Doctors warn performance pay will hit patient care: BMA predicts widespread resistance to government moves. Celia Hall reports

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The Independent Online
Patients will suffer if doctors' pay is made performance-related, as the Government intends, the British Medical Association said yesterday, warning that doctors across the country plan to resist it.

Consultants, junior doctors and public health doctors have tabled 25 separate motions in opposition for their conferences this month.

John Chawner, chairman of the BMA consultants committee, said yesterday that the Department of Health had given no idea how a system could work.

The Government also wants to see part of doctors' salaries 'devolved' to local hospital trusts and health authorities, which is also being strongly resisted.

He said that devolving an unknown proportion of pay to local negotiators and introducing performance related pay would be costly to the NHS and would lead to pay cuts for staff.

The current national pay review body cost pounds 600,000 a year and was good value. 'In a new system there would have to be negotiators in every trust in the land, not only for doctors but for nurses and ancillary staff as well. There would be a huge add-on cost to a service already starved of cash and the money could only come out of patient care,' Mr Chawner said.

He said that performance related pay had largely been discredited in industry. 'It was rejected by the police, adopted by BT and abandoned. We have heard of one hospital trust where managers on performance related pay are being taken off it.'

Doctors also fear that the emergence of local pay bargaining and performance related pay would be detrimental to the training of young doctors and would engender Cinderella specialties in the market-led NHS. Doctors working in popular and cost effective specialites like orthopaedics would be better paid than those working in psycho-geriatrics.

Yesterday, Baroness Cumberlege, the junior health minister, announced that pounds 2m was being made available for part-time consultant posts largely to promote the career interests of women doctors. It will provide for 85 part- time posts designed to loosen up career progression in the hospital service.

She told a conference organised by the Royal College of Physicians in London that bringing up children and developing other talents were also part of a doctor's life. 'This mirrors changes going on in careers everywhere and medicine must be flexible enough to respond or it will not attract the brightest and best,' she said.

However, the college maintains that the needs of doctors who want part-time careers in specialist medicine are not being met. In a report published today, the RCP says opportunities for part-time work are limited and if the situation does not change the NHS will be deprived of skilled staff and patient care will be affected.