Consultant roles in the NHS are competitive and are not simply based on tenure. Doctors often switch hospitals exactly as if this was the private sector, as NHS hospitals can compete against each other for staff. The NHS internal market system means the individual hospitals are very financially driven. The NHS also pays huge amounts on clinical negligence claims (they have a £60bn provision) although this is managed centrally - effectively the central NHS Resolution organisation is insuring individual hospitals in return for charging a levy.