Professor Alan Maynard, professor of health economics at York University, said that ‘demerit awards’ could be more effective at improving GP performance than bonuses. The health economist suggested GP and consultant income could be cut by 1 or 2 per cent if they did not achieve targets.
‘There have been two major pay awards but little productivity change,’ he said.
A 1 or 2 per cent seems a small enough margin so we could see how this works. We’d need to evaluate the policy so would start with small changes.
Professor Maynard’s theory is based on the premise that people placed more of an emphasis on what they may lose than on what they could gain.
So, doctors may be driven to perform better when faced with the possibility of losing face in front of their colleagues.
Professor Maynard said his suggestion was about increasing productivity not cost cutting.
‘The medical profession is always telling us that morale is at rock bottom,’ he said. ‘We have got to think about how to change the NHS and make it more efficient so that’s a risk we have to take.’
GPC deputy chairman Dr Laurence Buckman said GPs would not respond well to such a scheme: ‘I find punishing people baffling. It fits into the culture of name, blame and shame but it’s not the way professionals work or are incentivised.
Sussex GP and GPC member Dr Clarissa Fabre described the idea as ‘appaling’.
‘This is all about cost cutting from someone sitting in an ivory tower pontificating,’ she said.
Dr Fabre said it was a particularly galling suggestion after the pay freeze.
‘Doctors are performing better than the government expected. Now it is trying to claw back and claw back. It would be very bad for morale,’ she said.
The DoH and NHS Employers said that there were no plans to introduce demerit awards.
A DoH spokesman said performance incentives for GPs were working well and there were no plans to change this.
‘GPs’ income should be based on improvements in services for patients and there is evidence that the new GP contract, one of the first in the world that puts GPs on performance-related pay, has led to better care for patients with chronic diseases. We will continue to link GP income more closely to patient experiences.’
An NHS Employers spokesman added: ‘These proposals have not been discussed and are not on the table in negotiations at the moment.’