Performance-related pay for NHS consultants: exploring views and perceived impacts in one NHS Trust in England

Background/aim: To investigate senior doctors’ (consultants) views about local clinical excellence awards (CEAs; a form of performance-related pay (PRP)) in theory and in practice.

Methods: Online survey of consultants in one National Health Service Trust in England which had implemented new variations to local CEAs. 31% response rate, comprising 250–500 applicants and non-applicants. Descriptive statistics were conducted with quantitative data and content analysis with qualitative data.

Results: Most consultants (57%) were supportive of CEAs in theory and in practice. A minority was not supportive (21%). This was justified by not applying (due to opposition, limited time to apply or being apathetic about them); 22% were neutral. About one-third (32%) of respondents had not applied for local CEAs in 2022, mainly because they thought they would be unsuccessful (30%). Two-thirds (67%) of respondents felt that CEAs provided recognition for their work, with female respondents and those working less than full-time expressing most recognition. Respondents were not supportive of the idea that CEAs should be paid fully for those working less than full-time (45% disagreed, 35% agreed, 21% neutral).

Conclusions: The exploratory study found mixed support for CEAs. Engagement with CEAs was complicated by pension and tax issues, claims of limited time to apply, and equity concerns about current and previous applications. However, CEAs offered some consultants some recognition for their work. These findings are more nuanced than existing evidence and elaborate extant theoretical perspectives of PRP in relation to doctors.