Consultation outcome

Reforming the national Clinical Excellence Awards scheme

Updated 9 March 2022

Applies to England and Wales

The Department of Health and Social Care (DHSC) and the Welsh Government are seeking views on reforms to the national Clinical Excellence Award (CEA) scheme with the aim of introducing a new scheme from April 2022.

This consultation proposes to broaden access to the scheme, make the application process fairer and more inclusive, and to also change the current application process.

Why Clinical Excellence Awards are needed

Consultant doctors and dentists and academic GPs are amongst the most highly-trained workers in the UK. Their skills are valuable and sought-after both nationally and internationally by private medical providers, academic institutions and the life sciences industry, for example. It is important to retain these experts’ skills and knowledge and incentivise them to perform over-and-above their contractual role; this is for the benefit of the NHS, its patients, healthcare staff in training, public health and the impact on the wider UK ‘health economy’.

National CEAs (NCEAs) are an important mechanism for the NHS to retain these skills, allowing the service to maintain its reputation as a world leader in healthcare delivery, clinical research, and medical training, and improve efficiency and effectiveness in all these domains. Examples of this have been seen in the extraordinary work and results coming from the NHS during the COVID-19 pandemic.

On a local and national basis, clinicians reorganised and prioritised services to diagnose, test, contact trace and treat the sickest patients, while developing internationally recognised, evidence-based medicine. Equally important have been the untiring efforts of clinicians to maintain other clinical services, medical education and research in the face of the competing and immediate pressures associated with COVID-19. The current NCEAs are time-limited reward payments available through an annual competition, to consultant doctors, dentists and academic general practitioners (GPs).

To achieve a CEA, applicants must demonstrate achievements over and above what they would normally be expected to deliver in the following domains:

• delivering a high-quality service
• developing a high-quality service
• leadership and managing a high-quality service
• research and innovation
• teaching and training

The scheme runs in both England and Wales.

The Advisory Committee on Clinical Excellence Awards (ACCEA) is the independent advisory non-departmental public body responsible for the operation of the national CEA scheme in England and Wales and advises DHSC Ministers and the Welsh Government (who advise Welsh Ministers) on the granting of awards.

In England, the Secretary of State for Health and Social Care makes 300 new awards available each year at bronze, silver, gold and platinum levels (most at bronze, fewest at platinum). In the 2019 competition, 956 applications were received from across England from the eligible population of around 52,000 for 300 new awards, giving a success rate of 31.4%.

Awards last for 5 years and can be renewed, subject to an application successfully demonstrating that standards are being maintained. At present there are a little under 2,200 award holders.

National CEAs are valued at:

• £36,192 a year (bronze)
• £47,582 a year (silver)
• £59,477 a year (gold)
• £77,320 a year (platinum)

Awards are paid pro-rata for those working less than full-time (LTFT).

Applicants can progress upwards through the award levels over time, subject to successful application. Awards are currently pensionable, meaning that the total value of the award is higher than the headline figures above. In 2019 to 2020, spend across England and Wales national CEAs, including on-costs, was £131.5m.

In Wales, the Minister for Health and Social Services makes 15 to 18 awards available each year, depending on the level of the awards made. In the 2019 competition, 66 applications were received from across Wales, from an eligible population of 2,600, giving a success rate of 23%.

There are currently just under 100 award holders in Wales and these are valued at:

• £36,924 a year (bronze)
• £48,533 (silver)
• £60,666 (gold)
• £78,866 (platinum)

NCEAs operate alongside local CEAs (LCEAs), although NCEAs and LCEAs may not be held simultaneously. LCEAs were introduced in 2004 and operate at trust level in England only. These awards are contractual, non-consolidated and non-pensionable. Current arrangements are in place until March 2022 and in time will be reformed through discussion with trade unions. While Wales does not have LCEAs, Commitment Awards may start to be applied 3 years after a consultant reaches the top of the pay scale, subject to satisfactory performance.

The case for change

The current CEA scheme replaced Distinction Awards in 2004 and while there have been incremental changes since there have been no major reforms. In this time, the consultant workforce, and the way in which consultants work, has evolved. We want to ensure the national CEA scheme is up to date, offers good value for money and rewards the highest-performing consultants.

