Ethnic and sex bias in discretionary awardsBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7391.671 (Published 29 March 2003) Cite this as: BMJ 2003;326:671
Eliminating bias is part of modernising any new consultants' contract
- James Raftery, director (firstname.lastname@example.org)
- Health Economics Facility, Health Services Management Centre, Birmingham B15 2RT
See Papers p 687
George Bernard Shaw, in his preface to The Doctor's Dilemma, summarised his conclusions as follows: “Nothing is more dangerous than a poor doctor.” His solutions included making doctors into “civil servants with a dignified wage paid out of public funds” and “municipalise Harley St.”1 Shaw's reaction to the NHS, which arguably made hospital doctors into civil servants, is not recorded. Although he was aged 92 in 1948, he would probably have pointed to the implications of failing to municipalise Harley St.
The United Kingdom is unusual in the extent to which the state employs hospital consultants in state owned hospitals. International trends towards greater autonomy for local organisations have been partly reflected in the United Kingdom with the development of NHS hospital trusts from 1991 and, more recently, the plans for foundation hospitals.
Any economist reviewing how hospital doctors in the United Kingdom are paid would be struck by the following. Firstly, NHS national pay scales, which have survived the shift of consultants' contracts from regions to hospital trusts, make up 71% of consultants' income (table). These pay scales take no account of performance, let alone regional differences in the costof living, nor of the costs of qualifying and remaining up …