Advisory Committee on Clinical Impact Awards: annual report for the 2024 awards round
Published 29 July 2025
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Foreword
We are pleased to present the 2024 report for the Advisory Committee on Clinical Impact Awards (ACCIA). This was the third year of the new 3-level scheme aiming to recognise and reward those that go above and beyond their job plan to deliver value and benefits to patients and the NHS at the national level.
We continue our mission of achieving greater accessibility and inclusion in the scheme, to better reflect the diversity of the NHS workforce.
Although application numbers this year were slightly lower than expected, there have been many positive strides towards our inclusivity goals. For the first time ever, female applicants achieved higher overall success rates than male applicants. 82.7% of new awards were given to applicants with no previous award. Additionally, we have seen a marked increase in earlier career consultants applying.
We are pleased with the continued progress on achieving broadened access that the reforms of the scheme have enabled. However, we recognise that there is still work to do. ACCIA will continue to encourage more applications from consultants from diverse backgrounds and from all NHS specialties.
In 2024, to prepare for the 2025 awards round, we renewed our focus on stakeholder engagement, including building better connections with employers, royal colleges and societies. We also looked to gain first-hand insights from those who are most impacted by our scheme. In autumn 2024, ACCIA held focus groups with assessors, employers, current award holders and applicants, which led to some changes to the application process and payment policy for the 2025 awards round.
Having concluded yet another successful round of the national Clinical Impact Award (NCIA) scheme, we hope that the reformed scheme will continue to make a difference by supporting innovative and transformational activities that have a positive impact on the NHS across the country.
We would like to extend a special thank you to all the sub-committee scorers, regional sub-committee chairs and medical vice-chairs, and all our other committee members who continue to dedicate time and commitment in supporting the scheme, enabling us to recognise highly skilled clinicians drawn from all specialties, and from all regions.
Vinay Patroe, Chair
Kevin Davies, Medical Director
About ACCIA
The Advisory Committee on Clinical Impact Awards (ACCIA), formerly known as the Advisory Committee on Clinical Excellence Awards (ACCEA), is an independent, non-departmental public body. ACCIA advises ministers in the Department of Health and Social Care (DHSC) and the Welsh Government on the granting of NCIAs to NHS consultant doctors, dentists and academic general practitioners after an annual competitive process. ACCIA is not responsible for local awards.
The purpose of the awards scheme is to recognise senior clinicians’ achievements of national significance, beyond the expectations of their job plan. Separate schemes operate in England and Wales using the same broad principles and a shared application platform. Eligibility for the scheme is part of the NHS consultant contract and contributes to the reward and retention of talented and innovative clinicians.
ACCIA is responsible for the operation of the scheme and is led by a publicly appointed chair and medical director. Secretariat support throughout the process is provided by a small team of civil servants within DHSC.
The 2024 awards round was the third since the national awards scheme was reformed following a public consultation in 2021.
2024 awards round
Timetable
The 2024 awards round opened for applications on 4 March 2024 and closed on 15 April 2024. Scoring of applications took place from April to October 2024.
Regional sub-committee meetings were held between July and November 2024. The main committee meeting was held in November 2024. The main committee recommendations were sent to ministers for approval in December 2024.
Outcomes were communicated to applicants in January 2025. Appeals were processed between January and March 2025.
Clinical impact examples from 2024
NCIAs continue to recognise and reward senior clinicians delivering impact to the NHS at a national level.
Consultants granted awards in the 2024 awards round:
- contributed to the revision of national service specifications
- received extensive funding and published numerous peer-reviewed papers
- played important roles in improving sustainability and reducing environmental impact within their profession
- provided numerous other examples of activities that make a real difference to patients and staff in the NHS
Scoring group normalisation
Before the 2022 awards round, scoring groups were divided based on the level of award applied for (bronze, silver and so on) and all applications in each group were scored by every assessor. With a single level of application this was not possible. In the 2022 round, the regions with higher application numbers split the scoring groups to manage assessors’ workload.
Following the 2022 round, a review of scoring patterns identified small differences in scoring patterns between some groups, and ACCIA decided that there was a need for a means to manage this. A normalisation process was devised internally and reviewed by an independent statistician. This process was applied to all committees with multiple scoring groups in the 2024 awards round.
Withdrawn applications
Applicants may withdraw their application at any time before the awards are announced. ACCIA will also withdraw applications from assessment if the applicant leaves eligible employment during the awards round.
In the 2024 awards round, 4 people granted an NCIA declined the award after application outcomes had been announced, stating that they wanted to retain their local Clinical Excellence Award (LCEA) for financial reasons.
ACCIA considers the award granted as soon as ministers approve the recommendations of the main committee. The employer is instructed that the applicant has been successful and to withdraw the LCEA. An award holder can relinquish their award at any time once the award is granted. In this instance, reinstatement of an LCEA is a matter for determination by employers and is not necessarily automatic or guaranteed.
ACCIA has updated the guidance on relinquishing LCEAs when granted a national award and emphasised the need for potential applicants to consider the financial implications of all possible outcomes before submitting their application. Any award not accepted at the end of the process cannot be re-allocated because of the nature of the governance process for successful applications, meaning other potentially suitable applicants may be deprived of an award.
ACCIA guidance now makes it clear that only evidence since the last successful application can be considered, irrespective of whether the award was accepted.
New award analysis
ACCIA is committed to ensuring that the awards scheme does not contribute towards, or further entrench, pay disparities. Our aim is to ensure that the awards scheme is representative of the entire consultant workforce: this includes sex, age, ethnicity, disability and regional representation.
Applicants are not obliged to provide diversity monitoring information so a ‘prefer not to say’ option is always available. However, this does mean that the statistics reported on these areas below are not necessarily totally representative. In addition, some of the data reported below has been collated from wider NHS data platforms so there is potential for further minor inconsistencies.
In 2024, there were a total of 1,051 applications for new awards: 978 applications in England and 73 in Wales.
A total of 514 new awards were granted overall: 477 in England and 37 in Wales. This resulted in an overall success rate of 48.8% in England and 50.7% in Wales.
