Uncomfortable questions but no easy answers

Distinction awards are as old as the NHS. They were established in 1948 to reward specialists for “more than ordinary ability and effort”1 by increasing their salaries, and this aim has remained essentially unchanged. Any system that tries to identify and then reward distinction is likely to have its critics, and distinction awards are no exception. Suggestions that the system favoured men and certain specialties were made long ago,2 and now Esmail and Everington add the accusation of racial bias (p 193).3

Most consultants don’t have a distinction award.4 Those who do have achieved wide recognition in their specialty, often nationally or internationally, and receive a pensionable salary enhancement of £22 590 to £53 645, subject to review every five years. The system is run by the Advisory Committee on Distinction Awards, which has 33 members, most of them doctors, with a few NHS managers. The committee receives nominations from the royal colleges and faculties, other professional organisations, national employers such as the Medical Research Council, and regional committees of …