Education And Debate

In defence of merit awards

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6934.974 (Published 09 April 1994) Cite this as: BMJ 1994;308:974
  1. J Tobias
  1. Meyerstein Institute of Oncology, Middlesex Hospital, University College London Hospital Trust, London W1M 8AA.

    Never one to avoid controversy, Aneurin Bevan knew from the start that his newly nationalised health service could work only with the full cooperation of the profession. Although a Gallup poll taken early in 1948 confirmed that the overwhelming majority of the public supported it, Bevan was enough of a pragmatist to realise that the doctors were another matter altogether - read Michael Foot's wonderful biography for a thrilling account.1

    The merit award system was born of Bevan's recognition that to retain the services of the best, you must expect to pay. “Stuff their mouths with gold” was his simple yet effective prescription, a staggering volte face for an unflinchingly egalitarian Welshman. Effective? Highly, since most would agree that during the NHS's first half century one of its more remarkable features has been that the most outstanding individuals have indeed been attracted to staying within the service, usually working as consultants or University employees at large (generally teaching) hospitals.

    Performance related pay and process

    How has this been achieved? By the provision of merit awards, of course. Although all would agree that no system of preferment can possibly be perfect, what is wrong with the principle of recognising merit, then rewarding it? Casual reading of the General Medical Council's annual reports reminds us that not all doctors are the selfless altruists we all thought we were when we interviewed nervously at our medical schools. Don't give me all that tosh about how equally hard we all work, how uniform is the devotion of all practitioners to our patients, how we all love nothing better than a head-to-head two hour session with our students, etc, etc. It isn't true for teachers, nor for lawyers, musicians, estate agents, or even members of the royal family. Some are simply better at their jobs than others. Oddly enough …

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