652
BRITISH MEDICAL JOURNAL
a very basic factor which has survived into the make extensive inquiries before taking up any National Health Service. appointments overseas. The BMA is pleased W M E ANDERSON to supply 'Notes on Contracts for AppointDublin ments Overseas' and also, where possible, to give the names of contacts who have worked in Mee, A, Monmouthshire, p 156. London, Hodder and the country concerned."-ED, BM7. Stoughton, 1951. 2Howse, W H, Radnorshire, p 49. Hereford, Thurston, 1949.
Distinction awards
Difficulties of applicants for jobs
SIR,-With reference to Dr C S Ward's letter (18 February, p 446) I would like to draw attention to certain problems that are faced by doctors doing locum jobs. A situation arises when a doctor, having agreed to do a short locum hospital job (for example, 7-10 days) receives an offer from another hospital for a permanent job (at times up to a two-year contract). I have always found that in such a situation neither of the hospitals seems able to understand or to help, leaving the decision to the doctor himself. I am sure no one would blame the doctor opting for the permanent job, but if the hospitals were to be more helpful in such a situation then the permanent job could start slightly later and so give the other hospital long enough cover to find another locum. Secondly, on a number of occasions it has been noted that the health authorities have refused to let a doctor doing a locum job have time off to attend other interviews-surely a locum job is done during the time one is looking for a permanent post. If on such occasions a locum doctor does not get a chance to attend interviews for permanent posts it is going to affect adversely the question of locum jobs. I know of two such occasions where the consultant has refused permission to the locum doctor to attend for an interview, and on one occasion this led the locum doctor to resign. Can those seeking permanent jobs expect better co-operation from consultants and health authorities in the future ? M SALAHUDDIN Leicester
Posts in the Middle East SIR,-There have been many Mid-East positions advertised in the BMJ and prospective candidates will consider the many differences in conditions of medicine there before deciding to accept such posts. I wish to draw readers' attention to a condition in Saudi Arabia that will probably be new to them. Work permits there require sponsorship by the company or agency for whom they will work which lasts three years after leaving the country after an uncompleted contract (regardless of the reasons for this) and may last as long after a completed contract. Without release of sponsorship employment by another group or agency is illegal. This matter is important to prospective employees because there are fivefold differences in salaries offered to the same specialists within the kingdom. A prudent candidate will therefore seek the shortest term of contract possible and stipulate that release of sponsorship follow this completion. Such a contract could be renewed repeatedly or changed with experience. P E CONEN Harlow, Essex
***The Secretary writes: "This emphasises previous wamings that it is very necessary to
SIR,-There are occasions where it is blameworthy not to stand up and be counted for what one believes in. In this case I am stimulated by the annual moan and criticism of distinction awards by Drs S Bourne and P Bruggen (18 February, p 456). I am now retired and can possibly speak up with less embarrassment than can those who either have a distinction award or hope to win one. I have been a member of a distinction award committee and have been its chairman. May I explain to your readers the procedure in the West Midlands? There are 15 members of our C-award committee. Each member serves for three years and every year five members retire and five new members are appointed. New members are appointed by the Ministry from nominations sent to them by a local committee of the BMA. Thus there is an ever-changing committee to make recomm!mdations. During the year every member of the committee is sent a list of the names of every consultant in the region who is not an award holder. He is requested to study this and to make recommendations. We used to allocate hospitals or districts to each member, and then each member formed his own subcommittee to invite their recommendations. When each committee member had obtained recommendations from his own committee, citations were circulated by post so that each member of the C-award committee had the citations well in advance for study and discussion with his colleagues. In addition, recommendations are made in person, in writing, or on the telephone to the chairman or members of the committee. We in this region spend almost an entire day in frank and open discussion about each citation. It is an easy generalisation that "it's a small world," but it is remarkable how much is known of each individual who is discussed at that committee-his character, his achievements, his reputation, and his reliability and conscientious loyalty to the service. Each member of the committee then allocates marks on a mark-sheet and these are totted up so that a final list can be prepared of recommendations in order of priority. Subsequently the chairman of the central committee visits us with some of his colleagues and the opportunity is given for frank and open discussion, criticism, or both. We are then given the names of other non-award holders who have been recommended by outside bodies-including those who have recommended themselves! And we are asked to weigh these recommendations against our own and reallocate our order of precedence if we wish. Our final list is then taken to the central committee for discussion with those from other regions. I personally consider this the most democratic form of award-selection I have ever known. I consider that those who loudly criticise and sneer belong to that great band of levellers whose battle cry is "Drag 'em down." Of course many of those deserving distinction awards do not yet have one simply because there are not enough to go round. But
