Views And Reviews

BMA protests about performance related pay in the NHS

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6941.1443 (Published 28 May 1994) Cite this as: BMJ 1994;308:1443

The proposal to introduce locally negotiated performance related pay for employed doctors in the NHS will open the way to “unseemly and divisive” local disputes, according to the BMA. In a strongly worded letter to the secretary of state for health, the chairman of the BMA council, Dr Sandy Macara, said that the association had “profound objections” to the government's plans to amend doctors' terms and conditions of service.

Department of Health officials have told the BMA that from April 1995 the doctors' and dentists' review body will recommend only an “exceptionally modest pay” increase for doctors. This would lead local employers to award any further increases according to local performance related pay schemes if they were able to generate sufficient resources to do so through improved productivity.

In his letter to Mrs Bottomley, Dr Macara warns that the degree of control that such schemes offered managers introduced an extremely dangerous principle in medicine. There was a danger that a hospital's performance related pay scheme could give managers a tool with which to pressurise consultants into compliance with trusts' business needs. Far from improving performance, Dr Macara pointed out that there was growing evidence that performance related pay demotivated staff who saw such schemes as “unfair, discriminatory, or unattainable.”

The BMA has urged the secretary of state to reconsider the proposal and has said that it is willing to discuss alternative remuneration structures for doctors.

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