Table 1 shows the number of applications for new awards and success rates over time. Application numbers decreased through the period 2010 to 2019 except for the pandemic ‘catch up’ round in 2021. There was a decrease in application numbers for 2024, which was slightly disappointing. However, with a renewed plan for advertising the scheme for 2025, we have been pleased to see an increase in application numbers in the 2025 awards round. In addition there will be re-applications from many award holders who last applied in the 2021 awards round. If applicant numbers increase significantly, with a fixed number of awards, this will inevitably mean a reduction in success rate.
Table 1: number of applications for new awards and success rates over time in England and Wales
| Year | New applications for awards | Success rate |
|---|---|---|
| 2010 | 2,259 | 14.0% |
| 2011 | 2,406 | 13.2% |
| 2012 | 2,313 | 13.7% |
| 2013 | 1,817 | 17.4% |
| 2014 | 1,539 | 20.7% |
| 2015 | 1,198 | 26.4% |
| 2016 | 1,200 | 26.5% |
| 2017 | 1,078 | 29.5% |
| 2018 | 1,038 | 30.7% |
| 2019 | 1,003 | 31.5% |
| 2020 | Round suspended due to COVID-19 | Not applicable |
| 2021 | 1,804 | 29.3% |
| 2022 | 1,267 | 46.6% |
| 2023 | 1,257 | 45.8% |
| 2024 | 1,051 | 48.9% |
Table 2 shows the number of awards granted in England and Wales in 2024 and their percentage of the total number of awards granted per nation.
Table 2: number and percentage of awards granted per level in England and Wales
| Level | England | Wales |
|---|---|---|
| National 0 | Not applicable | 20 (54.1%) |
| National 1 | 258 (50.2%) | 10 (27.0%) |
| National 2 | 155 (30.2%) | 5 (13.5%) |
| National 3 | 64 (12.5%) | 2 (5.4%) |
| Total | 477 | 37 |
In England, the scheme operates on a 3-level award system, with a maximum of 600 awards, split into a target of 330 national 1 (N1) awards (£20,000), 200 national 2 (N2) awards (£30,000) and 70 national 3 (N3) awards (£40,000) per year. Awards are granted for 5 years
Wales has one additional tier, national 0 (N0) (£10,000) and determines its own award numbers at each of these 4 levels annually.
This replaced the previous bronze, silver, gold and platinum award system and increases the overall number of awards granted.
Table 3: number and percentage of awards by prior and non-prior award holders in England and Wales
| Level (total applicants) | Prior award | No prior award |
|---|---|---|
| N0 (20) | 0 (0.0%) | 20 (100.0%) |
| N1 (268) | 22 (8.2%) | 246 (91.8%) |
| N2 (160) | 35 (21.9%) | 125 (78.1%) |
| N3 (60) | 32 (48.5%) | 34 (51.5%) |
| Total | 89 (17.3%) | 425 (82.7%) |
Table 3 shows the number of awards granted to prior award holders compared with non-prior award holders. 82.7% of new awards have been given to applicants with no previous award. N0 (only applicable in Wales) and N1 were the levels in which those with no prior awards were the most successful.
In England, there was a significant increase in the proportion of N3 awards given to applicants with no prior award (51.5% compared with 6.3% in 2023). This trend has been replicated across all levels, with applicants with no prior awards having a higher success rate than those with a prior award.
Although application numbers were lower than expected, this positive trend shows that we are achieving our aim of reaching a broader audience.
Along with the significantly increased success rate since the scheme was reformed, this should encourage consultants who have not previously engaged with the national award scheme to submit applications.
ACCIA will continue to encourage consultants from all specialties and backgrounds to apply and there was a renewed focus on stakeholder engagement for the 2025 awards round.
Region
Table 4 shows the number of applications and success rate of new awards per regional sub-committee. Our regional process sets the indicative numbers for each award level in each region such that applicants in any region of England have a roughly equal chance of gaining an award. It is a fundamental principle of the scheme to recognise senior clinicians equitably across each region.
Overall, the mean success rate was 48.9% (across England and Wales), but there was significant variance between regions compared with 2023, with rates from 36.1% to 55.6%. The regions with the highest success rates were East of England (55.6%) and London South (51.9%). The region with the lowest success rate was East Midlands at 36.1% followed by Cheshire and Mersey at 36.4%.
In England, success rates for N1 awards varied between 12.1% and 30.5%, and N2 awards varied between 11.7% to 21.2%. There was still a wide range in success rates from 2.7% to 11.7% at the N3 level, with the North East achieving the highest N3 success rate.
Some variations in regional success rates are due to rounding up and down the indicative numbers at each award level in each region based on the number of applications received. Moreover, the top-ranked applications from each region are assessed and benchmarked nationally against candidates in all regions by the N3 sub-committee, which is made up of the most experienced scorers. The N3 committee (responsible for re-assessing candidates who meet the threshold for N3 awards) will assess the individual application based on merit regardless of the home region of the applicant. Applicants referred to the N3 committee who are unsuccessful at N3 level automatically gain an N2 award. This would explain some discrepancies between success rates per region for N3 and N2 awards. In addition, further variations are a result of re-scoring by the national reserve sub-committee (NRES) where ties occur at award level ranking cut-offs and where governance queries are raised.
As each region scores independently, it is not possible to make direct comparisons between regions in terms of absolute scores, as it is the ranking within regions that determines success. The variation in success rates between award rounds emphasises that direct comparisons between years are also not valid. Quality assurance governance processes are applied to all applications that are ranked within the indicative number for each region. ACCIA continues to monitor data annually to identify any patterns, and flags any inconsistencies to the sub-committees as required.
