Advisory Committee on Clinical Impact Awards: annual report for the 2025 awards round
Published 10 July 2026
Applies to England and Wales
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Foreword
We are pleased to present the 2025 report for the Advisory Committee on Clinical Impact Awards (ACCIA). This was the fourth 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.
Application numbers were expectedly high this year, with many of the 2021 national Clinical Excellence Award (NCEA) recipients due to re-apply. We also received more applications from individuals with no current national award this year than in the entire 2024 awards round.
The impact of the large number of NCEA re-applicants is clear in the data presented below, with diversity statistics more comparable to the legacy award scheme than that which has been in place since 2022. The overall success rate is also significantly lower than in the last 3 rounds, largely due to the high volume of applications.
ACCIA, therefore, considered carefully how to communicate outcomes to unsuccessful applicants, to avoid the possibility of the lower success rate discouraging some who might be successful in future years. Ahead of the 2026 awards round, we have worked with partners to identify barriers that may prevent under-represented groups engaging with the scheme and worked with experts to review our guidance and application process to make them as accessible as possible to all. We have also targeted communications more closely than previously, including offering and delivering webinars to present information about the scheme in as many different ways as possible.
Our regional sub-committee members, medical vice-chairs and chairs all deserve particularly strong praise. Many volunteered to score additional applications, which was vital to us being able to robustly assess the large number received this year. The effort that all members put into the assessment of applications, as well as attending training and other meetings, is invaluable and ACCIA would not be able to fulfil its functions without these contributions.
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 national Clinical Impact Awards (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 in DHSC.
2025 awards round
Timetable
The 2025 awards round opened for applications on 1 April 2025 and closed on 27 May 2025. Scoring of applications took place from June to October 2025.
Regional sub-committee meetings were held between July and November 2025. The main committee meeting was held in November 2025. The main committee recommendations were sent to ministers for approval in January 2026.
Outcomes were communicated to applicants in January 2026. The appeal window was open until 18 February 2026.
Clinical impact examples from 2025
NCIAs continue to recognise and reward senior clinicians delivering impact on the NHS at a national level.
Work by consultants granted awards in the 2025 awards round included:
- conducting the first UK robotic cochlear implant insertion
- leading national trials that prevented Alzheimer’s patients moving to residential care
- undertaking work to improve gynaecological cancer survival rates and address racial disparities in gynaecological health
Scoring groups and normalisation
As in the last 2 award rounds, multiple scoring groups were required so a normalisation process was again used to compensate for differences between scoring groups. This process is used to address difference in scoring patterns and average scores between groups within a regional sub-committee.
Due to the volume of applications received, all except 3 regional sub-committees required multiple scoring groups, with several requiring 3 groups. To manage potential conflicts of interest, sub-committee members are sometimes required to score outside their home region, and we also re-allocate some scorers to help address any imbalances in the sex and ethnicity composition of scoring groups.
At national reserve sub-committee (NRES) rescoring, applications referred from award levels National 1 and National 2 were scored in 2 groups and then normalised, before being separated into different award levels to determine outcomes.
You can read more about how applications were scored in part 5 of the 2025 applicants’ guide.
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 provided. However, this does mean that the statistics reported on these areas below are not necessarily totally representative. There has been an increase in the number of applicants selecting this option in recent years, with feedback survey responses indicating that some applicants are concerned about how their information will be used. We are considering ways we can address this to ensure that individuals feel able to share this information with us. In addition, some of the data reported below has been collated from wider NHS data platforms and, therefore, there is potential for further minor inconsistencies.
In 2025, there were a total of 1,693 applications for new awards: 1,628 applications in England and 65 in Wales. In England, 4 applications were withdrawn before outcomes were released, so the figures in this report are based on the revised total of 1,689.
A total of 539 new awards were granted overall: 502 in England and 37 in Wales, resulting in an overall success rate of 30.9% in England and 56.9% in Wales.