Reflecting a changed consultant population

The consultant population has grown considerably: from 31,000 consultants (by headcount) in England in 2004^{[footnote 1]} to 52,000 in 2019^{[footnote 2]}. The number of CEAs available each year has been held at 300 since 2009 (600 until 2009).

The gender composition has changed from 31% female consultants in 2010 to 38% in 2020^{[footnote 2]}. There has also been a slight increase in the numbers of consultants working part-time from 19% in 2010 to 21% in 2019.

Similarly, over the same period, the proportion of black, Asian and minority ethnic consultants working in England has increased significantly from 22%^{[footnote 1]} to 37%^{[footnote 2]}.

Diversity issues are covered in more detail below.

Reflecting changing work patterns

In the 17 years since the national CEA scheme was introduced, eligible clinicians have moved jobs more frequently and, in many cases, developed more varied, portfolio careers as job planning processes have continued to evolve and improve.

A reformed scheme to modernise CEAs should take account of these new ways of working, including improved recognition of those who are working LTFT, and recognise and reward excellence across a broader range of clinical, academic and leadership contributions.

Table 1: consultant workforce growth

Year	Full-time equivalent	Headcount
2009	35,010	36,932
2010	36,497	38,507
2011	37,583	39,758
2012	38,772	40,997
2013	39,852	42,125
2014	41,290	43,602
2015	42,903	45,349
2016	44,333	46,955
2017	45,825	48,607
2018	47,308	50,275
2019	48,926	52,130
2020	50,875	54,313

Source: NHS Digital Workforce Statistics

Improving diversity

Female and black, Asian and minority ethnic applicants are under-represented at all award levels; this effect increases at the higher levels.

Table 2: national CEA holder demographics as at 21 July 2020 for England and Wales

Demographic	Bronze	Silver	Gold	Platinum	Total
Male	860 (76.58%)	585 (83.81%)	191 (83.541%)	79 (86.81%)	1751 (80.10%)
Female	263 (23.42%)	113 (16.19%)	38 (17%)	12 (13.19%)	426 (19.90%)
White	874 (77.83%)	576 (82.52%)	188 (82%)	71 (78.02%)	1709 (79.82%)
Black, Asian and minority ethnic	213 (18.97%)	112 (16.05%)	34 (15%)	15 (16.48%)	374 (17.47%)
Not stated	36 (3.21%)	10 (1.43%)	7 (2%)	5 (5.49%)	58 (2.71%)
Total	1123	698	229	91	2141

Women and black, Asian and minority ethnic consultants have been consistently under-represented as a proportion of applicants. However, where women do apply, their success rates are now comparable to those of their male counterparts.

Table 3: new award success rates by gender 2014 to 2019

Year	2014	2015	2016	2017	2018	2019
Female	16.50%	26.40%	25.60%	26.70%	30.20%	33.20%
Male	21.70%	26.50%	26.80%	30.20%	31.30%	32.49%
Overall	20.70%	26.50%	26.50%	29.50%	31.00%	32.67%
Gap	-5.20%	-0.10%	01.20%	-3.50%	-1.10%	0.17%

For black, Asian and minority ethnic candidates, the picture is more mixed.

Table 4: award success rates by ethnicity 2014 to 2019

Year	2014	2015	2016	2017	2018	2019
Black, Asian and minority ethnic	13.90%	29.90%	26.10%	25.70%	23.30%	28.24%
White	21.60%	25.90%	26.80%	30.20%	31.80%	34.60%
Gap	-7.70%	4.00%	-0.70%	-4.50%	-8.50%	-6.36%

Data on success rates can be found in our annual reports

The publication of Mend the Gap – the independent review into gender pay gaps in medicine in England in December 2020 found that CEAs, both national and local, are a contributory factor for the 20% of the overall gender pay gap in medicine. They highlighted a number of reasons women are less likely to hold a CEA. For example, female consultants are more likely to be younger and are more likely to work in under-represented specialisms such as palliative medicine and geriatrics. They are also more likely to take career breaks, making it harder to compile 5 years’ worth of CEA evidence. However, they found that these factors together did not fully explain the gap.