Table 4: number of applications and success rate of each award level per regional sub-committee
| Sub-committee | Total applications in England and Wales | N1 (N0 in Wales) | N2 (N1 and N2 in Wales) | N3 | Total successful applications |
|---|---|---|---|---|---|
| Arm’s length bodies | 37 | 10 (27.0%) | 7 (18.9%) | 1 (2.7%) | 18 (48.6%) |
| Cheshire and Mersey | 33 | 4 (12.1%) | 7 (21.2%) | 1 (3.0%) | 12 (36.4%) |
| East Midlands | 36 | 6 (16.7%) | 5 (13.9%) | 2 (5.6%) | 13 (36.1%) |
| East of England | 81 | 24 (29.6%) | 15 (18.5%) | 6 (7.4%) | 45 (55.6%) |
| London North East | 121 | 34 (28.1%) | 17 (14.0%) | 11 (9.1%) | 62 (51.2%) |
| London North West | 49 | 14 (28.6%) | 7 (14.3%) | 4 (8.2%) | 25 (51.0%) |
| London South | 108 | 31 (28.7%) | 17 (15.7%) | 8 (7.4%) | 56 (51.9%) |
| North East | 60 | 17 (28.3%) | 7 (11.7%) | 7 (11.7%) | 31 (51.7%) |
| North West | 87 | 21 (24.1%) | 13 (14.9%) | 7 (8.0%) | 41 (47.1%) |
| South East | 39 | 10 (25.6%) | 8 (20.5%) | 1 (2.6%) | 19 (48.7%) |
| South | 95 | 29 (30.5%) | 15 (15.8%) | 4 (4.2%) | 48 (50.5%) |
| South West | 57 | 16 (28.1%) | 8 (14.0%) | 5 (8.8%) | 29 (50.9%) |
| West Midlands | 79 | 20 (25.3%) | 11 (13.9%) | 4 (5.1%) | 35 (44.3%) |
| Yorkshire and the Humber | 96 | 22 (22.9%) | 18 (18.8%) | 3 (3.1%) | 43 (44.8%) |
| Wales | 73 | 20 (27.4%) | 10 (13.7%) 5 (6.8%) | 2 (2.7%) | 37 (50.7%) |
Specialties
According to NHS England workforce statistics and StatsWales data on medical and dental staff by specialty and year, in March 2024 there were 61,287 consultants in the NHS in England (this does not include data on academic GPs) and 2,962 in Wales. Of these, the consultant numbers are broken down by 12 specialties.
Table 5 shows the number of the consultant workforce per specialty in the NHS in March 2024 for England and Wales. It also demonstrates what percentage of each specialty makes up the consultant workforce against the total number of consultants in the NHS in England (61,287) and Wales (2,962). In England, there was unaccounted specialty data for 4,546 consultants, meaning the result will not total to 100%.
Table 5: number and percentages of the consultant workforce per specialty in the NHS in March 2024 for England and Wales
| Specialty | Number of consultants - England | Percentage of consultant workforce - England | Number of consultants - Wales | Percentage of consultant workforce - Wales |
|---|---|---|---|---|
| Anaesthetics | 8,367 | 13.7% | 488 | 16.5% |
| Clinical oncology | 905 | 1.5% | 48.3 | 1.6% |
| Dental | 980 | 1.6% | 53 | 1.8% |
| Emergency medicine | 2,538 | 4.1% | 124.7 | 4.2% |
| General medicine | 14,297 | 31.4% | 735 | 24.8% |
| Obstetrics and gynaecology | 3,028 | 4.9% | 160 | 5.4% |
| Paediatrics | 4,254 | 6.9% | 220 | 7.4% |
| Pathology | 2,957 | 4.8% | 155 | 5.2% |
| Public health medicine | 52 | 0.1% | 41 | 1.4% |
| Psychiatry | 4,513 | 7.4% | 200 | 6.7% |
| Radiology | 3,933 | 6.4% | 172 | 5.8% |
| Surgery (including ophthalmology) | 10,917 | 17.8% | 566 | 19.1% |
Figure 1: proportion of applications relative to the proportion of the consultant workforce in England per specialty
| Specialty | Proportion of consultant workforce - England | Proportion of applications (%) - England |
|---|---|---|
| Anaesthetics | 13.7% | 7.6% |
| Clinical oncology | 1.5% | 1.6% |
| Dental | 1.6% | 2.8% |
| Emergency medicine | 4.1% | 1.5% |
| General medicine | 23.3% | 31.4% |
| Obstetrics and gynaecology | 4.9% | 3.5% |
| Paediatrics | 6.9% | 9.5% |
| Pathology | 4.8% | 5.0% |
| Psychiatry | 7.4% | 4.5% |
| Public health medicine | 0.1% | 1.6% |
| Radiology | 6.4% | 4.1% |
| Surgery | 17.8% | 25.2% |
Figure 2: proportion of applications relative to proportion of the consultant workforce in Wales per specialty
| Specialty | Proportion of consultant workforce - Wales | Proportion of applications (%) - Wales |
|---|---|---|
| Anaesthetics | 16.8% | 13.7% |
| Clinical oncology | 1.6% | 4.1% |
| Dental | 1.8% | 5.5% |
| Emergency medicine | 4.2% | 0.0% |
| General medicine | 24.8% | 30.1% |
| Obstetrics and gynaecology | 5.4% | 5.5% |
| Paediatrics | 7.4% | 9.6% |
| Pathology | 5.2% | 2.7% |
| Psychiatry | 6.7% | 1.4% |
| Public health medicine | 1.4% | 1.4% |
| Radiology | 5.8% | 1.4% |
| Surgery | 19.1% | 23.3% |
Figures 1 and 2 highlight the differences between the proportion of applications relative to the proportion of the consultant population in England and Wales per specialty.
As has been the case in previous years, the largest number of applications in England (31.4%) and Wales (30.1%) came from consultants in the general medicine specialty, which itself covers multiple sub-specialties. The proportion of applications is higher than the proportion of the workforce working in general medicine (23.3% in England and 24.8% in Wales).
Other specialties that have also had a higher representation in applications compared with the wider consultant population include dental, paediatrics, pathology, public health medicine and surgery (comprising several sub-specialties). Compared with the wider consultant pool, there is substantial under-representation of consultants specialising in anaesthetics in England (7.6% compared with 13.7%) and psychiatry in Wales (0% compared with 4.2%).
