[Free Full Text].
3.	Bruggen P, Bourne S. The distinction awards system in England and Wales 1980. BMJ 1982; 284: 1577-1580[Free Full Text].
4.	Beecham L. Women consultants lag behind in merit awards. BMJ 1994; 308: 1106[Free Full Text].
5.	Wise J. Trust accused of racism in awarding payments. BMJ 2000; 320: 269[Free Full Text].

(Accepted 9 September 2002)