Table 5: gender composition of Health and Care Professions Council (HCPC) doctors across primary areas of work, September 2018

Primary area of work	Female doctors	Male doctors
Clinical oncology	53.8%	46.2%
Clinical support	46.5%	53.5%
General acute	42.0%	58.0%
Imaging	38.1%	61.9%
Medicine	50.3%	49.7%
No area of work specified	56.9%	43.1%
Obstetrics and gynaecology	66.3%	33.6%
Occupational health	52.1%	47.9%
Pathology	54.9%	45.1%
Psychiatry	52.3%	47.7%
Public health medicine	72.6%	27.4%
Surgery	31.3%	68.7%

Source: Electronic Staff Records (ESR), NHS Digital, Mend the Gap review.

The review also found that women were more reticent in their pursuit of maximising earnings and cited participating in a self-selection process as a potential reason; currently, application for national CEAs is through self-nomination. We know that some are encouraged to put themselves forward by their managers, but this is not standard practice across the NHS and should be actively encouraged by employers through the process of appraisal. Feedback from our focus groups held in Autumn 2020 reinforced this, suggesting that women, particularly those working LTFT find it more difficult to obtain career advice, mentorship and employer support for applications.

We want the new scheme to be more accessible and one that encourages applications from those that have gone beyond their ‘day job’ regardless of their background and characteristics. The findings and recommendations of the Mend the Gap review have informed our proposals.

Ensuring an effective incentive for excellence

National CEAs are currently pensionable, a legacy from when they were treated as salary increases. This does not align with the concept of a modern, non-consolidated reward and recognition scheme.

CEAs’ pensionable status also has implications for taxation. Potential future tax liability for the accrued value of their NHS pension is something which has led significant numbers of award holders to consider surrendering their CEAs for financial reasons, reduce their hours, or ‘retire and return’ (often specifically relinquishing clinical responsibilities) and is also likely to have dissuaded applications.

Finally, the current scheme was transposed from its paper format onto the current online portal and is not designed as a ‘digital first’ service. The supporting IT is now 14 years old, not user-friendly and increasingly outmoded with limited update potential and support. The proposed new scheme represents an opportunity to build a more efficient and effective modern service, reducing burden on applicants, scorers and administrators alike.

Our objectives

Our proposed changes fall under 3 overarching themes:

• broadening access to the scheme
• making the application process simpler, fairer and more inclusive
• ensuring the scheme rewards and incentivises excellence across a broader range of work and behaviours

In 2012, UK health ministers asked the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) to ‘review compensation levels and incentive systems and the various Clinical Excellence and Distinction Awards schemes for NHS consultants at national and local levels’. In its consultant compensation levels report, the DDRB recommended changes to both the local and national CEA schemes.

In developing our proposals, we have also consulted widely with employers across the NHS, general medical practices, specialist associations and colleges and the British Medical Association (BMA). Many of our stakeholders, including the Royal Colleges and the BMA, have had sight of the proposed reforms and have provided helpful comments directly and through focus group discussions.

A modernised CEA scheme will be instrumental in helping deliver the Long Term Plan in England, alongside the People Plan 2020 to 2021,which sets out immediate priorities for attracting and retaining more people, working differently in a compassionate and inclusive culture in the NHS. The Long Term Plan provides a strategic framework for how new models of care will be transformed over the course of the next 5 years to improve outcomes for our populations.

A new scheme will support the Long Term Plan and the NHS People Plan by recognising contributions of consultants and academic GPs that deliver at a national level:

• innovation in digital and technology or efficiency improvements that release time for care
• better health prevention and/or personalised care that narrows health inequalities
• advances in medical research to improve future patient outcomes
• modern multi-professional education and training – engaging, leading and implementing strategic change
• improvements for NHS staff, through leadership, mentoring or otherwise making the NHS a great place to work

For Wales, a modernised CEA scheme would help deliver A Healthier Wales, the long term plan for health and social care that sets out a long term future vision of a ‘whole system approach to health and social care’ focussing on health and wellbeing, and prevention.

