National Health Service consultants’ experiences and views of performance pay in England: a qualitative interview study
Jo Parsons, Mark Exworthy, Nicholas Murphy, Julia GaulyObjectives
To explore National Health Service (NHS) consultants’ experiences and views of the local Clinical Excellence Award (CEA) scheme following changes to performance-related pay in England.
Design
This was a qualitative study.
Setting
This study was set in one NHS Trust in England.
Participants
20 NHS consultants took part in the study. Out of these, seven had successfully applied for performance pay and 13 had not applied for performance pay in 2023 (one of these had applied unsuccessfully in a previous year). The majority of participants were male (n=11) and of White British ethnicity (n=12), and the majority had been qualified as a consultant for 10 or more years.
Methods
Interviews were conducted online, audio-recorded, transcribed verbatim and analysed thematically using both inductive and deductive coding. Data collection continued until thematic saturation was reached. The reporting of this qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist.
Results
Five key themes were identified: (1) motivations for engagement with the scheme, (2) experience of the application process, (3) perceptions of fairness and equity and (4) influence of organisational and contextual factors. Participants described challenges with defining ‘excellence’, time pressures and discomfort with self-promotion. While the revised CEA structure was generally welcomed, concerns remained about inequities, the separation of research from clinical work and cultural barriers to sustainable service development.
Conclusions
Consultants’ engagement with performance-related pay is shaped by personal, organisational and systemic factors. Although awards were valued as recognition and professional validation, performance pay was perceived to function more as symbolic recognition than as a motivator of performance. Findings highlight the need for transparent, equitable and team-oriented approaches to consultant recognition.