Doctors 'should face salary cut'

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Doctors should have their pay cut if they do not hit targets or increase productivity, a leading health economist has proposed.

Alan Maynard, professor of health economics at York University, said "demerit awards" were more effective at improving performance than bonuses.

And he suggested the NHS should consider taking away up to 2% of GPs' or consultants' annual salary.

But doctors said the proposal would "foster low morale".

Most people respond to the carrot far more favourably than the stick British Medical Association spokesman

Professor Maynard said that, according to prospect theory, people value gains differently from losses as they place a greater emphasis on what they are losing.

He said the motivation to perform was not just driven by financial consequences but over the prospect of losing face in front of colleagues.

And GPs and consultants were good candidates for such measures as they were decision makers so had a great deal of control over how the health service performed, he added.

"The issue is whether this could be built into the GP and consultant contracts in order to get them to do higher levels of activity or more evidence-based levels of activity.

"But I believe it could be extremely effective at ensuring good performance."

Doctor pay, especially for GPs, has been in the headlines recently.

Pay

Family doctors have seen their yearly pay break through the £100,000 barrier after the introduction of a new contract in 2004.

However a third of their pay now comes from bonuses they get for meeting a host of targets from measuring blood pressure to patient satisfaction.

Consultant pay has increased less dramatically, but they are still getting close to £100,000 before money from private work is taken into account.

They too can receive bonuses in the form of clinical excellence awards - although only a minority receive these.

Professor Maynard said "careful evaluation" would be needed to see how the suggested pay reductions could be incorporated into the system either instead of bonuses or alongside them.

But a spokesman for the British Medical Association said: "We suspect most people would find the idea of having their pay packet reduced because of a failure to meet a government target an unsavoury prospect.

"Doctors have worked hard to meet the myriad of targets thrown up. Indeed, GPs and consultants have exceeded the expectations in bringing down waiting lists and delivering a higher quality service than expected.

"The introduction of the system proposed is likely to foster low morale and seriously damage relationships between employer and employee.

"Most people respond to the carrot far more favourably than the stick."

NHS Employers, which has represented the government in pay negotiations, said such proposals had not been discussed and were not on the table at the moment.