Pay proposals may penalise consultants who don’t comply with management goals, BMA warns

Proposed changes to the clinical excellence awards and to consultants’ pay scales could allow organisations to financially penalise consultants who did not comply with managers’ objectives, the BMA has warned.

The Review Body on Doctors’ and Dentists’ Remuneration (DDRB) has suggested that local clinical excellence and distinction awards for NHS consultants should be awarded on the basis of job performance.1 The DDRB proposed that this should include doctors’ contribution to their employing organisation’s objectives.

Under the plans, employers would review doctors’ performance annually. They would also be able to withdraw or downgrade a consultant’s local award if they considered that the doctor’s performance no longer merited the payment.

Paul Flynn, chairman of the BMA’s Consultants Committee, said that under this system local awards could end up being given for compliance with managers’ goals. For example, awards could be given for meeting targets on cost efficiency or waiting times and not for true clinical excellence, he said. “We feel that there should be more objective measures that are reproducible across organisations,” he said.

The DDRB has also made “observations” on the consultant pay scale.2 It suggested that pay for most consultants should be limited to the first five points of the current eight point pay scale. Progression up the pay scale would be determined by employers on the basis of consultants’ performance rather than on length of service. Consultants could also potentially be moved down pay scales as well as up.

“We can see the danger that employers could award [pay increments] on the basis of who has been the most compliant with management directives and not necessarily on the basis of who is the most excellent and deserving clinician,” Flynn said.

The Consultants Committee has not yet decided whether to negotiate with the government on the changes, having discussed the issue at a special meeting last week.

“The decision we took was that we would talk and explore what is up for negotiation, but we still need to be convinced that there are benefits for our members in being involved in these negotiations,” said Flynn. “We can have discussions about the structure and value of awards—we’ve always been willing to look at those—but to simply slash a lot off the value of the consultant remuneration package is not something we could sign up to.”

The government hopes to reach broad “heads of agreement” on the changes in the coming months, with implementation beginning in April 2014. However, the BMA has said that this timescale is unrealistic. “These are major changes, and they’re not something to be rushed into,” said Flynn.