Discusses the building blocks required for National Health Trusts in the UK to move effectively towards local pay determination as part of an overall coherent reward strategy. Concludes that the current preoccupation with purely the pay part of the reward strategy, combined with the absence of many of the other required building blocks, may well result in an extremely patchwork approach to reward and will leave the National Health Service in the position where it has lost the advantages of a national system, while failing to achieve the benefits of local pay determination.
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