Proposed changes to the national CEAs scheme

With the objectives above in mind, we are consulting on:

• increasing the number of new CEAs, with this made possible by making them non-consolidated and non-pensionable

• removing time-based ‘progression’ between the award levels, with the level of awards linked to the impact of achievement

• changes to the domains for assessing national CEA applications

• the role of citations and ranking by accredited national nominating bodies (NNBs) and specialist societies (SSs)

• retaining the 5-year award period, but ending the current renewals process for awards, with clinicians applying for a new award at the point of expiry

• how to ensure award holders maintain excellence during the period covered by a CEA

• whether you have any further comments on future arrangements for the national CEA scheme

In parallel with the formal consultation process, National Institute for Health Research (NIHR) are supporting research focused on ACCEA’s scoring and assessment processes. This will be starting shortly and the investigators will report in the autumn.

We would like to hear from medical and dental consultants and academic GPs, doctors in training, NHS trusts and foundation trusts, Medical Royal Colleges, representative organisations, trade unions, the National Institute for Health Research, Health Education England and other medical and health-focused institutions who may also be interested in responding to this consultation.

Consultation questions

Broadening access to the scheme

Number of NCEAs

Do you agree or disagree that the number of CEAs should be increased so that 1% of the eligible clinical population could hold a platinum award; 2% a gold award and 3% a silver award?

What number of CEAs do you think should be made available, at what level and why, recognising that the costs of the scheme will remain broadly the same?

Wales specific questions

Do you agree or disagree with the proposed award levels in light that there is no local CEA (LCEA) scheme in Wales?

In Wales we propose to retain the bronze level award scheme because there is no LCEA scheme in place. Do you agree or disagree that this is a good option?

What alternative scheme would you like to see in place?

Once the transition from the current scheme is complete, in England we propose that there should be awards available for roughly 6% of the eligible consultant population, that may be held simultaneously with the local awards or their replacement scheme:

• 1% (about 500) of the eligible consultant population would potentially hold a platinum award, worth at least £40,000 per year

• 2% (about 1000) of the eligible consultant population would potentially hold a gold award, worth at least £30,000 a year

• 3% (about 1500) of the eligible consultant population would potentially hold a silver award, worth at least £20,000 a year

We propose to drop the bronze level of national awards in England. The remaining levels, will reward national and international achievements. The local awards scheme will still recognise local achievement, but, subject to the outcome of discussions, could, at the higher end, also recognise regional efforts, such as additional work carried out across integrated care organisations and sustainability and transformation partnerships. Through allowing consultants to hold local and national awards concurrently, we are increasing the number of consultants who are eligible to receive local awards; as total spend on local CEAs is dependent upon the size of eligible population, this means that additional funding will need to be made available for the scheme. We will ensure that this additional cost to trusts is covered, but would suggest, subject to the ongoing discussions on the local scheme, that this additional funding be put towards recognition of regional excellence.

Under this proposal, each year there would be approximately 300 new silver awards, 200 new gold awards and 100 new platinum awards. This roughly doubles the number of awards available each year in England (from 300 to 600). This is intended to encourage more consultants to apply and increase the opportunity for success. The number and distribution of awards each year will need to be set and reviewed taking into account affordability parameters.

In Wales, there are currently 2,612 full time consultants and is proposed that:

• 1% (26) of the eligible consultant population would potentially hold a platinum award, worth at least £40,000 per year

• 2% (52) of the eligible consultant population would potentially hold a gold award, worth at least £30,000 a year

• 3% (78) of the eligible consultant population would potentially hold a silver award, worth at least £20,000 a year

• And 4% (104) of the eligible consultant population would potentially hold a bronze award, worth at least £10,000 a year

We propose that applicants should not have to progress through the different levels of national CEAs as at present. In the new scheme, applicants will apply without specifying the level of award to which they aspire. The regional scoring process would determine whether applicants have reached the required standard for an award and, if so, the level of that award. To ensure equity of opportunity, each region (these may change from the current ones) will be allocated a number of awards proportionate to the number of applications made from eligible clinicians working there, as is currently the case, with a fixed proportion at each of the three proposed levels. Applications will be scored by the relevant regional committee with Wales remaining a region as at present.

