Chris Lancelot: DoH should overhaul pay for committee work

The furore about MPs' expenses vividly demonstrates so much of what is wrong in government today.

Putting aside the overtly fraudulent claims, it wasn't just MPs' fault that they were claiming for bath plugs or TVs but the system itself. The over-generous allowance mechanism was specifically designed to give them a pay rise without their salary cheques increasing. It was the opposite of a stealth tax: a stealth reward.

The system itself was less than transparent - intentionally so. Yet any opaque system of reimbursement inevitably risks inconsistency and abuse, coupled with despair when apparently totally legitimate claims are disbarred.

This lack of clarity is everywhere in government. Take payment for NHS committee work performed by GPs at local, regional or national level. A number of colleagues have told me that often no direct payment is offered: attendees are instead invited to claim locum payments in lieu. This is all very well where the GP is full-time and a locum has been brought in - but what if the remaining GPs in the practice absorb the extra work? Is it still appropriate to claim for 'locum expenses'?

What if the GP attends the committee in their spare time? Is it ethical to claim for 'locum payments' at all? And should remuneration for work done during a GP's time off still be paid through their practice - which is what the NHS often insists upon? Doesn't this constitute money-laundering?

The NHS's convoluted payment system for committee work is at best untidy and at worst ethically dubious - though in fairness hallowed by decades of custom and practice.

What about remunerating practice managers for NHS committee work? Practice managers never have locums. They give up a day to attend a meeting, aren't paid directly, can't claim locum expenses, and then go back to all the work that has piled up in their absence. No wonder so few attend trust, board, SHA or national committees.

This is unnecessarily complicated and discourages good people from becoming involved. The cure is simple - the DoH should abandon its convoluted payment systems and instead remunerate primary care clinicians and staff directly and personally for their time.

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