It is not clear why consultants from some specialties are more likely to apply than others. We are keen to work with membership organisations, such as royal colleges and specialist societies (particularly those representing smaller less-populated specialties), to encourage applications from their members and for them to reflect our guidance to improve the overall quality of applications and likelihood of attaining an award.
Table 6: number of applications against number of consultants and success rates by specialty in England
| Specialty | Number of applications | Proportion of applications | Number of awards granted | Success rates |
|---|---|---|---|---|
| Academic GP | 17 | 1.7% | 11 | 64.7% |
| Anaesthetics | 74 | 7.6% | 25 | 33.8% |
| Clinical oncology | 16 | 1.6% | 10 | 62.5% |
| Dental | 27 | 2.8% | 12 | 44.4% |
| Emergency medicine | 15 | 1.5% | 3 | 20.0% |
| General medicine | 307 | 31.4% | 178 | 58.0% |
| Obstetrics and gynaecology | 34 | 3.5% | 16 | 47.1% |
| Paediatrics | 93 | 9.5% | 44 | 47.1% |
| Pathology | 49 | 5.0% | 26 | 53.1% |
| Public health medicine | 16 | 1.6% | 6 | 37.5% |
| Psychiatry | 44 | 4.5% | 25 | 56.8% |
| Radiology | 40 | 4.1% | 20 | 50.0% |
| Surgery (including ophthalmology) | 246 | 25.2% | 101 | 41.1% |
| Total | 978 | 100% | 477 | Not applicable |
Table 7: number of applications against number of consultants and success rates by specialty in Wales
| Specialty | Number of applications | Proportion of applications | Number of awards granted | Success rates |
|---|---|---|---|---|
| Academic GP | 1 | 1.4% | 0 | 0.0% |
| Anaesthetics | 10 | 13.7% | 5 | 50.0% |
| Clinical oncology | 3 | 4.1% | 3 | 100.0% |
| Dental | 4 | 4.6% | 3 | 75.0% |
| Emergency medicine | 0 | 0.0% | 0 | 0.0% |
| General medicine | 22 | 30.1% | 13 | 59.1% |
| Obstetrics and gynaecology | 4 | 5.5% | 1 | 25.0% |
| Paediatrics | 7 | 9.6% | 6 | 85.7% |
| Pathology | 2 | 2.7% | 2 | 100.0% |
| Public health medicine | 1 | 1.4% | 1 | 100.0% |
| Psychiatry | 1 | 1.4% | 1 | 100.0% |
| Radiology | 1 | 1.4% | 0 | 0.0% |
| Surgery (including ophthalmology) | 17 | 23.3% | 4 | 23.5% |
| Total | 73 | 100% | 38 | Not applicable |
Tables 6 and 7 show the number and proportion of applications and their success rates by specialty in England and Wales in 2024. The greatest number of awards at all levels were granted to consultants whose registered specialty was general medicine and surgery.
The discrepancies between success rates for each specialty in table 7 reflect the small numbers of awards in Wales, making any proportionate analysis difficult. In England, the higher numbers of awards make analysis across the larger specialties more meaningful. Therefore, it would not be appropriate to make comparisons between England and Wales.
In England, the lowest success rate is seen in emergency medicine with a 20.0% success rate, followed by anaesthetics with a 33.8% success rate. The highest success rate in England comes from academic GPs: a 64.7% success rate in comparison with the overall success rate of 48.8%.
ACCIA is aware of the difference between specialties in terms of demonstrating national impact, but remains committed to working with employers, membership organisations and other stakeholders to ensure that consultants from all specialties can be recognised for exemplary work. Senior clinicians could be encouraged to develop their evidence portfolios and consider application at annual appraisals and revalidation discussions, and we will continue to encourage employers to embed such discussions into their local processes.
ACCIA will continue to encourage applications from consultants from diverse backgrounds and from all NHS specialties, and we will be renewing our focus on stakeholder engagement to ensure access to the scheme is broadened.
Diversity reporting
Up to the 2021 awards round, success rates by protected characteristics were reported for England and Wales together. However, from the 2022 round, the N0 award level has only been available to applicants in Wales. This means that combined figures including that award level are potentially misleading to analyse.
The sections below summarise success rates across 4 protected characteristics in England and Wales together, followed by a separate N0 table. For N0, and some of the other award levels where numbers are small, percentage rates must be interpreted with caution. Several years’ data may be needed to assess longer-term trends, but we will continue to monitor both application and success data to identify those that do arise.
Age
Table 8 shows the proportion of applications against proportion of consultant population. We continue to receive the largest number of applications from consultants in the 45 to 54 year old age group (38.9%). This year, we have seen an increase in 35 to 44 year olds (19.7%) applying and a decrease in applications from the 55 to 64 year old age group (18.3%) compared with 2023 (17.8% and 22.4%, respectively). Interpretation of the results must be made with caution given that there was also a slight increase of people who preferred not to disclose their age.
Table 9 shows the number of applications and success rates per award level by age group in England and Wales. The highest success rate was achieved by the 65 year old and over age group (65.0%), an increase from 2023 (54.5%). As in 2023, the difference between the success rate for the 55 to 64 year old age group and the 45 to 64 year old group remains at 11.2%. Moreover, the success rate for 35 to 44 year old age group increased from 26.9% (2023) to 44.4%.
Only evidence from time spent as a consultant is eligible for assessment and it inevitably takes time to generate evidence of impact. Predictably, this results in lower success rates from applications submitted early in a consultant’s career.
The 2022 reforms allowed consultants at any point in their career to access all levels of awards. ACCIA will continue to engage in proactive messaging and engagement to encourage consultants from across the age brackets to feel empowered to apply and understand that they can be recognised for national impact at all stages of their consultant career.