Table 1 shows the number of applications for new awards and success rates over time. An increase in applications was expected due to the large number of NCEAs granted in 2021 due to expire in 2026. This was because of the suspension of the 2020 awards round due to the COVID-19 pandemic and subsequent granting of double the number of new awards in 2021. There was also an increase in applications from individuals with no current national award in England, potentially due to the cessation of the local Clinical Excellence Award (LCEA) scheme in 2024 and the increased stakeholder engagement we carried out following the low number of applications received in 2024. As highlighted in last year’s annual report, the increase in applications saw a concurrent decrease in success rates.
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% |
| 2025 | 1,689 | 31.9% |
Table 2 shows the number of awards granted in England and Wales in 2025 and the 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 | 275 (54.8%) | 10 (27.0%) |
| National 2 | 158 (31.5%) | 5 (13.5%) |
| National 3 | 69 (13.7%) | 2 (5.4%) |
| Total | 502 | 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, 200 National 2 (N2) awards and 70 National 3 (N3) awards per year, with awards being granted for 5 years. Wales has one additional tier, National 0 (N0) 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 increased the overall number of awards granted. Following the acceptance by the UK and Welsh governments of the recommendations made by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) report in May 2025, the value of the awards from 1 April 2025 is as follows:
- N0 (Wales only) £10,500
- N1 £21,000
- N2 £31,500
- N3 £42,000
Table 3: number and percentage of awards by prior and non-prior award holders in England and Wales
| Level (number of awards granted) | Prior award | No prior award |
|---|---|---|
| N0 (20) | 3 (15.0%) | 17 (85.0%) |
| N1 (285) | 190 (66.4%) | 95 (33.3%) |
| N2 (163) | 140 (85.9%) | 23 (14.1%) |
| N3 (71) | 70 (98.6%) | 1 (0.4%) |
| Total | 403 (74.6%) | 136 (25.2%) |
Table 3 shows the number of awards granted to prior award holders compared with non-prior award holders. N0 (only applicable in Wales) and N1 remained the levels in which those with no prior awards were the most successful but, compared with the 2024 awards round where 82.7% of awards were granted to individuals with no prior award, in 2025, the comparable figure was 25.2%.
This situation was foreseeable due to the high number of NCEA holders due to re-apply in 2025, but we are aware that the low number granted to individuals with no prior award creates a risk of discouraging individuals who in other years might be successful. To mitigate this risk, outcome letters to unsuccessful applicants with no prior award were amended to explain this situation, and promotional materials and activities for the 2026 awards have been adapted to address this issue directly.
We are also aware that the progress made in recent years towards application and success rates from female and ethnic minority background applicants being more representative of the consultant community is not seen in the results from the 2025 awards round. Following the results from 2025, ACCIA has been actively engaging with staff networks, membership organisations representing doctors with specific protected characteristics and other bodies to better understand how:
- we can promote higher engagement rates from some groups
- organisations can best support their members to be successful in their applications
ACCIA continues to encourage consultants from all specialties and backgrounds to apply. The focus of our stakeholder engagement for the 2026 awards round has included direct work with organisations that support under-represented groups.
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 all regions.
Overall, the mean success rate was 31.9% (across England and Wales), but there was more significant variance between regions than in 2024 with rates ranging from 26.2% to 33.9%. The regions with the highest success rates were the arm’s length bodies (33.9%), North East (33.3%) and West Midlands (33.3%). The region with the lowest success rate was the North West at 26.7% followed by London North West at 27.8%.
In England, success rates for N1 awards varied between 13.3% and 21.4% and N2 awards varied between 7.1% and 14.4%. No N3 awards were granted in the London North West region this year. The highest success rate at this level was in South (5.6%).
