Policy responses and statements

Name of organisation:

Name of organisation: Review Body on Doctors' and Dentists' Remuneration (DDRB)

Name of policy document:

Review of compensation levels, incentives and the Clinical Excellence and Distinction Award schemes for NHS consultants

Deadline for response:

26 November 2010

Background: At the request of the four UK Health Departments, the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) is carrying out an independent review looking at compensation levels and incentive systems and the various Clinical Excellence and Distinction Award Schemes for NHS consultants at both national and local level in England, Wales, Scotland and Northern Ireland.

The full terms of reference for this review are as follows:

“The review is to look at compensation levels and incentive systems and the various Clinical Excellence and Distinction Award Schemes for NHS consultants at both national and local level in England, Wales, Scotland and Northern Ireland. The review will take place in the context of key Government documents and the remit is -

• To consider the need for compensation levels above the basic pay scales for NHS consultant doctors and dentists including clinical academics with honorary NHS contracts, in order to recruit, retain and motivate the necessary supply of consultants in the context of the international medical job market and maintain a comprehensive and universal provision of consultants across the NHS. The review will consider total compensation levels for consultants and may make observations (rather than recommendations) on basic pay scales
• To consider the need for incentives to encourage and reward excellent quality of care, innovation, leadership, health research, productivity and contributions to the wider NHS - including those beyond the immediate workplace, and over and above contractual expectations. The review should specifically reassess the structure of and purpose for the Clinical Excellence and Distinction Awards Schemes and provide assurance that any system for the future includes a process which is fair, equitable and provides value for money

The review will be fully linked into other activity on public sector pay including:

• The benchmarking work on senior public sector pay being carried out by the Senior Salaries Review Body;
• The Fair Pay Review in the public sector led by Will Hutton; and
• The review of public service pensions by the Independent Public Service Pensions Committee chaired by John Hutton

The review should consider issues of comparability with other public sector and NHS incentive schemes. The recommendations of the review must take full account of affordability and value for money. The recommendations must also respect the accrued rights of individuals.

The review is to be led by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The DDRB as an independent body will work closely with a range of external stakeholders, including NHS Employers, the British Medical Association and the independent Committees which make awards in the four countries.

The review has been commissioned by Ministers of the four countries in the UK.

The DDRB has been asked to submit recommendations to UK Ministers by July 2011.

COMMENTS ON
REVIEW BODY ON DOCTORS' AND DENTISTS' REMUNERATION (DDRB)
REVIEW OF COMPENSATION LEVELS, INCENTIVES AND THE CLINICAL EXCELLENCE AND DISTINCTION AWARD SCHEMES FOR NHS CONSULTANTS

The Royal College of Physicians of Edinburgh is pleased to respond to the consultation on Clinical Excellence and Distinction Awards by the Review Body on Doctors’ and Dentists’ Remuneration, and offers the following comments which also reflect the perspective of the College Lay Advisory Committee.  Our comments refer to national rather than local awards which allow reward for nationally recognised activity and are achieved by a smaller proportion of doctors.

1. The College understands that, at this time of economic hardship, such a scheme could be portrayed negatively in terms of favouring doctors, and the College believes it is important to emphasise that the value of national awards is cumulative, not additive, and that recent developments have improved the schemes across the UK.

2. The College Lay Advisory Committee recommends that any future scheme has greater transparency of purpose, selection and outcome to communicate clearly the objectives and benefits to the patients and the wider NHS.  Introducing clear externality into the selection process will support the objectivity of the scheme and perceptions of fairness.

3. The College believes there is little doubt that national awards provide an incentive over the working lives of consultants to innovate and drive up standards.  They offer a means of recognising and rewarding excellence in areas of quality improvement for patients, whether in research, clinical effectiveness or teaching.  This effort may be difficult to generate in future with the increased emphasis on direct clinical care in job plans and rising problems in achieving professional leave for work for the benefit of the wider NHS. This includes technology assessment, guideline development, standard setting, updating curricula, multi-disciplinary teaching at all levels, quality assurance, policy development  and clinical research.  

4. National awards also offer the opportunity to increase income for those delivering excellence who could otherwise choose to undertake private practice.

5. Their role in recruitment and retention is rather less clear, although a clear monetary difference between consultant and general practitioner remuneration opportunities will deter some high calibre candidates from hospital medicine and may also deter high performing school leavers from selecting medicine as a profession.  The international global market for doctors must also be considered in the context of monetary reward, professional recognition and other changes influencing the lives of doctors working in the public sector in the UK.  Of perhaps greater importance is the potential to introduce a market for doctors across the UK if any future system is not UK-wide.

6. The College recognises that the current systems operating in all 4 nations could be improved to reform the shape of the awards framework, increase the transparency of the selection process and ensure equity of opportunity over the diversity of the consultant community.

7. The current system operates with criteria that are imprecise and weighted to academic and major hospital environments and to the larger medical specialities, making it difficult for those working it smaller units to rise to prominence.

8. The College believes that future criteria must seek to measure excellence and mark achievements in clinical and related competence and not stray into performance measures which would be better left for remuneration scales or local awards.

9. The College recommends a full review of the scale and scope of awards to ensure the purpose of national awards is to incentivise and recognise true excellence.  The College accepts that such awards should not carry monetary reward for life without regular review, but the incentive aspect will be significantly diminished if not pensionable, particularly if future pensions are linked to average earnings.

10. The criteria and self-nomination system may be indirectly discriminatory, given the historic barriers that inhibit those working less than full time from putting themselves forward for relevant national work or for awards that stem from such work.  Rewarding excellence for those working less than full time or in smaller medical units or “Cinderella” specialties must be protected

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[29 November 2010]