Consultants' merit award system to be reformed

BMJ 1998; 317 doi: (Published 15 August 1998) Cite this as: BMJ 1998;317:429
  1. John Warden, parliamentary correspondent
  1. BMJ

    Government discontent with the system of distinction awards paid to British consultants surfaced this week in a package of measures that the Department of Health described as the biggest reform of consultants' pay for 50 years, with a more fundamental review to follow next year.

    Although issued for consultation, the proposals reflect already firm government policy, which will influence the 1999 doctors' pay review. Under these proposals, the Advisory Committee on Distinction Awards, which currently comprises 33 members (including 25 consultants), would be reduced to 14--a chairman, five consultants, and eight representatives of NHS employers and patients' interests.

    The new committee would be able to review and withdraw awards at any time--for example, after General Medical Council findings, criminal conviction, or a decision by the proposed Commission for Health Improvement. Future awards should recognise outstanding commitment to achieving the goals of the NHS, including the delivery of high quality patient care in hard pressed service areas. This implies fewer awards to consultants in teaching hospitals. Awards should also recognise a commitment to clinical governance, evidence based medicine, and external audit. Employers' views would be sought for all nominations, and awards committees would have to include a fair representation of women and ethnic minority members.

    The proposals take account of the views of the advisory committee under its new chairman, Sir William Reid, and medical director, Sir Christopher Paine. The proposals have been sent to the presidents of the medical royal colleges, the BMA, and other bodies for consultation, which ends on 18 September.

    The Department of Health emphasised that these are only interim proposals and that a more fundamental review of distinction awards is likely next year.

    The government's action follows public concern that Mr James Wisheart--the paediatric surgeon who was struck off the medical register following the investigation into the deaths of 29 babies in Bristol--continued to receive merit awards until his retirement (27 June, p 1924). The health secretary, Frank Dobson, wanted to stop Mr Wisheart's awards but was advised that he could not legally do so.

    Health minister Alan Milburn said this week that the government wanted a radical change in the sytem. He added: “Merit awards are not for life; they have to be earned. In future the changes I am proposing will mean that poor performance, outright failure, or inappropriate conduct will result in immediate removal of the awards.” He said that the changes were designed to open up a secretive system and make it fairer, with patients and employers having a say about how awards were made.

    The deputy chairman of the BMA's Central Consultants and Specialists Committee, Dr Peter Hawker, said that the committee welcomed any moves to make the scheme fairer and more open. “Contrary to what ministers have said, distinction awards are not regarded as a right by consultants, nor are they bonus payments. They are part of the consultants' remuneration scheme.”

    Dr Sam Everington, who on behalf of the Medical Practitioners Union has helped to expose what he believes is racism in the system, said: “Those doctors who have long campaigned against racism and sexism in the medical profession will regard this as excellent news.”

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