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CEAs: forget performance-related-pay, it’s about recapturing the principle of reward

In recommending the creation of distinction awards the Spens committee was clear in its intention to ensure that ‘specialists must be able to feel that more than ordinary ability and effort receive an adequate reward’. This concept of rewards was recognised in the remit to the Kendell committee in 1993, to develop proposals for a scheme for rewarding performance by hospital and community doctors and dentists.

Over time the concept of remuneration replaced rewards. Working parties and commissions were asked to devise incentives or motivating factors to encourage contributions over and above those required in their remunerated contracts. It eventually deteriorated into carrots and sticks to get the best out of a member of a caring profession. The world of banking introduced a concept alien to a caring profession and it was not long before parallels are drawn between award and bonuses in the banking profession.

Could things get any worse? Bereft of any new ideas and inspired by the DDRB in his ministerial statement of 16 July the Secretary of State declared: “We will also introduce a new performance pay scheme, replacing the outdated local clinical excellence awards so that we reward those doctors who are making the greatest contribution to patient care”. Before you swallow this hook line and sinker please be reminded that in 2003 the service based consultants were assured that “The majority of awards will go to those who make the biggest contribution to delivering and improving local and health services”.

The DDRB report in 2012 still shows that 38% of clinical academics hold national awards and 10% of NHS consultants hold national awards. The service consultants were deceived and the politicians were placated. What’s the guarantee that it would be different this time round?

Although the DDRB shows great reluctance in calling  a spade a spade,  you have guessed it: we are back to Performance Related Pay (PRP). How better can you do than replace an outdated scheme with a  discredited one? One solution of course is to introduce a brand ‘new concept’ as suggested by the DDRB and agreed by the minister: “awards for achieving excellence”, a new and exciting concept for a complete break with the outmoded concept of “clinical excellence awards”. Who do you think you are kidding Minister?

There is undoubtedly dissatisfaction about the awards scheme, but is it outdated? The evidence is there for all to see that it is maladministration that has brought the whole system into disrepute. The buck stops with you Sir.

Many discrepancies, the gender specialty and ethnicity imbalances in the awards have been investigated and partially rectified but the imbalance between academic and service consultants remains. When the figures for the discrepancy are quoted there is an implication that the academics are particularly favoured. For years the scheme operated without clarity of who are the clinical academics who benefit unfairly.

The DDRB is clear in their understanding and even goes as far as defining this group. The ACCEA however informed the DDRB that they do not gather statistics for academics since they cannot categorise this entity. Did the Policy lead for CEA in the DOH – and also the Head of the secretariat created to assist the ACCEA in the smooth and efficient administration of the scheme – not recognise this blatant inconsistency?

Those with good grades enter the better universities, and obtain employment in academic institutions. Ability and opportunity is a combination for success. It is not their success that should be a concern. It is the failure to reward those bearing the ‘heat and burden of the day’ and who keep the NHS afloat that should be our concern. They fly the flag for the NHS as much as the academics fly the flag for British medicine.

A peep into the past is very revealing. During the last overhaul of the remuneration for doctors and dentists there was a clamour by the employers for greater local control of remuneration. PRP naturally reared its head but to the credit of the  of the BMA this was fiercely and successfully resisted, but not without consequence.

As the then chairman of the CCSC wrote to me ‘if we were to avoid the imposition of locally determined PRP we had to accept certain changes to the merit award system’: the creation of local awards and national awards for work of national and international significance. These made the national awards less achievable by the smaller DGH consultants.

The formerly influential Kendell committee cited a study by three large British organisations operating PRP systems: “the benefits most often claimed for PRP are not met in practice” and “PRP does not serve to motivate (even those with high performance ratings) and may do more to demotivate employees”.

The Secretary of State is going ahead with determination to change the award scheme beyond recognition describing it as outmoded. Why is it then that every single working party and commission has  recommended the retention of the awards scheme?

May I make a plea for the return to the concept of reward. Every attempt by the Secretary of State to dismantle the scheme should be resisted. He has not made one case for the changes he wants to make. Permit my audacity and arrogance if I give the BMA a slogan: “The medical profession is not safe in their hands.”

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