Observations on the review body's 1983 report.

Abstract

The thirteenth report of the review body on doctors' and dentists' remuneration, which was published last month,1 is potentially very important for several reasons. Coming hard on the heels of the second stage of settlements for National Health Service workers, which provided for 4?% increases during the year 1983-42 and which contained the offer of an independent review mechanism for nurses, midwives, and the professions supplementary to medicine,3 it was bound to excite curiosity. Furthermore, the government's response to the report's two predecessors was only partial implementation and on 9 May a general election was announced. The falling annual rate of inflation had been expected to moderate pay settlements generally and signs of an increase in white collar unemployment were being mirrored in the medical profession. The pay bill for the medical profession (excluding the provision made for the practice expenses of independent contractors) represented, in 1982-3?at just under ? 1200m? some 8oo of NHS expenditure (table I). So it is an important component of public expenditure. For just this reason the review body system embodies an assurance that the profession's remuneration will not be used as an economic regulator. In recommending increases in pay that would have added ?121m, or a little over 10%, to this total the review body has abided by this condition in its terms of reference. Its recommendations exceeded by ?68m the amount expressly built into NHS expenditure for pay increases in 1983-4. The government, in staging the recommendations, has saved about ?25m of this excess, which takes its total bite out of medical earnings to ?87m over the last three years. The implementation of the award in two stages will add over the year 8-1% to the pay bill, comprising 6-8% for most doctors, with more substantial gains for most junior hospital staff*. Two issues dominate the review body's 1983 considerations. These are, firstly, the manner in which the review body has reacted to the now familiar case put on behalf of hospital junior doctors for remuneration more accurately reflecting their onerous hours of duty and work, and, secondly, a detailed explanation of the way in which recommendations on general practitioner remuneration are arrived at and, by implication, translated into the fees and allowances received by general practitioners each quarter.