Is targeted pay the solution to solving shortages among medical staff?

Sean King

In this blog, Sean King, policy manager at NHS Employers, explores whether targeting pay by specialty and/or geography among doctors and dentists could be the solution to recruitment and retention problems.

In a remit letter released last month, the Secretary of State for Health and Social Care asked the Doctors and Dentists Remuneration Body (DDRB) to specifically consider targeting pay for doctors and dentists to help address recruitment and retention and geographical or specialty shortages.

In the past, employers have not generally been in favour of targeting pay, either because they have not been sufficiently funded to do this fairly, or because of the potentially demotivating effect on those whose pay was uplifted least. 

In NHS Employer’s evidence submitted to the DDRB last year, we argued that there was not a well enough developed evidence-base to justify targeting pay. This year, the DDRB is keen to revisit the question of targeting pay and to understand a bit more about why employers have not supported targeting pay in the past.

To do this, NHS Employers has developed a short survey, to gather employers views on this issue.

Further evaluation

In its last report, the DDRB noted that, in the absence of a full evaluation, targeting may be having some effect on initial recruitment of trainees in histopathology, general practice, psychiatry and emergency medicine. They said:

“Pay incentives could be useful even if they only redistribute shortages to address the most serious cases and the DDRB urges the parties to pursue these options further in situation where there are persistently high shortages, relative to other geographies or specialties…and evaluate the outcomes.”

While work is currently underway through the Interim NHS People Plan to look at the distribution of training posts across the country, this will take some while to complete.

Workforce figures

Amidst this, recent workforce data shows that demand is continuing to exceed supply.

Figures published by NHS Digital showed that the NHS workforce had grown by 2.5 per cent over the previous year, however, there was a 4 per cent increase in attendances at A&E.

In June this year, there were 9,947 medical and dental vacancies, ranging from 5.5 per cent of acute posts vacant in the south west to 18 per cent of mental health vacancies in the Midlands. In its most recent workforce census, the Royal College of Radiologists reported that one post for a clinical oncologist had been vacant for four years and had been advertised four times.

How would targeting pay work?

Targeting pay could take two forms; using pay premia to incentivise certain specialties, grades or locations or by targeting the distribution of the annual pay award.

Share your views

To help inform NHS Employer’s evidence to the DDRB for the 2020/21, please take our short survey by Friday 8 November to let us know what you think about pay targeting as an employer.

If you have any other thoughts or more in-depth views to share, please contact








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