“Bonuses for senior doctors rise”

It was reported this week that “bonuses for senior doctors” in NHS Scotland is on “the rise”:


This reminded me of a range of views expressed after I offered my personal considerations about “pay awards” for NHS Consultants.

I should say that I found the ‘award panel’ to be thorough but hugely labour intensive in terms of time and resource. “Cost” should perhaps be considered a number of ways:


This was one reply:

Discretionary points2

This was another:

Discretionary points3

This week’s report began:

Discretionary points5

Consultants can get up to seven “discretionary points” before moving on to three levels of “merit awards”:

Discretionary points6

Discretionary points8

Discretionary points9

My personal view is that such financial incentivisation risks skewing behaviour. This potential has been evidenced in other areas of healthcare where “incentivisation” has been involved.

There may be further consequences of financial incentivisation: such that professionalism may be “guided” more by managers, politicians and “improvement science” than by experience, training and knowledge.

Discretionary points9c

It is many years since I was part of a discretionary award panel but I noted at the time that a number of applicants were working “jointly” with the pharmaceutical industry, particularly in research. Such research would significantly improve the chance of a senior doctor getting discretionary points or merit awards. None of these senior doctors did I ever find declaring such interests on any register of any sort.

I noticed one reply to this recent article commented that:

Discretionary points9d

We must also consider that:

Discretionary points9e

Here are the criteria for Discretionary points as part of any annual application:


Declaration: I have one discretionary point. I no longer apply for awards. This is my personal view. I respect all other views.

Historical note: Additional payment to consultants dates back 
to 1948 when "incentive payments" were available to encourage 
consultants to join the NHS. The "merit award" system was 
nationally based and has progressed to the present mixed local 
and national awards system.

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