Letter: NHS merit awards

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Sir: What can you mean by suggesting that "the abolition of consultants' automatic merit awards should create the scope to offer perhaps larger incentives to those who are truly outstanding" (leading article, 11 August)? To do so would introduce the scale of inequities of the boardroom and barristers' chambers, and would remove the incentives which a modest B or C award can offer to a skilled, hard-working consultant, who must otherwise spend more time in private practice.

And where on earth do you get the concept of "automatic" awards? In my experience recommendations from a hospital or other organisation were only made after much, often organised, discussion and inquiry. It is very difficult to assess clinical merit. One can get useful opinions from fellow consultants, others in the same speciality, from nurses, junior doctors, students and of course patients. But often it is the long-term benefit to patients (after several years perhaps) which is most relevant.

There is a heavy responsibility on those who make recommendations to the awards committee to do so carefully and impartially. There will be failures and it is never going to be easy but it will best be done on as wide a basis of clinical knowledge as possible.