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 explains some discrepancies between success rates per region for N3 and N2 awards, including that no N3 awards were granted in the London North West or South East regions. In addition, further variations are a result of rescoring by NRES where ties occur at cut-off points between N2 and N1, and N1 and no award, 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 of scores between years are also not valid. Our governance processes are followed for all applications that are ranked as potentially successful for each region after first round scoring, and ACCIA continues to monitor data annually to identify any patterns and flag 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 | 56 | 12 (21.4%) | 4 (7.1%) | 3 (5.4%) | 19 (33.9%) |
| Cheshire and Mersey | 58 | 10 (17.2%) | 6 (10.3%) | 3 (5.2%) | 19 (32.8%) |
| East Midlands | 72 | 11 (15.3%) | 7 (9.7%) | 4 (5.6%) | 22 (30.6%) |
| East of England | 132 | 20 (15.2%) | 14 (10.6%) | 6 (4.5%) | 40 (30.3%) |
| London North East | 199 | 38 (19.1%) | 17 (8.3%) | 11 (5.5%) | 66 (33.2%) |
| London North West | 90 | 12 (13.3%) | 13 (14.4%) | 0 (0.0%) | 25 (27.8%) |
| London South | 170 | 32 (18.8%) | 15 (8.8%) | 8 (4.7%) | 55 (32.4%) |
| North East | 93 | 17 (18.3%) | 10 (10.8%) | 4 (4.3%) | 31 (33.3%) |
| North West | 150 | 20 (13.3%) | 14 (9.3%) | 6 (4.0%) | 40 (26.7%) |
| South East | 93 | 16 (17.2%) | 12 (12.9%) | 0 (0.0%) | 28 (30.1%) |
| South | 160 | 29 (18.1%) | 12 (7.5%) | 9 (5.6%) | 50 (31.3%) |
| South West | 99 | 16 (16.2%) | 12 (12.1%) | 2 (2.0%) | 30 (30.3%) |
| West Midlands | 120 | 23 (19.2%) | 11 (9.2%) | 6 (5.0%) | 40 (33.3%) |
| Yorkshire and the Humber | 132 | 19 (14.4%) | 11 (8.3%) | 7 (5.3%) | 37 (28.0%) |
| Wales | 65 | 20 (30.8%) | 10 (15.4%) 5 (7.7%) | 2 (3.1%) | 37 (56.9%) |
Specialties
According to NHS England workforce statistics and StatsWales data on medical and dental staff by specialty and year, in March 2025 there were 59,073 full-time equivalent consultants in the NHS in England (this does not include data on academic GPs) and 2,923 full-time equivalent consultants 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 (59,073) and Wales (2,923).
Table 5: number and percentages of the consultant workforce per specialty in the NHS in March 2025 for England and Wales
| Specialty | Number of consultants - England | Percentage of consultant workforce - England | Number of consultants - Wales | Percentage of consultant workforce - Wales |
|---|---|---|---|---|
| Anaesthetics | 8,653 | 14.5% | 508 | 17.4% |
| Clinical oncology | 956 | 1.6% | 72 | 2.5% |
| Dental | 992 | 1.7% | 51 | 1.7% |
| Emergency medicine | 2,733 | 4.6% | 139 | 4.8% |
| General medicine | 14,947 | 25.3% | 760 | 26.0% |
| Obstetrics and gynaecology | 3,142 | 5.3% | 160 | 5.5% |
| Paediatrics | 4,403 | 7.5% | 229 | 7.8% |
| Pathology | 3,135 | 5.3% | 153 | 5.2% |
| Psychiatry | 4,646 | 7.9% | 207 | 7.1% |
| Public health medicine | 48 | 0.1% | 39 | 1.3% |
| Radiology | 4,095 | 6.9% | 189 | 6.5% |
| Surgery (including ophthalmology) | 11,323 | 19.2% | 416 | 14.2% |
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 | 14.6% | 5.7% |
| Clinical oncology | 1.6% | 1.8% |
| Dentistry | 1.7% | 1.1% |
| Emergency medicine | 4.6% | 1.9% |
| General medicine | 25.3% | 34.7% |
| Obstetrics and gynaecology | 5.3% | 5.0% |
| Paediatrics | 7.5% | 12.0% |
| Pathology | 5.3% | 5.0% |
| Psychiatry | 7.9% | 3.2% |
| Public health medicine | 0.1% | 3.8% |
| Radiology | 6.9% | 4.2% |
| Surgery (including ophthalmology) | 19.2% | 21.6% |
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 | 17.4% | 4.6% |
| Clinical oncology | 2.5% | 10.8% |
| Dentistry | 1.7% | 1.5% |
| Emergency medicine | 4.8% | 1.5% |
| General medicine | 26.0% | 33.8% |
| Obstetrics and gynaecology | 5.5% | 7.7% |
| Paediatrics | 7.8% | 16.9% |
| Pathology | 5.2% | 6.2% |
| Psychiatry | 7.1% | 3.1% |
| Public health medicine | 1.3% | 1.5% |
| Radiology | 6.5% | 0.0% |
| Surgery (including ophthalmology) | 14.2% | 12.3% |
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 (34.7%) and Wales (33.8%) came from consultants in the general medicine specialty, which itself covers multiple sub-specialties. The proportion of applications remains higher than the proportion of the workforce working in general medicine across both England and Wales, while the proportion of applications in some specialties (psychiatry and anaesthetics) remains lower, as has been the case for a number of years.