This change is expected to improve the diversity of the award holders at each level. It will also increase turnover of award holders, improving the opportunity for senior clinicians to attain an award which may be at a higher level much earlier in their careers. To ensure platinum awards recognise only the highest achievements, we plan to continue to score these nationally. Each year, once we determine the number of platinum awards to be made, we will draw twice that number of the top-scoring applications proportionately from each regional pool. These will then be re-scored by a platinum committee. The higher-scoring half of these applicants will achieve a platinum award, the lower-scoring half a gold award (from regionally allocated golds).

As is currently the case, applicants working for DHSC’s arm’s length bodies, academic GPs contracted by NHS England and public health consultants employed by Public Health England would be scored by a central non-geographic committee.

Local performance awards and NCEAs

Do you agree or disagree with the proposed value at which the NCEAs will be set at the different levels, of at least: silver - £20,000, gold - £30,000 and platinum - £40,000, in light of local performance awards also being available to NCEA holders from 2022?

When the Clinical Excellence Awards scheme was introduced, it had 12 levels, with levels 1 to 9 being awarded locally and 9 to12 the national awards (bronze, silver, gold and platinum). The overlap at level 9 and bronze was intended as the interface between the local and national schemes, however this caused confusion as to which scheme would more appropriately recognise excellence at that level.

We propose to drop the bronze level of national awards. The remaining levels, through the single tier application process, will reward national and international achievements. The local awards scheme will still recognise local achievement, but, subject to the outcome of discussions could, at the higher end also recognise regional efforts, such as additional work carried out across integrated care systems or a wider regional footprint.

Through allowing consultants to hold local and national awards concurrently we are increasing the number of consultants who are eligible to receive local awards. As total spend on local CEAs is dependent upon the size of eligible population, this means that additional funding will need to be made available for the scheme. We will ensure that this additional cost to trusts is covered, but would suggest, subject to the ongoing discussions on the local scheme, that this additional funding be put towards recognition of regional or system-level excellence.

Academic GPs will continue to be eligible to apply for a national CEA. It should be noted that academic GPs working in England do not have access to local performance pay schemes.

In Wales there is no local award scheme, however consultants are eligible to receive Commitment Awards which start to be applied 3 years after a consultant reaches the top of the scale. It is expected that holding a national award in Wales in any new scheme will continue to cease eligibility to hold a Commitment Award, however the current provision enabling consultants to be eligible to return to the Commitment Award scale should they no longer receive a national CEA would remain.

Changes for domains for assessing national CEA applications

Do you agree or disagree with these modified domains?

What domains would you like to see and why, and/or how would you modify the descriptors provided for the proposed 5 domains?

The current evidence ‘domains’ have not been substantially reviewed since national CEAs replaced Distinction Awards in 2004. We propose the following domains for the new scheme:

• developing and delivering your service – designing or redesigning and implementing a service that has been widely adopted, boosting effectiveness within and beyond your locality

• leadership – developing significant policy, embedding change, leading people, developing vision and strategy, reaching across boundaries, with tangible impact above local and regional level for patient care or for the NHS as an employer

• education, training and people development – developing and introducing training and impactful learning materials, innovative assessment methods contributing to postgraduate education, and contribution to teaching and assessment in the UK or abroad. Promoting inclusivity and accessibility in training, teaching and assessment, and recognising the importance of patient and public education. Contributing to people development to positively impact the experience and performance of NHS staff

• innovation and research – contribution to research and/or supported innovation. Development of new evidence-based techniques, innovative systems or service models. Improvements in public and patient engagement in research and new ways of thinking around improving patient services. Impact of research on health service practice and policy

• one other domain in which applicants can provide evidence of any other work of nationally or internationally recognised quality in areas that could include medical care or management, education, health promotion, research and development

In England, this fifth domain could include, for example:

• Care Quality Commission’s inspection domains

• NHS Long Term Plan priorities (new service models, action on prevention and health inequalities)

• Secretary of State priorities: ‘people, prevention, infrastructure and technology’ to improve patient care

Other national strategic priorities, including:

• contributing to delivery of the NHS People Plan
• contributing to the development of integrated care systems
• support emerging NHS priorities, such as emergency responses and service and staff recovery
• demonstrating through reflective leadership for example, the NHS values, behaviours and support of cultural change in line with those set out in the NHS People Promise

In Wales, this might be:

• alignment to the Health and Care Standards

• Healthier Wales (Development of patient care in new Health and Social Care Systems)

• any other areas of work and impact as felt appropriate by the applicant that reflects their contribution ‘over and above’ their job plan

Improving access to the NCEA

Do you agree or disagree with our proposals for improving access to the NCEA competition?