1 1 MARCH 1978
if the majority of your colleagues consider you deserving, then there is no doubt that in this region (I can only speak with experience of this region) you will eventually have one. In every hospital there are consultants who were "lucky" to get the job. In every hospitai there are consultants who were appointed and made that hospital lucky indeed to have them. Surely it is despicable to envy and depreciate an award of merit bestowed on them by their own colleagues. Whatever criticisms are justifiably made, let's improve the method of selection wherever necessary. But for goodness' sake let's not join the vast numbers of citizens who begrudge all others the rewards and honours their work and their character bring them. Let's have an end to the melodramatic sneers of "traps" and "baits" and 'seductive mixtures." To those who constantly criticise let me say quite frankly, "Look to the quality of your work and the facets in your character until it is obvious to your colleagues that you are well above the average. You will soon be a distinction award holder." And when you are I hope nobody belittles your success or sneers at your achievement but rejoices with you at the honour and the financial reward. BERNARD H PRICE Redditch, Worcs
New consultant contract SIR,-Both Dr J Lowther (18 February, p 445) and Mr J Neely (28 January, p 240) stress that they must do 13 sessions of NHS work each week. Neither gives sufficient detail for us to know whether this is imposed on them by the regional health authority or is on a voluntary basis. If on a voluntary basis, have they considered that, by keeping waiting lists down, they may be concealing from the RHA the need for extra paid consultant sessions ? Without doubt they get little appreciation of their extra work from the RHA and DHSS. Not only may they be shortening their own lives, and possibly, through tiredness, putting their patients at risk, but they are preventing public recognition of the true plight of the NHS. How many of our problems are selfinflicted ? J M GUMPEL
PS-Although sceptical about the 10-session contract and its implication of more work for 100% more money, may I put in a word of appreciation for all the hard work of our negotiators, who deserved better results ?-
JMG. Northwick Park Hospital and Clinical Research Centre, Harrow, Middx
SIR,-I see from the report on the meeting of 9 February (18 February, p 454) that the Central Committee on Hospital Medical Services believes that the whole-time commitment issue has been whittled down to a mere differential ceiling on extra notional half-days. A very lofty ceiling at that, which would not come into operation until more than 11 routine scheduled sessions (excluding on-call and administration) had been worked. As 11 sessions is the present whole-time contract it is apparent that there would be a massive shift in relative remuneration from
BRITISH MEDICAL JOURNAL
a very basic factor which has survived into the make extensive inquiries before taking up any National Health Service. appointments overseas. The BMA is pleased W M E ANDERSON to supply 'Notes on Contracts for AppointDublin ments Overseas' and also, where possible, to give the names of contacts who have worked in Mee, A, Monmouthshire, p 156. London, Hodder and the country concerned."-ED, BM7. Stoughton, 1951. 2Howse, W H, Radnorshire, p 49. Hereford, Thurston, 1949.
Distinction awards
Difficulties of applicants for jobs
SIR,-With reference to Dr C S Ward's letter (18 February, p 446) I would like to draw attention to certain problems that are faced by doctors doing locum jobs. A situation arises when a doctor, having agreed to do a short locum hospital job (for example, 7-10 days) receives an offer from another hospital for a permanent job (at times up to a two-year contract). I have always found that in such a situation neither of the hospitals seems able to understand or to help, leaving the decision to the doctor himself. I am sure no one would blame the doctor opting for the permanent job, but if the hospitals were to be more helpful in such a situation then the permanent job could start slightly later and so give the other hospital long enough cover to find another locum. Secondly, on a number of occasions it has been noted that the health authorities have refused to let a doctor doing a locum job have time off to attend other interviews-surely a locum job is done during the time one is looking for a permanent post. If on such occasions a locum doctor does not get a chance to attend interviews for permanent posts it is going to affect adversely the question of locum jobs. I know of two such occasions where the consultant has refused permission to the locum doctor to attend for an interview, and on one occasion this led the locum doctor to resign. Can those seeking permanent jobs expect better co-operation from consultants and health authorities in the future ? M SALAHUDDIN Leicester
Posts in the Middle East SIR,-There have been many Mid-East positions advertised in the BMJ and prospective candidates will consider the many differences in conditions of medicine there before deciding to accept such posts. I wish to draw readers' attention to a condition in Saudi Arabia that will probably be new to them. Work permits there require sponsorship by the company or agency for whom they will work which lasts three years after leaving the country after an uncompleted contract (regardless of the reasons for this) and may last as long after a completed contract. Without release of sponsorship employment by another group or agency is illegal. This matter is important to prospective employees because there are fivefold differences in salaries offered to the same specialists within the kingdom. A prudent candidate will therefore seek the shortest term of contract possible and stipulate that release of sponsorship follow this completion. Such a contract could be renewed repeatedly or changed with experience. P E CONEN Harlow, Essex