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 | 29 | 1.8% | 12 | 41.4% |
| Anaesthetics | 92 | 5.7% | 25 | 27.2% |
| Clinical oncology | 30 | 1.8% | 14 | 46.7% |
| Dental | 18 | 1.1% | 4 | 22.2% |
| Emergency medicine | 31 | 1.9% | 6 | 19.4% |
| General medicine | 564 | 34.7% | 184 | 32.6% |
| Obstetrics and gynaecology | 81 | 5.0% | 21 | 25.9% |
| Paediatrics | 195 | 12.0% | 57 | 29.2% |
| Pathology | 81 | 5.0% | 28 | 34.6% |
| Psychiatry | 52 | 3.2% | 11 | 21.2% |
| Public health medicine | 32 | 2.0% | 13 | 40.6% |
| Radiology | 68 | 4.2% | 21 | 30.9% |
| Surgery (including ophthalmology) | 351 | 21.6% | 105 | 29.9% |
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 | 1.5% | 1 | 100.0% |
| Anaesthetics | 3 | 4.6% | 2 | 66.7% |
| Clinical oncology | 7 | 10.8% | 4 | 57.1% |
| Dental | 1 | 1.5% | 1 | 100.0% |
| Emergency medicine | 1 | 1.5% | 0 | 0.0% |
| General medicine | 22 | 33.8% | 12 | 54.5% |
| Obstetrics and gynaecology | 5 | 7.7% | 4 | 80.0% |
| Paediatrics | 11 | 16.9% | 4 | 36.4% |
| Pathology | 4 | 6.2% | 3 | 75.0% |
| Public health medicine | 2 | 3.1% | 1 | 50.0% |
| Psychiatry | 0 | 0.0% | 0 | 0.0% |
| Radiology | 0 | 0.0% | 0 | 0.0% |
| Surgery (including ophthalmology) | 8 | 12.3% | 5 | 62.5% |
Tables 6 and 7 show the number and proportion of applications and their success rates by specialty in England and Wales in 2025. The greatest number of awards at all levels were granted to consultants whose registered specialty was general medicine and surgery, although the difference between surgery and some other specialties was less marked in Wales than in England.
The discrepancies between success rates for each specialty in table 7 reflects the small numbers of awards in Wales, making any proportionate analysis difficult, while 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.
As in 2024, the lowest success rate in England was in emergency medicine at 19.4%, followed by psychiatry at 21.2%. Clinical oncology and academic general practice continue to have the highest success rates in England at 46.7% and 41.4% respectively, even though the proportion of applications from these groups were the second lowest received in the 2025 awards round.
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 important stakeholders to ensure that consultants from all specialties can be recognised for exemplary work. Senior clinicians should be encouraged to develop their evidence portfolios and consider application at annual appraisals and revalidation discussions. We will continue to encourage employers to embed such discussions into their local processes.
Membership organisations such as royal colleges and specialist societies can play an important role in this area, as mentoring and support to new applicants from those with experience of the scheme can help individuals improve the quality of their applications. We continue to encourage organisations to work with us on this and have been holding regional information events during 2026 to highlight the scheme and provide information on how to apply directly to consultants.
Diversity reporting
Up to the 2021 awards round, success rates by protected characteristics have been reported for England and Wales together. However, from the 2022 awards round, the N0 award level became available to applicants in Wales. This means that including that award level in combined figures would be potentially misleading to analyse.
