Consultant pay proposals could destabilise workforce, warn anaesthetists

Plans to change consultants’ pay and bonuses could disproportionally affect anaesthetists and destabilise the specialty’s workforce, say the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland.

The two bodies said that “radical” proposals from the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) were unfair in the face of a three year pay freeze and increases in pension contributions. They argued that the proposed changes would be a major disincentive to doctors to engage in the wider NHS at local and national levels.

They suggested that the proposed changes to pay and to clinical excellence awards could lead to many senior consultants taking early retirement and the best anaesthetists emigrating. “This would clearly destabilise the medical workforce and be to the detriment of patients,” they said.

The two bodies said that anaesthetists in particular had in the past “suffered from a degree of prejudice” in terms of pay progression. So few clinical excellence awards were available in anaesthetics that many able consultants did not even apply for those on offer, they said.

The DDRB has proposed that pay for most consultants be limited to the first five points of the eight point pay scale.1 It also recommended that high performing consultants be moved to a new “principal consultant” grade. It supported the continuation of clinical excellence awards but suggested that a cap be placed on the maximum sums on offer and on the number of local and national awards.2

The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland have submitted a joint response to the DDRB’s recommendations. In it they suggested that tying pay progression to performance could result in a “postcode lottery” in the criteria for pay progression, as local managers would have their own priorities for productivity and budgeting. There was therefore a “sinister” possibility that the workforce would be rewarded for complying with managerial strategy rather than for meeting clinical targets, they warned.

“There is also the risk that cash strapped employers may suddenly move the goal posts for pay progression in order to meet short term fiscal targets,” they said. It would be “disastrous,” they said, if a repeat of the Mid-Staffordshire debacle occurred because clinicians “were frightened to speak out due to a bullying culture over pay progression.”

The two organisations also offer views on the local and national awards systems. They said that the proposed restructuring was simply to save money and would make the system “a shadow of its former self.”

They also warned about the effect of cuts in the funding available for national awards and the lack of clarity on the performance targets to be used for local awards. They said that these issues could dissuade the next generation of consultant anaesthetists from engaging in non-clinical aspects of the role, such as research, education, medical management, and medical leadership.