Bonuses for hospital doctors too ‘costly and unwieldy’

The NHS bonus payment system for doctors has been branded “costly” and “unwieldy” by the head of medical pay and workforce at NHS Employers.

Bill McMillan voiced his concerns after the BBC discovered a loophole that large pay bonuses cannot be taken away from doctors, even if their performance deteriorates.

It means that more than half of the 36,000 consultants in England now get what are effectively “lifetime” awards on top of their £89,400 basic pay.

Doctors provide details of excellent performance and innovation in terms of clinical care, research and training. Bonuses worth as much as £75,000 are awarded to those deemed to have performed over and above the usual standard expected of their NHS role as part of the consultant pay rewards scheme.

The scheme was introduced in 1948 but has been under review since the summer in order to “bring the awards scheme up to date and in line with other public sector pay schemes”.

The awards are assessed every five years. However, the BBC reports that a loophole has created a culture where the checking process is effectively obsolete and the Advisory Committee on Clinical Excellence Awards – the body that oversees the top payouts – acknowledges that reassessments have not always taken place.

Just seven of the top awards worth more than £35,484 were withdrawn between 2006 and 2009, the BBC claims.

“The current clinical excellence awards scheme is costly, unwieldy and out of step with other pay systems in the NHS,” McMillan said.

“NHS organisations have told us that the system is inflexible and a review is needed to ensure it is consistent with pay and reward in today’s NHS. They would like a system that is more focused on business needs and provides employers with the flexibility to reward consultants in a way that is integrated into local systems and requirements rather than being forced to spend money on a system over which they have little control.”

A Department of Health spokesman said: “Anomalies like this are exactly why the secretary of state announced a review into these awards. In future we want to see a much tougher approach, including withdrawing them from people who no longer display the quality of work that would merit an award now.”

Last year the NHS spent more than £200 million on the awards, which are paid on top of consultant salaries.

A British Medical Association spokesman pointed out that rewards encourage quality and innovation in the NHS. “The BMA has always believed that transparency and equity are important in award schemes and is happy to engage with the current review. However, it is important to keep in mind that not all consultants receive an award and fewer than 1% receive the highest.”

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