Table 8: proportion of applications against proportion of consultant population (NHS England workforce statistics, March 2024)
| Age | Proportion of consultant population | Proportion of applications |
|---|---|---|
| Under 25 | 0.0% | 0.0% |
| 25 to 34 | 1.4% | 0.1% |
| 35 to 44 | 31.5% | 19.7% |
| 45 to 54 | 40.6% | 38.9% |
| 55 to 64 | 22.3% | 18.3% |
| 65 and over | 4.3% | 1.9% |
| Not declared or incorrect | 0% | 21.1% |
Note: ACCIA relies on consultants self-reporting their date of birth to calculate age. A significant minority of applicants either chose not to declare their date of birth or had made an obvious mistake such as entering the date the application was completed.
Table 9: number of applications and success rates per award level by age in England and Wales
| Age | Number of total applications | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Overall success rate |
|---|---|---|---|---|---|---|
| Under 25 | 0 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| 25 to 34 | 1 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| 35 to 44 | 207 | 92 | 25.1% | 14.5% | 3.4% | 44.4% |
| 45 to 54 | 409 | 199 | 29.1% | 12.7% | 4.9% | 48.7% |
| 55 to 64 | 192 | 115 | 20.8% | 22.4% | 14.6% | 59.9% |
| 65 and over | 20 | 13 | 30.0% | 20.0% | 15.0% | 65.0% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022. This now means applications are submitted for all levels and scores depict award level.
Sex
Table 10 shows that in 2024 we received 37.1% of applications from females and 61.2% from males in England and Wales, showing a 3.6% rise in the proportion of applications from female consultants. The proportion of awards granted to males (61.1%) in 2024 is a decrease from 67.2% in 2023, whereas the proportion of awards granted to females (37.2%) has increased by 7.2% over the same period.
The success rate gap between females and males has closed this year, with the female success rate (49.0%) slightly higher than the male success rate (48.8%). This is positive news given the reforms introduced in 2022 to broaden access and improve fairness and equity of the scheme.
The data illustrates that there is still an under-representation for females in application rate (37.1%) when compared with the wider consultant population (40.5% female). Although we have seen a positive increase in applications from females in recent years, there is still more to be done to encourage and support women to apply and ensure that our materials and processes support all applicants appropriately.
Table 10: number of applications and success rates by sex in England and Wales
| Sex | Number of total applications | Proportion of new applications | Number of successful applications | Success rates |
|---|---|---|---|---|
| Female | 390 | 37.1% | 191 | 49.0% |
| Male | 643 | 61.2% | 314 | 48.8% |
| Identify as other or prefer not to say | 18 | 1.7% | 9 | 50.0% |
Table 11 shows success rates for each sex, broken down by award levels, for the 2024 awards round. As mentioned above, the gap between overall male and female success rates has decreased.
Females have a higher success rate for N1 level awards (28.2% compared with 24.0% for males), whereas males have a higher success rate for N3 level awards (7.2% compared with 4.6% for females).
ACCIA remains committed to eroding discrepancies in success rates per level between males and females.
Table 11: success rates per sex in England and Wales
| Sex | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Overall success rate |
|---|---|---|---|---|---|
| Male | 643 | 24.0% | 15.9% | 7.2% | 48.8% |
| Female | 390 | 28.2% | 14.1% | 4.6% | 49.0% |
| Identify as other or prefer not to say | 18 | 22.2% | 16.7% | 11.1% | 50.0% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022. This now means applications are submitted for all levels and scores depict award level.
Table 12 show the success rates over time by sex. This year, we have seen a positive shift in the trend, with females achieving an overall higher success rate compared with males. We hope this positive trend of having comparable success rates between sex categories continues.
Table 12: success rates over time by sex in England and Wales
| Year | Male | Female | Difference |
|---|---|---|---|
| 2017 | 30.20% | 26.70% | 3.5 |
| 2018 | 31.30% | 30.20% | 1.1 |
| 2019 | 30.50% | 31.60% | 1.1 |
| 2021 | 29.50% | 28.30% | 1.2 |
| 2022 | 48.4% | 42.9% | 5.5 |
| 2023 | 48.0% | 41.1% | 6.9 |
| 2024 | 48.8% | 49.0% | 0.2 |
Ethnicity
According to NHS England workforce statistics, the consultant population in March 2024 was made up of 53.2% clinicians from White ethnic groups and 41.2% from Black, Asian and other ethnic minorities - with 5.6% of the consultant population preferring not to disclose. There has been a long-term trend of the consultant population becoming more diverse, and this continues. ACCIA aims for and expects the applicant pool to mirror the consultant population by ethnicity as well as by sex.
Table 13 shows the proportion of applicants and success rates for different ethnic groups, demonstrating that White ethnic groups are over-represented in terms of both applicants (56.0%) and success rates (55.3%), compared with applicants from other ethnic groups who represent 41.6% of applicants with a success rate of 39.8% in 2024. The proportion of applications received is now more reflective of the consultant workforce, and it is positive that a lower proportion of applicants prefer not to disclose this information than in the population statistics. Nonetheless, the disparity in success rates continues to be of concern and ACCIA will continue to work with employers, membership organisations and other stakeholder groups to enable applicants from all backgrounds to access the award scheme in a way that gives them the best possibility of success.
The success rate per award level by ethnicity in England and Wales is shown in table 14. There are significant differences in success rates in all award categories, with White ethnic groups having higher success rates. However, the biggest disparities are at N2 and N3 levels. It is worth noting that the gap between success rates at N1 (2.5%) is significantly lower this year than in 2023 (6.4%). A breakdown of the larger sub-sections of ethnic groups from this high-level data is shown in the annex.
Table 13: number of applications and success rates by ethnicity in England and Wales
| Ethnicity | Number of applications | Proportion of applications | Number of successful applications | Success rates |
|---|---|---|---|---|
| White ethnic groups combined | 589 | 56.0% | 326 | 55.3% |
| All other ethnic groups combined | 437 | 41.6% | 174 | 39.8% |
| Prefer not to say | 25 | 2.4% | 14 | 56.0% |
Table 14: success rates per award level by ethnicity in England and Wales
| Ethnicity | Success rates - N1 | Success rates - N2 | Success rates - N3 |
|---|---|---|---|
| White ethnic groups combined | 26.8% | 18.8% | 7.6% |
| All other ethnic groups combined | 24.3% | 9.6% | 4.1% |
| Prefer not to say | 16.0% | 28.0% | 12.0% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022. This now means applications are submitted for all levels and scores depict award level.