Do you have suggestions on how we can improve access to the scheme for women and those with protected characteristics?

How far do you agree that those working LTFT should be in receipt of the full award values as opposed to the current pro-rated award payment?

Details of the current application process can be found in our applicants’ guide.

Both DHSC and the Welsh Government want to explore options for improving the current application process. Our objectives are to encourage the most deserving applicants to apply for an award and to be fair and equitable, not disadvantaging any eligible group of applicants. As such, it should be devised with diversity in mind and the statistics reported and published on an annual basis

Alongside this, DHSC and the Welsh Government want to encourage employers to ensure that applicants from their organisation reflect the diversity of their consultant workforce, with support for more female and black, Asian and minority ethnic consultants. As part of this, they should consider encouraging applications from traditionally under-represented speciality groups such as palliative care or community paediatrics, with reporting of application diversity against appropriate benchmarks.

The ‘Mend the Gap’ review recommended that there should be a closer monitoring of applications and improvement in reporting to help facilitate applications from specialties that are generally in receipt of lower awards.

Those working LTFT may have their contribution and level of support for an application assessed against the same standard as a full-time colleague. ACCEA advise our scorers to carefully assess evidence in the domains against the job plan to ensure a valid expectation of role delivery is established; to assess what is ‘over and above’ for all applicants using this baseline. LTFT applicants however, if successful in their application, receive a pro-rata value of their award, based on the number of sessions in their job plan. This raises concerns about access to the NCEA scheme and the level of reward if the successful applicant, despite being contracted to work fewer hours, still demonstrates clinical excellence. DHSC and the Welsh Government propose that in future NCEA awards should not be paid on a pro-rated basis but instead be paid at the full-award value. This should be a contributory factor in reducing the gender pay gap. We would wish employers to play a key role in encouraging applications from those working LTFT.

Maintaining excellence during the period covered by a CEA

Do you agree or disagree that this is an appropriate way of incentivising the maintaining of excellence during the period covered by a CEA?

What proposals do you have to ensure CEA holders maintain clinical excellence throughout the time they hold the award?

ACCEA wants to ensure that, in recognising clinical excellence, progress is maintained for the full period that the CEA is in place. At present, only evidence of achievements over the past 5 years is considered in the scoring of applications.

As part of the application process, we are considering asking applicants to provide an outline plan covering the period for which, if successful, the CEA would be paid. This would show how they plan to maintain/continue to develop the work for which they are being recognised. We recognise that applicants’ plans and portfolio of responsibilities may change over time. As such, this is not proposed to be a scored domain, or binding on future applications, but to act as a prompt to set out how their contribution will develop over time.

An end to the renewals process

Do you agree or disagree that the 5-year award period should be retained, but ending the renewals process for awards, with clinicians applying for a new award at the point of expiry?

We propose to retain the 5-year award period but to end the current renewals process for awards, with clinicians applying for a new award at the point of expiry.

Abolishing renewals sets a clearer expectation that all applicants compete with each other along a continuum at the time of application. This should incentivise existing award holders who wish to obtain a new award in the next round to continue to strive for excellence during the 5 years of their award, in anticipation of their next application. This may serve to improve diversity generally and enhance access to awards for younger high-performing staff.

However, higher turnover will also result in fluctuations in income; especially for younger consultants as they develop their careers. The potential variations in income for the individual may make financial planning more challenging.

Under the present scheme the procedure for applying to renew a national CEA is essentially identical to the process for making an application for a new award. However, maintaining the separation between the 2 types of application is burdensome and somewhat duplicatory for both ACCEA’s scoring sub-committees and its central secretariat.

The pensionable status of NCEAs

Do you agree or disagree that NCEAs should be non-pensionable?

The DDRB, in its 2012 review stated: ‘We think it is no longer appropriate for the awards to be pensionable. This is consistent with practice across the public and private sectors. Individuals will have the option to make additional voluntary contributions from their award to the NHS (or a private) pension scheme.’

