All NHS consultants must have equal entitlement to awards
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7296.1249/a (Published 19 May 2001) Cite this as: BMJ 2001;322:1249
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GPs do make similar, valuable contibutions to the health service as
do the hospital consultants, however, as Dr Ian Bogle and the BMA would
point out, they are rewarded under a completely diferent type of contract
to that held by hospital doctors so are not eligible for awards.In any
case, GPs receive seniority payments. Although the consultant awards are
meant to be for outstanding contributions, paragraph 25 of the
consultation document acknowledges that length of service in the NHS is
also considered and reflected in the age at which consultants normally
receive awards. At present there is discrimination against younger
consultants.
The new award scheme may not be limited just to consultants as
proposals have been put forward by the Department of Health to open the
awards to salaried academic GPs. They clearly must be considered by the
DoH to have a greater and more valuable input into health services than
the salaried non-academic GPs.
With a new and revised consultant contract a complex award system
dating back to the 1940s with minor modifications may not be in the health
service's best interest.
Competing interests: No competing interests
Anton Joseph makes a useful contribution to the awards debate. Why
limit the awards to consultants? Many GPs and non-consultant hospital
doctors make valuable contributions to the health service. As it stands
the current awards system is ancchronistic and neither encourages
innovation or rewards fairly
Andrew Burnett
Competing interests: No competing interests
The Government appears committed to fair pay and reward for all
groups of NHS staff and Anton Joseph's concerns about the new NHS Clinical
Excellence award scheme causing serious consequences for academic medicine
are somewhat overstated. (1,2)The consultation document states in
paragraph 74 that "There is a clear need to increase rewards for service
achievements, without diminishing the recognition of university and MRC
based consultants"
Other examples of Government commitment to fair pay for all in the
NHS can be found in letters about senior managers' pay sent to Health
Authority and Trust chairmen and chief executives by people such as Frank
Dobson, Alan Langlands, and Nigel Crisp. For example, in January 1998
Frank Dobson wrote indicating that an individual maximum of 2.7% was to be
taken by each individual board member and senior manager in 1998/9 so as
to be firm and fair and not damage morale and motivation within the NHS or
public perceptions. Each trust annual report, that can be examined by
members of the public to ensure probity, even had to contain a compliance
statement to ensure that his explicit instruction was carried out.
Similarly, Alan Langlands wrote a letter in October 1999 about the
1999/2000 pay rise for NHS managers indicating "The Government does not
expect to see senior managers being awarded increases out of line with the
rest of the public services". (3)
It is fortunate that the proposed scheme is only at the consultation
document stage as if implemented largely unchanged it could produce a
large number of appeals or litigation claims by dissatisfied consultants
who have had access to awards stifled by lack of local opportunities and
investment in services. There are several key paragraphs: paragraph 45 "A
large number of consultants feel discriminated against on the basis of
race, gender, specialty, and degree of management contribution"; paragraph
51 ".. the criteria for the new scheme will be tied closely to the
objectives to ensure that the aims are clear"; paragraph 59 "Local awards
will be payable to those consultants making an outstanding contribution at
local level against nationally set criteria."; paragraph 93 "These entry
criteria must be formally signed off by the employer before the consultant
can be considered for an award". If the facilities and opportunities are
not made available to consultants to provide services that measure up
against national standards to place them in a position to compete for
awards they will be discriminated against and potentially financially
disadvantaged. Furthermore, although a consultant may self-nominate in
this equitable award scheme any conflict between consultants and managers
over service support and provision may make the management reluctant or
refuse to sign off the consultant's entry. This could be a powerful veto
for managers to control their consultants.
Many of the aims of the award scheme as set out in paragraph 101
could be achieved in a fair and unbiased way through the basic consultant
contract, job plan, and annual appraisal process with appropriate, fair
remuneration for work and responsibilities undertaken. If a higher awards
scheme is to remain for outstanding achievements by a minority of
outstanding consultants in the NHS then it perhaps should be simplified
and based on the US Presidential Rank Awards scheme as described in box
5.3, page 47 of the recent report by the Performance and Innovation Unit
on Strengthening Leadership in the Public Sector. (4)
Those who are happy for the BMA and Department of Health to produce a
fair and equitable scheme similar to the out of hours supplement scheme
need do nothing; others should write to Room 2N35D, Quarry House, Leeds
lS2 7UE or e-mail CONS-AWARD-SCHEME@doh.gsi.gov.uk with any concerns
before the closing date for comments at the end of this month.
(1) Joseph AEA All NHS consultants must have equal entitlement to
awards
(2) Department of Health. New award scheme: rewarding commitment and
excellence in the NHS. London:DoH, 2001
(3) www.doh.gov.uk/nhsexec/alpayletter.htm
(4)
www.cabinet-office.gov.uk/innovation/leadershipreport/default.htm
Competing interests: No competing interests
Entitlement to awards
I was surprised to read that 39% of award holders are honorary
consultants in the NHS, as I had been led to believe that honorary
consultants are not entitled to either distinction awards or even
discretionary points. I am a hospice medical director who holds an
honorary consultant contract with the local hospital, but I have been told
on more than one occasion that I am not entitled to apply.
In fact, the
Association for Palliative Medicine seem to be under the same impression.
We are a specialty who provide services to the NHS at a very cheap rate
(the average NHS contribution to the funding of adult hospices is around
30%) and are mostly working single handed with very little junior cover
compared with our hospital colleagues. In addition we have very little
opportunity for, and I suspect little desire for, private practice. Many
of us are becoming increasingly involved in meetings involving cancer
networks, PCG's and other statutory bodies for which our hospices are
funding us. I feel we are very much a cinderella specialty in many senses
and we do not always get the recognition or remuneration we deserve. I
would be interested to hear from colleagues who may have further
information or advice to offer.
Competing interests: No competing interests