Table 15 shows success rates broken down ethnicity over time. In 2022 and 2023, there was a widening of the gap in success rates, which, taken in context with the trend since 2021, is cause for concern. However, positively, the gap has decreased slightly from 2023 to 2024.
While not all the factors behind the disparities in success rates are under ACCIA’s control or influence, we will continue to improve the way we provide support for applicants to ensure they stand the best chance to succeed within the scheme, particularly those for whom English is not their first language. We will particularly work on what we are able to do to increase the quality of applications submitted, including through training materials and promotion of case studies and guidance that can help prospective applicants demonstrate the impact they have done in the most suitable way.
Table 15: success rates for new awards over time by ethnic group in England and Wales
| Year | White ethnic groups combined - success rates | All other ethnic groups combined - success rates | Difference |
|---|---|---|---|
| 2017 | 30.2% | 25.7% | 4.5 |
| 2018 | 31.8% | 23.3% | 8.5 |
| 2019 | 33.0% | 27.6% | 5.4 |
| 2021 | 32.4% | 24.4% | 8 |
| 2022 | 51.7% | 37.9% | 13.8 |
| 2023 | 53.1% | 35.0% | 18.1 |
| 2024 | 55.3% | 39.8% | 15.5 |
Sex by ethnicity
Table 16 shows the number of applications and success rates by sex and ethnicity in England and Wales.
As in 2023, and not considering prefer not to say categories, males from White ethnic groups have the highest overall success rate of 57.8%, followed by females from White ethnic groups at 52.4%. There remains a significant difference in success rates for other ethnic groups, with males from an ethnic minority background achieving 38.4% and females from an ethnic minority background achieving a success rate of 43.1%. There has been a positive increase in success rates of females from an ethnic minority background from 30.6% in 2023 to 43.1% in 2024.
Males from ethnic minority backgrounds achieved the lowest success rate at N1 with 23.0%. However, at N3 level female applicants from other ethnic groups had an increase in success rate to 3.1% (compared with 2.1% in 2023), whereas the success rate of male applicants from other ethnic groups increased slightly to 4.6% (compared with 4.2% in 2023). While it is encouraging that these rates have remained steady or increased, it should be noted that most awards at this level are granted to holders of existing awards, so familiarity with the scheme and application process are significant factors.
Data from those who preferred not to state their sex or ethnicity is presented for completeness, but the numbers are too small to meaningfully interpret. For these applicants and other protected characteristics with very few applicants, any analysis will be performed over 2 or more years of the scheme to gain a more representative sample size and to avoid any inadvertent identification of individuals in such reporting annually.
ACCIA remains committed to tackling success rate discrepancies between sex by ethnicity and plans to work with employers to encourage discussions about award applications more broadly at annual appraisals.
Table 16: number of applications and success rates by sex by ethnicity in England and Wales
| Sex by ethnicity | Number of applications | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Success rate |
|---|---|---|---|---|---|---|
| Female - White ethnic groups | 252 | 132 | 29.8% | 15.5% | 5.2% | 52.4% |
| Male - White ethnic groups | 332 | 192 | 25.0% | 21.4% | 9.3% | 57.8% |
| Prefer not to say - White ethnic groups | 5 | 2 | 0.0% | 20.0% | 20.0% | 0.0% |
| Female - other ethnic groups | 130 | 56 | 26.9% | 10.8% | 3.1% | 43.1% |
| Male - other ethnic groups | 305 | 117 | 23.0% | 9.2% | 4.6% | 38.4% |
| Prefer not to say - other ethnic groups | 2 | 1 | 50.0% | 0.0% | 0.0% | 50.0% |
| Female - prefer not to say | 8 | 3 | 0.0% | 25.0% | 12.5% | 37.5% |
| Male - prefer not to say | 6 | 5 | 16.7% | 50.0% | 16.7% | 83.3% |
| Prefer not to say - prefer not to say | 11 | 6 | 27.3% | 18.2% | 9.1% | 54.5% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022. This now means applicants apply for an award and the scores determine the award level.
Disability
Table 17 shows the number and success rates by applicants’ declared disability. As in 2023, it is encouraging that the total number of applications from this cohort is mirrored by the percentage of the awards granted. The proportion of NCIA applicants (3.6%) declaring a disability is still higher than the wider consultant workforce (2.3%), but the proportion of applicants not declaring has remained the same.
As with all protected characteristics where the annual numbers are relatively small and so difficult to analyse individually, ACCIA will continue to monitor this data and highlight to employers and their medical directors the importance of adequate representation of their local population in the award scheme. We expect employers to encourage high-performing senior clinicians to apply during annual appraisal discussions, and to provide access to support and local advice directly or through membership organisations based on our comprehensive guidance.
Table 17: number of applications and proportion of successful awards by disability
| Disability | Number of applications | Proportion of applications | Number of successful applications | Success rates |
|---|---|---|---|---|
| Yes | 26 | 3.6% | 13 | 50.0% |
| No | 993 | 92.3% | 482 | 48.5% |
| Prefer not to say or did not disclose | 32 | 4.1% | 19 | 59.4% |
Diversity reporting for N0 awards in Wales
Table 18: number of applications and success rates for N0 awards in Wales by age, sex, and ethnicity
| Age, sex and ethnicity | Number of total applications | Number of successful applications | Success rate (%) |
|---|---|---|---|
| Age - not declared or incorrect | 15 | 5 | 33.3% |
| Age - 35 to 44 | 12 | 3 | 25.0% |
| Age - 45 to 54 | 30 | 8 | 26.7% |
| Age - 55 to 64 | 16 | 4 | 25.0% |
| Sex - female | 27 | 8 | 29.6% |
| Sex - male | 45 | 12 | 26.7% |
| Sex - identify as other or prefer not to say | 1 | 0 | 0.0% |
| Ethnicity - White ethnic groups combined | 40 | 12 | 30.0% |
| Ethnicity - all other groups combined | 30 | 8 | 26.7% |
| Ethnicity - prefer not to say | 1 | 0 | 0.0% |
| Sex by ethnicity - female, White ethnic groups | 19 | 5 | 26.3% |
| Sex by ethnicity - male, White ethnic groups | 21 | 7 | 33.3% |
| Sex by ethnicity - female, other ethnic groups | 6 | 3 | 50.0% |
| Sex by ethnicity - male, other ethnic groups | 24 | 5 | 20.8% |
| Sex by ethnicity - prefer not to say, prefer not to say | 1 | 0 | 0.0% |
| Sex by ethnicity - female, prefer not to say | 2 | 0 | 0.0% |
| Sex by ethnicity - male, prefer not to say | 1 | 0 | 0.0% |
Note: of 73 total applications, 20 N0 awards were granted. Categories where no applications were received have been intentionally omitted.
