Letter: NHS merit awards

Sir: In the debate about merit awards for consultants, it has been ignored that GPs, the other main clinical arm of the NHS, decided long ago that an award system for themselves would be unfair and invidious, and did not press for it. We realised that to base awards on clinical competence, an unmeasurable concept, was impossible, and to rank other contributions to medicine such as research or committee work was to risk rewarding merely short-term, or, even worse, self-aggrandising contributions.

For Professor Kay (letter, 13 August) to assert that "a skilled or hard- working consultant must otherwise spend more time in private practice" is disingenuous. Consultants only do private practice if they wish to boost their income.

Professor Kay says that in his experience awards were often made "after much discussion and inquiry". I should hope so. These awards are made for the rest of the doctor's working life and have a profound effect on the pension, itself protected and index-linked. Finally, in his list of others who may be consulted over recommendation for an award, he fails to mention GPs, perhaps those in the best long-term position to judge the value of an individual consultant's contribution to patient care.