The categories below provide summaries of success rates for award levels N1 to N3 relating to age, sex and ethnicity in England and Wales together, with a separate N0 table that follows. 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 the proportion of the consultant population. As in previous years, the application proportion was greatest in the 45 to 54 age group (37.2%), but a significant cohort of applicants either chose not to declare their age or made an obvious error when entering their date of birth.
The proportion of applications received from earlier-career consultants has fallen in comparison to recent award rounds, but this was anticipated due to the large number of legacy award holders due to re-apply in the 2025 awards round. The actual number of applications received from this group continues to increase.
Table 8: proportion of applications against proportion of the consultant population
| Age | Proportion of consultant population | Proportion of applications |
|---|---|---|
| 25 to 34 | 1.5% | 0.0% |
| 35 to 44 | 31.0% | 13.6% |
| 45 to 54 | 40.2% | 37.2% |
| 55 to 64 | 22.6% | 24.0% |
| 65 and over | 4.7% | 3.2% |
| Not declared or incorrect | 0% | 22.0% |
Source: NHS England workforce statistics, March 2025
ACCIA relies on consultants self-reporting their date of birth to calculate age, and 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 shows the number of applications and success rates per award level by age group in England and Wales. The 55 to 64 and 65 and over age categories had the highest success rates at 51.2% and 51.9% respectively, reflective of the fact that many legacy award holders (who tend to be in higher age groups) re-applied this year.
Although the 2022 reforms allowed consultants at any point in their career to access all levels of awards, only evidence from time spent as a consultant is eligible for assessment and it inevitably takes time to generate evidence of impact, resulting in predictably lower success rates from applications submitted early in a consultant’s career. 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 the opportunity for recognition of national impact at all stages of their consultant career.
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 |
|---|---|---|---|---|---|---|
| 25 to 34 | 0 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| 35 to 44 | 230 | 18 | 7.0% | 0.9% | 0.0% | 7.8% |
| 45 to 54 | 628 | 172 | 15.6% | 9.4% | 2.4% | 27.4% |
| 55 to 64 | 406 | 208 | 25.4% | 16.7% | 9.1% | 51.2% |
| 65 and over | 54 | 28 | 25.9% | 13.0% | 13.0% | 51.9% |
| Not declared or incorrect | 371 | 93 | 14.6% | 7.3% | 3.2% | 25.1% |
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 2025 we received 35.3% of applications from females and 60.0% from males in England and Wales, which constitutes a reduction in the proportion of applications from female consultants. This could be in part explained by the increase in the proportion of applicants who chose not to declare their sex or identify other than as male or female (from 1.7% to 4.8%).
There was no difference in success rate between females and males in the 2024 awards round, but in 2025 the rates were 25.0% and 34.2% respectively. Although this is in some part due to the impact of the legacy scheme in this particular year, we remain conscious of the need to encourage female consultants to apply and will continue to work with partners to address this.
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 | 595 | 35.2% | 149 | 25.0% |
| Male | 1,013 | 60.0% | 346 | 34.2% |
| Identify as other or prefer not to say | 81 | 4.8% | 44 | 54.3% |
Table 11 shows success rates for each sex, broken down by award level, for the 2025 awards round. As mentioned above, the gap between overall male and female success rates has increased compared with 2024.
The success rate at N3 level shows the greatest difference, with 1.7% of females successful at this level compared with 5.6% of males.
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 |
|---|---|---|---|---|---|
| Female | 149 | 13.9% | 7.9% | 1.7% | 25.0% |
| Male | 346 | 17.2% | 10.4% | 5.6% | 34.2% |
| Identify as other or prefer not to say | 44 | 34.6% | 13.6% | 4.9% | 54.3% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022.
Table 12 show the success rates over time by sex. Over recent years, the trend has been for the gap between female and male success rates to close, but this year it is higher than it has been for over a decade. While this is disappointing, the recent increase in female success rates has been driven by those applying with no prior award, and applicants of both sexes in this category have been less successful in this awards round.
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 |
| 2025 | 34.2% | 25.0% | 9.2 |
Note: the 2020 round was suspended due to COVID-19.