Appeals
In the 2024 awards round, ACCIA received a total of 19 appeals from applicants in England and Wales. Every appeal is carefully assessed to determine whether there is a basis for an appeal and to ensure that due processes have been followed.
Grounds for appeal can only be made based upon demonstration of any of the following criteria:
- the committee did not consider all the supporting information or documents sent with the application
- irrelevant information was taken into account
- discrimination due to protected characteristics such as sex, ethnicity or age
- the usual evaluation processes were not followed
- the committee, or any of its members, showed bias or had a conflict of interest, such as where someone involved in a decision could be affected by the result
Disagreement with the outcome of the scoring is not in itself grounds for appeal.
All requests were reviewed by the ACCIA Chair and Medical Director, followed by an independent panel of at least 2 senior assessors, typically consisting of a regional sub-committee chair and medical vice-chair who had not scored the application previously. After review of each request, scoring patterns and the process flow for each applicant who requested consideration, the appeal panel concluded that none of the cases was deemed to have sufficient grounds for appeal to ACCIA.
Governance
ACCIA is led by an independent Chair and Medical Director, who are appointed by the Secretary of State for Health and Social Care. Together, they are responsible for:
- ensuring that ACCIA:
- operates to high standards and reflects public sector values
- is fair and robust in its assessment of applications
- operates effectively, efficiently and transparently
- advising on the development of the NCIA scheme
At the time of the 2024 awards round (from June 2024), Dr Vinay Patroe was Chair and Professor Kevin Davies was the Medical Director.
Where existing award holders inform ACCIA of changes in circumstances, such as changes of employer and changes to job plans, the Chair and Medical Director review each case and determine any impact on the award. For legacy national Clinical Excellence Awards (NCEAs), this can include pro rating of the award payment. For both NCEAs and NCIAs, changes can affect the duration of an award.
In autumn 2024, ACCIA carried out a series of focus groups to gain insight into how our processes and policies are viewed by assessors, employers, current award holders and applicants. Following this, a proposal for changes to the application process and payment policy for the 2025 awards round was taken to, and agreed by, the main committee in November 2024. These changes will apply to applicants employed in both England and Wales.
Chair of ACCIA from June 2024 - Dr Vinay Patroe
Vinay trained as an anaesthetist and worked in the NHS before embarking on a career in the pharmaceutical industry. He has worked with multiple companies, including several roles with GSK. Until September 2023 he was Medical Director for Janssen UK. Vinay started his term as ACCIA Chair in June 2024.
As Chair of ACCIA, Vinay reports to the Director of Workforce at DHSC. His responsibilities include:
- providing leadership to ACCIA
- ensuring the effective functioning of the NCIA scheme
ACCIA Medical Director - Professor Kevin Davies
Kevin was recently Foundation Chair of Medicine at Brighton and Sussex Medical School and Consultant Physician and Rheumatologist at Brighton and Sussex University Hospitals NHS Trust. He has been involved with ACCIA at a senior level for many years, as Medical Vice-Chair for the South East region and as a member of our main committee. He previously held a gold NCEA.
The Medical Director’s responsibilities include:
- advising on the medical and professional aspects of the scheme, ensuring it reflects and rewards current best medical practice
- the leadership of training for scorers, employers and applicants
ACCIA secretariat
The Chair and Medical Director are supported by a secretariat of civil servants employed by DHSC. For 2024, the secretariat was staffed by 3.5 substantive full-time equivalents (4 staff).
You can contact ACCIA by:
- emailing accia@dhsc.gov.uk or calling 020 7972 4608 for England
- emailing accia@wales.nhs.uk for Wales
ACCIA main committee
The main committee is ACCIA’s decision-making body. It meets to discuss and agree changes to ACCIA policy and procedures, and to agree the final recommendations to ministers for new awards. A list of members is available on the ACCIA governance page.
Regional sub-committees
All applications for awards are scored by voluntary assessors. Our assessors are recruited regionally and can be re-assigned to another region to score applications. This helps to manage any conflict of interest, balance workload and ensure diversity of scorers.
Each sub-committee is led by a lay chair and a medical vice-chair who are responsible for the good governance of their committee. Regional sub-committee chairs and medical vice-chairs are also members of the N3 scoring committee (scored nationally) and score applications that are sent to NRES for additional scrutiny.
The remainder of each regional sub-committee consists of a mixture of:
- professional members (practising clinicians from across a range of specialties, including public health and academia)
- employer members (from NHS organisations, including senior managers and other leaders)
- non-medical professional or lay members (from a variety of backgrounds, including higher education, law, human resources, research, management, business or retired healthcare professionals)
In total, there are 14 regional sub-committees in England, with one additional sub-committee assessing applications in Wales.
The 14 regional sub-committees are:
- DHSC and arm’s length bodies
- Cheshire and Mersey
- East of England
- East Midlands
- London North East
- London North West
- London South
- North East
- North West
- South
- South East
- South West
- West Midlands
- Yorkshire and the Humber
More information on our regional sub-committees can be found in the applicants’ guide for the 2024 awards round.