***The Secretary writes: "This emphasises previous wamings that it is very necessary to
SIR,-There are occasions where it is blameworthy not to stand up and be counted for what one believes in. In this case I am stimulated by the annual moan and criticism of distinction awards by Drs S Bourne and P Bruggen (18 February, p 456). I am now retired and can possibly speak up with less embarrassment than can those who either have a distinction award or hope to win one. I have been a member of a distinction award committee and have been its chairman. May I explain to your readers the procedure in the West Midlands? There are 15 members of our C-award committee. Each member serves for three years and every year five members retire and five new members are appointed. New members are appointed by the Ministry from nominations sent to them by a local committee of the BMA. Thus there is an ever-changing committee to make recomm!mdations. During the year every member of the committee is sent a list of the names of every consultant in the region who is not an award holder. He is requested to study this and to make recommendations. We used to allocate hospitals or districts to each member, and then each member formed his own subcommittee to invite their recommendations. When each committee member had obtained recommendations from his own committee, citations were circulated by post so that each member of the C-award committee had the citations well in advance for study and discussion with his colleagues. In addition, recommendations are made in person, in writing, or on the telephone to the chairman or members of the committee. We in this region spend almost an entire day in frank and open discussion about each citation. It is an easy generalisation that "it's a small world," but it is remarkable how much is known of each individual who is discussed at that committee-his character, his achievements, his reputation, and his reliability and conscientious loyalty to the service. Each member of the committee then allocates marks on a mark-sheet and these are totted up so that a final list can be prepared of recommendations in order of priority. Subsequently the chairman of the central committee visits us with some of his colleagues and the opportunity is given for frank and open discussion, criticism, or both. We are then given the names of other non-award holders who have been recommended by outside bodies-including those who have recommended themselves! And we are asked to weigh these recommendations against our own and reallocate our order of precedence if we wish. Our final list is then taken to the central committee for discussion with those from other regions. I personally consider this the most democratic form of award-selection I have ever known. I consider that those who loudly criticise and sneer belong to that great band of levellers whose battle cry is "Drag 'em down." Of course many of those deserving distinction awards do not yet have one simply because there are not enough to go round. But
1 1 MARCH 1978
if the majority of your colleagues consider you deserving, then there is no doubt that in this region (I can only speak with experience of this region) you will eventually have one. In every hospital there are consultants who were "lucky" to get the job. In every hospitai there are consultants who were appointed and made that hospital lucky indeed to have them. Surely it is despicable to envy and depreciate an award of merit bestowed on them by their own colleagues. Whatever criticisms are justifiably made, let's improve the method of selection wherever necessary. But for goodness' sake let's not join the vast numbers of citizens who begrudge all others the rewards and honours their work and their character bring them. Let's have an end to the melodramatic sneers of "traps" and "baits" and 'seductive mixtures." To those who constantly criticise let me say quite frankly, "Look to the quality of your work and the facets in your character until it is obvious to your colleagues that you are well above the average. You will soon be a distinction award holder." And when you are I hope nobody belittles your success or sneers at your achievement but rejoices with you at the honour and the financial reward. BERNARD H PRICE Redditch, Worcs
New consultant contract SIR,-Both Dr J Lowther (18 February, p 445) and Mr J Neely (28 January, p 240) stress that they must do 13 sessions of NHS work each week. Neither gives sufficient detail for us to know whether this is imposed on them by the regional health authority or is on a voluntary basis. If on a voluntary basis, have they considered that, by keeping waiting lists down, they may be concealing from the RHA the need for extra paid consultant sessions ? Without doubt they get little appreciation of their extra work from the RHA and DHSS. Not only may they be shortening their own lives, and possibly, through tiredness, putting their patients at risk, but they are preventing public recognition of the true plight of the NHS. How many of our problems are selfinflicted ? J M GUMPEL
PS-Although sceptical about the 10-session contract and its implication of more work for 100% more money, may I put in a word of appreciation for all the hard work of our negotiators, who deserved better results ?-
JMG. Northwick Park Hospital and Clinical Research Centre, Harrow, Middx
SIR,-I see from the report on the meeting of 9 February (18 February, p 454) that the Central Committee on Hospital Medical Services believes that the whole-time commitment issue has been whittled down to a mere differential ceiling on extra notional half-days. A very lofty ceiling at that, which would not come into operation until more than 11 routine scheduled sessions (excluding on-call and administration) had been worked. As 11 sessions is the present whole-time contract it is apparent that there would be a massive shift in relative remuneration from