Ethnicity
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 (35.2%), compared with applicants from other ethnic groups who represented 38.2% of applicants with a success rate of 24.2% in 2025. While only small, there has been a reduction in the proportion of applications from minority ethnic groups compared with 2024.
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 | 945 | 56.0% | 333 | 35.2% |
| All other ethnic groups combined | 645 | 38.2% | 156 | 24.2% |
| Prefer not to say | 99 | 5.9% | 50 | 50.5% |
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 and the disparities being greater at N2 and N3 levels. A breakdown of the larger subsections of ethnic groups from this high-level data is shown in the annex.
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 | 17.5% | 11.7% | 5.0% |
| All other ethnic groups combined | 14.0% | 5.9% | 2.9% |
| Prefer not to say | 30.3% | 14.1% | 5.1% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022.
Table 15 shows success rates broken down by ethnicity over time. Although the gap in success rates is lower this year, as the overall success rate is significantly lower this year, this does not represent a true narrowing.
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 |
| 2025 | 35.2 | 24.2 | 11.0 |
Note: the 2020 round was suspended due to COVID-19.
Sex by ethnicity
Table 16 shows the number of applications and success rates by sex and ethnicity in England and Wales.
Setting aside the ‘prefer not to say’ categories where some of the numbers are too small for meaningful analysis, female and male applicants from White backgrounds continue to have the highest success rates, 29.7% and 38.6% respectively, while female applicants from other ethnic backgrounds have the lowest success rate at 17.1%. This continues a pattern seen in all award rounds since the NCIA scheme was launched in 2022, although as stated previously, the high number of legacy award holders re-applying in 2025 caused the figures to be more similar to the closed scheme than those from the 2024 awards round.
Data from those who preferred not to state their sex or ethnicity is presented for completeness, but some of 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.
We continue to engage with stakeholders to help encourage applications from under-represented groups and explain how the resources we share publicly can be used to support potential applicants.
Table 16: number of applications and success rates by sex and 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 | 377 | 112 | 16.7% | 9.5% | 2.1% | 29.7% |
| Male - White ethnic groups | 562 | 217 | 17.8% | 13.0% | 6.9% | 38.6% |
| Prefer not to say - White ethnic groups | 6 | 4 | 33.3% | 33.3% | 0.0% | 66.7% |
| Female - other ethnic groups | 210 | 36 | 9.5% | 5.2% | 1.0% | 17.1% |
| Male - other ethnic groups | 433 | 120 | 16.4% | 6.2% | 3.9% | 27.7% |
| Prefer not to say - other ethnic groups | 2 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| Female - prefer not to say | 8 | 1 | 12.5% | 0.0% | 0.0% | 12.5% |
| Male - prefer not to say | 18 | 9 | 16.7% | 27.8% | 5.6% | 50.0% |
| Prefer not to say - prefer not to say | 73 | 40 | 35.6% | 12.3% | 5.5% | 54.8% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022.
Disability
Table 17 shows the number of applications, awards and success rates by declared disability. The proportion of NCIA applicants declaring a disability (3.5%) has remained almost identical to that in 2024, and applicants who have a declared disability remain as likely to be granted an award as those who declare they have none.
As with all protected characteristics, where the annual numbers are relatively small and therefore 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 | 59 | 3.5% | 20 | 33.9% |
| No | 1,531 | 90.6% | 471 | 30.8% |
| Prefer not to say or did not disclose | 99 | 5.9% | 48 | 48.5% |
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 | 10 | 4 | 40.0% |
| Age - 35 to 44 | 12 | 3 | 25.0% |
| Age - 45 to 54 | 22 | 10 | 45.5% |
| Age - 55 to 64 | 20 | 3 | 15.0% |
| Sex - female | 24 | 9 | 37.5% |
| Sex - male | 40 | 10 | 25.0% |
| Ethnicity - White ethnic groups combined | 40 | 10 | 25.0% |
| Ethnicity - all other groups combined | 24 | 9 | 37.5% |
| Sex by ethnicity - female, White ethnic groups | 17 | 5 | 29.4% |
| Sex by ethnicity - male, White ethnic groups | 23 | 4 | 17.4% |
| Sex by ethnicity - female, other ethnic groups | 7 | 5 | 71.4% |
| Sex by ethnicity - male, other ethnic groups | 17 | 5 | 29.4% |
Note: of 65 total applications, 20 N0 awards were granted. Categories where no applications were received have been intentionally omitted, as have some categories where the number of applications received means publishing would breach data protection principles.
