The proposal for a bonus - equivalent to well over twice the starting salary for a nurse - has won the backing of Tony Blair. But it will once again put ministers on a collision course with the nursing unions, who are already angry about their pay squeeze.
The plan emerges at a sensitive time. Ministers face criticism at this week's TUC Congress and in October at the Labour Party conference over their three-year austerity package which will keep a tight lid on the pay of almost a million employees in the National Health Service.
The 1.2 million-strong public service union Unison - Labour's largest affiliate - agreed to table a motion for the conference expressing "grave concern" over government policies.
The row will be further fuelled by the revelation that the Chancellor, Gordon Brown, is attempting to veto generous rises for nurses in the next pay round. Frank Dobson, the Health Secretary, wants to recommend to the independent pay review body that nurses should receive above-inflation wage increases and is insisting the award should not be staged.
The Prime Minister has already indicated support for the consultants' bonus proposal. Ministers at the Department of Health are drawing up the plan to give a special annual "loyalty bonus" to senior doctors who dedicate themselves to treating patients in state-run hospitals.
The bonus would be on top of the annual basic NHS salary of between pounds 44,780 and pounds 57,800 earned by consultants. The system of "merit awards" of up to pounds 55,000 is also under review.
The proposal reflects growing concern among ministers that hospital waiting lists are lengthening because doctors spend so little time working for the NHS. A recent study found that some surgeons spend as few as 10 hours a week operating on NHS patients.
Consultants' total earnings from private work doubled to 50 per cent in the 10 years to 1994. The most senior doctors can earn pounds 300,000 a year in Harley Street.
Although the plan will infuriate health workers, ministers believe the bonus must be "large enough" to make a genuine difference. "Many surgeons would far rather work for the NHS than go into private practice - but the rewards are so much greater in the private sector, many cannot afford to do so," said one minister. "They should be rewarded for their loyalty to the NHS."
Rodney Bickerstaffe, general secretary of Unison, registered his anger over the proposals yesterday. "It would be nice if similar size offers could be made to buy out poverty among public sector workers."
Mick Graham, head of public services at the GMB General Union, warned NHS staff would be furious. "This kind of decision makes people even more angry. They seem to be prepared to see my members, whose work is essential to the service, left on poverty pay."
The Chancellor is calling for tight constraint in wage increases to keep inflation under control. "There will be no let up on pay," a Treasury source said. "We are not going to have a free for all. If we give the nurses too much that sends the wrong signals out."Reuse content