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LETTERS: Anton E A Joseph All NHS consultants must have equal entitlement to awards BMJ 2001; 322: 1249a [Full text]

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Fair and flawed?

Nigel Dudley   (21 May 2001)

How about all NHS doctors must have equal entitlement to awards

Andrew Burnett   (23 May 2001)

Re: How about all NHS doctors must have equal entitlement to awards

Nigel Dudley   (24 May 2001)

Entitlement to awards

Michael Cushen   (31 May 2001)

Fair and flawed? 21 May 2001
Nigel Dudley, Consultant in Elderly Medicine St James's University Hospital LEEDS Send response to journal: Re: Fair and flawed?	The Government appears committed to fair pay and reward for all groups of NHS staff and Anton Joseph's concerns about the new NHS Clinical Excellence award scheme causing serious consequences for academic medicine are somewhat overstated. (1,2)The consultation document states in paragraph 74 that "There is a clear need to increase rewards for service achievements, without diminishing the recognition of university and MRC based consultants" Other examples of Government commitment to fair pay for all in the NHS can be found in letters about senior managers' pay sent to Health Authority and Trust chairmen and chief executives by people such as Frank Dobson, Alan Langlands, and Nigel Crisp. For example, in January 1998 Frank Dobson wrote indicating that an individual maximum of 2.7% was to be taken by each individual board member and senior manager in 1998/9 so as to be firm and fair and not damage morale and motivation within the NHS or public perceptions. Each trust annual report, that can be examined by members of the public to ensure probity, even had to contain a compliance statement to ensure that his explicit instruction was carried out. Similarly, Alan Langlands wrote a letter in October 1999 about the 1999/2000 pay rise for NHS managers indicating "The Government does not expect to see senior managers being awarded increases out of line with the rest of the public services". (3) It is fortunate that the proposed scheme is only at the consultation document stage as if implemented largely unchanged it could produce a large number of appeals or litigation claims by dissatisfied consultants who have had access to awards stifled by lack of local opportunities and investment in services. There are several key paragraphs: paragraph 45 "A large number of consultants feel discriminated against on the basis of race, gender, specialty, and degree of management contribution"; paragraph 51 ".. the criteria for the new scheme will be tied closely to the objectives to ensure that the aims are clear"; paragraph 59 "Local awards will be payable to those consultants making an outstanding contribution at local level against nationally set criteria."; paragraph 93 "These entry criteria must be formally signed off by the employer before the consultant can be considered for an award". If the facilities and opportunities are not made available to consultants to provide services that measure up against national standards to place them in a position to compete for awards they will be discriminated against and potentially financially disadvantaged. Furthermore, although a consultant may self-nominate in this equitable award scheme any conflict between consultants and managers over service support and provision may make the management reluctant or refuse to sign off the consultant's entry. This could be a powerful veto for managers to control their consultants. Many of the aims of the award scheme as set out in paragraph 101 could be achieved in a fair and unbiased way through the basic consultant contract, job plan, and annual appraisal process with appropriate, fair remuneration for work and responsibilities undertaken. If a higher awards scheme is to remain for outstanding achievements by a minority of outstanding consultants in the NHS then it perhaps should be simplified and based on the US Presidential Rank Awards scheme as described in box 5.3, page 47 of the recent report by the Performance and Innovation Unit on Strengthening Leadership in the Public Sector. (4) Those who are happy for the BMA and Department of Health to produce a fair and equitable scheme similar to the out of hours supplement scheme need do nothing; others should write to Room 2N35D, Quarry House, Leeds lS2 7UE or e-mail CONS-AWARD-SCHEME@doh.gsi.gov.uk with any concerns before the closing date for comments at the end of this month. (1) Joseph AEA All NHS consultants must have equal entitlement to awards (2) Department of Health. New award scheme: rewarding commitment and excellence in the NHS. London:DoH, 2001 (3) www.doh.gov.uk/nhsexec/alpayletter.htm (4) www.cabinet-office.gov.uk/innovation/leadershipreport/default.htm
How about all NHS doctors must have equal entitlement to awards 23 May 2001
Andrew Burnett, GP Sonning Common Send response to journal: Re: How about all NHS doctors must have equal entitlement to awards	Anton Joseph makes a useful contribution to the awards debate. Why limit the awards to consultants? Many GPs and non-consultant hospital doctors make valuable contributions to the health service. As it stands the current awards system is ancchronistic and neither encourages innovation or rewards fairly Andrew Burnett
Re: How about all NHS doctors must have equal entitlement to awards 24 May 2001
Nigel Dudley, Consultant in Elderly Medicine St. James's University Hospital LEEDS Send response to journal: Re: Re: How about all NHS doctors must have equal entitlement to awards	GPs do make similar, valuable contibutions to the health service as do the hospital consultants, however, as Dr Ian Bogle and the BMA would point out, they are rewarded under a completely diferent type of contract to that held by hospital doctors so are not eligible for awards.In any case, GPs receive seniority payments. Although the consultant awards are meant to be for outstanding contributions, paragraph 25 of the consultation document acknowledges that length of service in the NHS is also considered and reflected in the age at which consultants normally receive awards. At present there is discrimination against younger consultants. The new award scheme may not be limited just to consultants as proposals have been put forward by the Department of Health to open the awards to salaried academic GPs. They clearly must be considered by the DoH to have a greater and more valuable input into health services than the salaried non-academic GPs. With a new and revised consultant contract a complex award system dating back to the 1940s with minor modifications may not be in the health service's best interest.
Entitlement to awards 31 May 2001
Michael Cushen, Consultant in Palliative Medicine St Elizabeth Hospice and Ipswich Hospital, Ipswich Send response to journal: Re: Entitlement to awards	I was surprised to read that 39% of award holders are honorary consultants in the NHS, as I had been led to believe that honorary consultants are not entitled to either distinction awards or even discretionary points. I am a hospice medical director who holds an honorary consultant contract with the local hospital, but I have been told on more than one occasion that I am not entitled to apply. In fact, the Association for Palliative Medicine seem to be under the same impression. We are a specialty who provide services to the NHS at a very cheap rate (the average NHS contribution to the funding of adult hospices is around 30%) and are mostly working single handed with very little junior cover compared with our hospital colleagues. In addition we have very little opportunity for, and I suspect little desire for, private practice. Many of us are becoming increasingly involved in meetings involving cancer networks, PCG's and other statutory bodies for which our hospices are funding us. I feel we are very much a cinderella specialty in many senses and we do not always get the recognition or remuneration we deserve. I would be interested to hear from colleagues who may have further information or advice to offer.