The pensionable status of national CEAs is a legacy from a time when they were treated as permanent salary increases. This does not fit with the idea of a modern, non-consolidated reward scheme. The current pensionable status of CEAs has tax implications for some higher-level national award holders of long standing, as it may mean that NHS pension growth exceeds their annual tax-free allowance limit, and in some cases even reduces (or tapers) their annual allowance, resulting in them being liable for an annual allowance tax charge. This has led some award holders to consider surrendering their CEAs for financial reasons, reduce their hours or retire early. It may also have dissuaded applications and reduced the ability of the scheme to promote the retention of high performing senior clinicians within the NHS.

However, we recognise that making CEAs non-pensionable may affect consultants at the earlier stages of their careers. We acknowledge that these will include an increasing proportion of women, but, expect that this would be offset by increased access of a much greater proportion and number of women and black, Asian and minority ethnic consultants to awards, where they are currently under-represented.

In addition, local CEAs have not been pensionable since the current interim scheme began in April 2018 and agreed via discussion between NHS Employers and trade unions.

Non-consolidated CEAs would be counted as taxable income and as such may still have annual allowance implications for some award holders. However, as a result of the Government increasing the annual allowance taper thresholds from 6 April 2020, award holders can earn an additional taxable income of up to £90,000 before having their annual allowance limit reduced.

We therefore agree with the DDRB recommendation that CEAs should be non-consolidated and non-pensionable, bringing them into line with local CEAs. This will reduce the cost of each award, enabling us to offer more awards (as set out above). Working on the pension implications of the new national CEA scheme will be published on GOV.UK

The role and value of rankings and citations in the award process

Do you support the changes proposed for the role of employers?

Do you have any other comments on the role that employers should take in a new national award process?

Do you agree or disagree with the changes proposed for identifying who should be an accredited NNB or SS and reducing potential over-representation of specialties and sub-specialities?

What criteria should determine whether an NNB or SS should be accredited?

How far do you support the changes proposed for third-party citations?

Under the present scheme, although application is by self-nomination, employers have historically been required to score and sign off all applications from their employees, providing an employer statement and stating their level of support (supported, qualified support, not supported). Certain employers also provide rankings of their supported applicants and was modified in the 2020 to 2021 round with employers simply indicating their level of support.

NNBs and SSs are accredited as permitted to provide rankings and citations for their members. Accredited organisations are allotted a number of “ranking places” based upon the size of their membership and their national standing. The 28 NNBs are mainly Royal Colleges. There are around 130 accredited SSs of various sizes, covering a wide range of specialties and subspecialties. In 2019 there were over 1,600 nominations made for the 300 awards available.

In the current scheme, applicants are also able to solicit supportive third-party citations from any other individual or organisation should they wish to do so, but not permitted for the 2021 round.

There are instances of applicants with high numbers of citations that do not add to the triangulation of evidence and therefore we wish to reduce the workload for applicants, scorers and citation providers.

We propose to improve and streamline the process of ranking and citations for CEAs as described below:

• retaining employer sign off, scoring, levels of support and the provision of employer statements. In addition, we will implement a requirement for employers to provide ACCEA with a statement of their process to ensure equality and diversity and balanced representation of applicants from their eligible population of senior clinicians. We propose to remove any ranking of applicants by employers

• reviewing the list of accredited NNBs and SSs to ensure no specialty/sub-specialty is represented by multiple different bodies, potentially over-leveraging its influence. We wish to ensure that any accredited NNB/SS is of national standing and influence. As above, NNBs and SSs will be asked to provide a statement of their process to ensure equality and diversity and balanced representation of applicants from their membership and the wider specialty

• limiting the number of third-party citations to a maximum of 2. In many cases, we see identical citation text from different sources, there being no quality assurance process possible for such citations

Any further comments on future arrangements for the national CEA scheme

Do you have any additional proposals or further comments on future arrangements for the NCEA scheme?