Appeals
A total of 49 requests to appeal were received in the 2025 awards round. The requests covered a range of claimed grounds for appeal, including:
- alleged discrimination because of a protected characteristic
- assessors not properly appreciating the impact of an applicant’s work
- potential conflicts of interest regarding sub-committee members
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, it was concluded that none of the cases were 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
- advises on the development of the NCIA scheme
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 NCEAs, this can include prorating of the award payment, and for both NCEAs and NCIAs, changes can affect the duration of an award.
Chair of ACCIA - 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. Vinay was Medical Director for Janssen UK until September 2023. 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 and 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, and the leadership of training for scorers, employers and applicants.
Kevin’s second term ends in June 2026, however an extension has been agreed by ministers to allow an appropriate handover period with the new medical director.
ACCIA secretariat
The chair and medical director are supported by a secretariat of civil servants employed by DHSC. The secretariat is comprised of 4 full-time staff.
ACCIA can be contacted:
- for England by emailing accia@dhsc.gov.uk or calling 020 7972 4608
- for Wales by emailing accia@wales.nhs.uk
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
- 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 is available on the ACCIA website.
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 2025 awards round, new assessors were recruited but many were not able to score in their home regions, or at all, due to conflicts of interest caused by their re-application. Due to the high number of applications received, those assessors who did score had high workloads, with many volunteering to score additional applications where appropriate. As ever, the success of the round depends on the commitment and effort of these volunteers.
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 feel 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. To achieve this, regional sub-committees underwent a re-balancing exercise with the aim of ensuring that the 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.
Table 19 shows the composition of the re-balanced sub-committees. While there is greater variation than there has been in previous award rounds, the situation with a high number of assessors applying and an unusually high workload made it necessary to move more assessors between regions. The figures in the table include any instances where individuals scored in more than one region.
Table 19: re-balanced 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 | 18% | 82% | 64% | 36% |
| Cheshire and Mersey | 30% | 70% | 50% | 50% |
| East of England | 44% | 56% | 61% | 39% |
| East Midlands | 50% | 50% | 75% | 25% |
| London North East | 28% | 72% | 59% | 41% |
| London North West | 39% | 61% | 72% | 28% |
| London South | 31% | 59% | 70% | 30% |
| North East | 28% | 72% | 50% | 50% |
| North West | 29% | 71% | 67% | 33% |
| South | 23% | 77% | 65% | 35% |
| South East | 44% | 56% | 61% | 39% |
| South West | 55% | 45% | 55% | 45% |
| West Midlands | 44% | 56% | 44% | 56% |
| Yorkshire and the Humber | 50% | 50% | 60% | 40% |
As the Welsh committee and the Welsh scheme operates separately, no re-balancing 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 and main committee, were held virtually, a total of £133.80 of expenses were claimed by the chair and medical director in 2025 to 2026.
Lay regional sub-committee members and chairs can also claim expenses for travel, meeting attendance and other costs such as scoring and appeal reviews. The total figure for the 2025 awards round was £76,641.91.
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 within the department and for awards paid to consultants working within any of DHSC’s arm’s length bodies.
Most awards in England are funded through 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 NCIAs.
Total value of awards in payment
The total cost of awards in payment in England for the 2025 to 2026 financial year was £105 million, and for the 2025 awards onwards, all new awards will commence on 1 April in the year following application. This means that all costs for awards granted in 2025 will fall in the following financial year.
This total cost includes on-cost calculations, such as National Insurance and pension contributions, for NCEAs and NCIAs granted in previous award rounds that are now in transition arrangements.
IT
ACCIA continues to work with SmartSimple and Re-Solved. The contract for the online application and assessment platform provided by SmartSimple has been extended to allow time to procure a replacement contract without impacting the awards round.
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.