Letter: Pay in the NHS

Sir: As a consultant in the NHS, I was greatly cheered by your leading article "The NHS is in need of a little surgery," referring to the Government's plans to reform the merit award system (11 August).

As you rightly point out, the profession in general and consultants in particular do feel that there is room for improvement in the allocation of these awards. Apart from racial and sexual discrimination and the gross discrepancy between remuneration for top merit award holders and other equally dedicated non-medical members of the NHS, the issue which has not been mentioned is that of the honour of getting such an award.

It would be quite possible to maintain the exercise of rewarding and awarding those consultants who are judged by their peers to offer an excellent service in all departments, but to remove the pecuniary aspect of the award. Introduce an award system similar to the Oscars or other awards which professional groups confer on themselves, based on peer review. Even without the remuneration, it is likely that doctors in general, who are extremely competitive, and consultants in particular, who are even more so, would relish the prospect of the continuation of the merit award system.

Mr M ADISESHIAH FRCS

Consultant Surgeon

London NW2