The proposed changes fall under 3 overarching themes:

• broadening access to the scheme
• making the application process simpler, fairer and more inclusive
• ensuring the scheme rewards and incentivises excellence across a broader range of work and behaviours

In addition, and outlined in the Our objectives section above:

• implementing the majority of the recommendations from the DDRB to ‘review compensation levels and incentive systems and the various Clinical Excellence and Distinction Awards schemes for NHS consultants at national and local levels’

• ensuring a modernised CEA scheme will be instrumental in helping deliver the Long Term Plan and NHS People Plan 2020 to 2021. A new scheme will reflect these national strategic ambitions and recognise those consultants and academic GPs who, in addition to providing excellence across different domains, also live up to the values and culture of the NHS, as set out in the NHS People Promise

• introducing a new scheme that is more accessible and encourages applications from those that have gone beyond their day to day role regardless of their background

Annex A – eligibility criteria for national CEAs

Senior doctors are eligible for national Clinical Excellence Awards, as set out in ACCEA’s applicants’ guide, if they are:

• a fully registered medical or dental practitioner on the General Dental Council (GDC) specialist list or General Medical Council (GMC) specialist register. They must have a licence to practise and have been a permanent NHS consultant for a year on 1 April in the award year. The year does not include time spent as a locum, but they can give evidence from their achievements as a locum in the same role

They will qualify if they:

1. are employed by an NHS organisation (in England or Wales), DHSC and Welsh Government or its arm’s length bodies, a university, medical or dental school, local authority, or are employed by similar Welsh Government-associated organisations. Applications from employees of other organisations may be eligible

2. are an academic GP, if their responsibilities are the same as consultant clinical academic staff. They can apply for awards if they:

• work at least half their hours as an academic GP and/or

• are a practising clinician providing some direct NHS services

3. do at least 5 programmed activities or equivalent sessions that help the NHS, including teaching and clinical research

4. are a consultant or a dental practitioner with an honorary NHS contract, who is fully registered with a licence to practise. Whether they qualify for an award depends on their contribution to the NHS for more than direct patient care

5. are a fully registered public health consultant on the GMC specialist register or on the GDC specialist list, with a licence to practise

6. are a postgraduate dean fully registered with the GMC or GDC, with a licence to practise, who competed for the role against GPs and consultants, and is responsible for postgraduate trainees across all specialties

7. are a consultant or academic GP later employed as a dean or head of school in medicine or dentistry, fully registered with the GMC or GDC, with a licence to practise

8. are a consultant fully registered with the GMC or GDC, with a licence to practise, working as an NHS trust clinical or medical director, or a similar level medical manager post. If they almost always work in medical management, they can still qualify if they have an active consultant contract with a specific clinical leadership role and continue to renew their licence to practise. If they move into general management and/or have a management contract outside of the consultant pay scale, they do not qualify for an award.

Annex B – pay protection provisions

Members of the 1995 and 2008 sections of the NHS Pension Scheme can apply to protect their pensionable pay if it is reduced, as set out in regulation R9 of the 1995 NHS Pension Scheme Regulations and Chapter 2.D.12 of the 2008 NHS Pension Scheme Regulations.

Under the existing CEA scheme, if a member’s award is not renewed following their application, or if it is due for renewal but they choose not to apply, pensionable pay protection is provided. These pay protection provisions ensure that members who receive an award but are not close to retirement may still have the award counted towards the final salary that is used to calculate pension benefits at retirement.

Pay protection would also be in place for:

• those who hold a national CEA under the current scheme and successfully apply for a new award under the new scheme. This is because Schedule 30 of the consultant contract has provision for financial compensation for award holders who transition to any new national scheme, requiring that the new national award is pensionable for the first cycle and the difference in value between any equivalent level new award and their existing award be paid to them in the form of a pensionable LCEA; and

• those who hold a national CEA under the current scheme and unsuccessfully apply for a new award under the new scheme, as they would benefit, subject to their scores, from the existing mechanism under Schedule 30, whereby they would revert to a pensionable local award under the now-replaced local scheme.

The provisions set out in Schedule 30 have been collectively agreed with the BMA and can only be altered through a negotiated agreement with medical trade unions.

Under the new CEA scheme, new-style awards would not be pensionable and would be non-consolidated. As these new awards would not be considered towards a member’s final salary, there would be no requirement to use the protection of pay provisions.

1. Department of Health 2004 medical and dental workforce census ↩ ↩²

2. NHS Workforce Statistics – September 2019 ↩ ↩² ↩³