Sub-committee recruitment and training
ACCIA regularly refreshes the membership of our regional sub-committees to balance experience with fresh perspectives. Our aim is for the membership of each sub-committee to fully reflect the diverse make-up of the NHS consultant population they assess.
For the 2024 awards round, 47 new assessors were recruited. As ever, ACCIA owes a debt of gratitude to all those assessors who have and who continue to give their time to help make the scheme work.
As in previous years, all new assessors were required to undertake training run by the ACCIA Medical Director and Chair, with training sessions also open to any existing assessors who felt they would benefit. After each awards round, scoring patterns are analysed to ensure consistency of approach by assessors, with the option to request that assessors re-attend training before they score in another round.
Sub-committee diversity
ACCIA aims to reflect the wider consultant population in the make-up of sub-committees, where females made up 40.5% of the workforce in March 2024, with Black, Asian and other ethnic minorities constituting 41.2%.
The regional sub-committees underwent a rebalancing exercise to ensure that membership of each sub-committee reached closer representation of the sex and ethnicity of the consultant population. This saw some members moved from their home regions to other sub-committees to score.
All regional sub-committees have more than 27% female and 33% other than White ethnic group representation, but there is still more to be done. We will continue to use the model of re-allocating assessors between regions, both to manage conflicts of interest and to rebalance committees, bearing in mind the need to maintain a regional ‘identity’ for each sub-committee due to their different characteristics. We will continue to work with our regional chairs and medical vice-chairs to recruit new members and will be actively engaging with external stakeholders to promote the benefits of assessing for prospective applicants and employers alike.
Table 19: rebalanced regional sub-committee membership by sex and ethnicity
| Sub-committee | Female | Male | All White ethnic groups | All other ethnic groups combined |
|---|---|---|---|---|
| DHSC and arm’s length bodies | 36% | 64% | 50% | 50% |
| Cheshire and Mersey | 33% | 67% | 53% | 47% |
| East of England | 38% | 62% | 62% | 38% |
| East Midlands | 47% | 53% | 53% | 47% |
| London North East | 33% | 67% | 59% | 41% |
| London North West | 33% | 67% | 67% | 33% |
| London South | 33% | 67% | 55% | 45% |
| North East | 29% | 71% | 57% | 43% |
| North West | 27% | 73% | 58% | 42% |
| South | 34% | 66% | 56% | 44% |
| South East | 40% | 60% | 53% | 47% |
| South West | 36% | 64% | 50% | 50% |
| West Midlands | 33% | 67% | 53% | 47% |
| Yorkshire and the Humber | 37% | 63% | 52% | 48% |
As the Welsh committee and the Welsh scheme operate separately, no rebalancing was implemented between Wales and England.
Operations
Finances
The ACCIA chair and medical director are paid at a rate of £52,240 per year.
The ACCIA chair and medical director may claim expenses for travel and other associated costs. As most meetings (except N3, main committee, Yorkshire and Humber committee, Wales committee and some London-based meetings) were held virtually, a total of £568.55 of expenses were claimed by the chair and medical director in 2024 to 2025.
Lay regional sub-committee members and chairs can also claim expenses for travel, meeting attendance and other costs such as scoring and appeal reviews. In 2024 to 2025 claims for such costs totalled £68,692.95.
Additional costs arise from the ACCIA secretariat, who manage the running and operations of the scheme. The secretariat consists of 4 civil servants employed by DHSC. The team includes one grade 7, one senior executive officer and 2 higher executive officers.
Funding flows
DHSC holds the budget for the small number of awards paid to those working in the department and for NHS Blood and Transplant, as well as awards paid to consultants working in any of DHSC’s arm’s length bodies.
Most awards in England are funded by NHS England. NHS trusts and foundation trusts receive their budgets from NHS England, which include the relevant provision for any renewed and new NCIAs. Where an award holder is employed by a university or other academic institution, their academic employer recovers the costs for awards from NHS England.
In Wales, most awards are funded by the Welsh Government. Health boards in Wales receive their budgets from the Welsh Government and these incorporate costs associated with new and renewed Clinical Impact Awards.
Total value of awards in payment
The total cost of awards in payment in England for the 2024 to 2025 financial year was £105,474,026, including £9,890,000 of new awards granted in the 2024 round and backdated to 1 April 2024. Costs for new awards granted in the 2024 awards round to previous NCEA holders will fall in the 2025 to 2026 financial year when their new awards commence.
This total cost includes on-cost calculations and is the total value spread across 2 instalments.
Ongoing costs include National Insurance and pension contributions for NCEAs and NCIAs granted in the 2022 and 2023 awards round that are now in transition arrangements. In 2024, these on-costs were calculated at 23.7% for award holders on the NHS Pension Scheme and 14.5% for award holders on the University Superannuation Scheme.
The 2024 personal statements and 2024 nominal roll provide information on awards in payment by award level and specialism, as well as details of new award holders’ activities.
IT
ACCIA continues to work with SmartSimple and Re-Solved, and the contract for the online application and assessment platform provided by SmartSimple was reissued for one year from October 2024.
Annex: ethnicity
Table 20: success rates per award level by high level ethnic descriptors in England and Wales
| Ethnicity | Number of applications | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Overall success rate |
|---|---|---|---|---|---|---|
| All Asian ethnic groups | 340 | 138 | 63.0% | 225% | 9.4% | 40.6% |
| All Black ethnic groups | 24 | 4 | 100.0% | 0.0% | 0.0% | 16.7% |
| Mixed or any other background | 73 | 32 | 46.9% | 34.4% | 15.6% | 43.8% |
| White - British or Irish | 450 | 267 | 46.1 | 34.5% | 15.4% | 59.3% |
| White - any other background | 139 | 59 | 54.2% | 32.2% | 6.8% | 42.4% |
| Prefer not to say | 25 | 14 | 28.6% | 50.0% | 21.4% | 56.0% |
Figures for N0 awards in Wales have not been included due to the low numbers in some categories, which could have allowed the identification of individuals from the data.