Guidance

Employers' guide: 2023 awards round

Updated 11 May 2023

Applies to England and Wales

About this guide

This guide is to aid employers in signing off applications from NHS consultant doctors, dentists and academic GPs for new national Clinical Impact Awards, previously the national Clinical Excellence Awards (NCEA).

It covers the 2023 national Clinical Impact Awards (NCIA) competition in England and Wales and tells you:

• how the award scheme works
• how the new application and assessment processes work
• your role in the process as an employer

Read this guide before providing employer sign-off and use the information within it as a reference guide when supporting an application. Part 1 and part 2 provide an overview of the scheme and its principles and processes, while part 3, part 4 and part 5 explain how things work in more detail and the role you play as an employer.

We’ve created a useful quick guide to the scheme (primarily designed for applicants) that summarises how the scheme works - see all guides on the application guidance page.

If you’re based in Wales, you’ll find anything extra you need to know in the boxes throughout this guide.

Go to the application portal to ensure you can log in to support applications from your employees.

For any assistance, you can contact the Advisory Committee on Clinical Impact Awards (ACCIA) Secretariat at accia@dhsc.gov.uk.

Applicants must have submitted their application by 5pm on 5 May 2023. As an employer you must have confirmed your sign-off for an application by this deadline, or applicants will be unable to submit them. Any applications received after this time will not be considered.

Part 1: introduction

About ACCIA and the Clinical Impact Awards scheme

The Advisory Committee on Clinical Impact Awards (ACCIA) runs the national Clinical Impact Awards scheme for the Department of Health and Social Care (DHSC) in England.

ACCIA provides governance for the awards for the Welsh Government in Wales.

Health ministers agree a limited number (up to 600) of new awards each year in England, so the selection process is very competitive. Three levels of award are available in England, from lowest to highest:

• National 1 (N1)
• National 2 (N2)
• National 3 (N3)

In Wales a lower level (National 0) also exists.

The awards last for 5 years and have an annual, non-pensionable value of £10,000 (N0), £20,000 (N1), £30,000 (N2), £40,000 (N3).

Consultants can apply for a new award at any time after they have completed a full year in an eligible role. If they already hold a clinical excellence award granted under the old scheme, transitional arrangements apply in England between the old and the new schemes.

To be considered, applications need to show what has been delivered that has had an impact at a national level, over and above the expectations defined in an applicant’s job plan.

There are 5 domains for applicants to tell us about their contributions and provide supporting evidence:

1. Developing and delivering a high-quality service
2. Improving the NHS through leadership
3. Education, training and people development
4. Innovation and research
5. Additional impact, in which applicants can provide other evidence, particularly if it relates to published NHS or other relevant health objectives

In all of the domains, applicants should consider providing evidence of national impact relating to equality, diversity and inclusion.

There is a single online application form for all awards, so every applicant can highlight their contributions in the same way.

Based on the strength of applications, our regional sub-committees and our main committee will recommend applicants for national awards to health ministers, for them to approve. The level of award recommended depends on the scores given by our committees after careful review of the evidence in each application. The relative ranking of all applicants determines who gains which award level, based on the number of awards available at each award level.

Impact of transitional arrangements

Transitional arrangements only apply to applicants in England whose NCEAs are expiring after 2023. In Wales there are no transitional arrangements, however award holders may still be eligible for pension protection and should contact their employer in the first instance for further information.

Schedule 30 of the consultant contract in England provides transitional pay protection for existing NCEA holders. This protection is costly, peaking at over £30 million in 2025 to 2026, and this has an impact on the funding available for new awards in the transitional period.

Applicants should review the details of the transitional arrangements carefully and discuss their personal circumstances with their employers if they have any questions. Any questions relating to awards that employers cannot answer can be put to ACCIA.

The cost of pay protection means we have had to alter some elements of the scheme for the transitional period, with any adjustments made each year if possible. For example, although NCIAs will ultimately be able to be held concurrently with local awards, this is not yet affordable. Also, the numbers of NCIAs granted at each level may vary during the transition period. All these arrangements will be reviewed on an ongoing basis.

More details on the transitional arrangements are in the annex. NCEA holders and their employers should read these carefully.

What the national scheme rewards

The national scheme rewards consultants or academic GPs who deliver national impact above the expectations of their job role or other paid work. They specifically recognise the dissemination and implementation of that work and its impact on the wider NHS and public health. Applicants do not need to hold any local award or a previous NCEA to be eligible to for a national impact award.

To apply, applicants need to give evidence of impact across the 5 domains described above. Only the evidence in these domains is scored - the other parts of an application are not scored but provide context for the assessment of the evidence within the domains. These domains are described fully in part 5 of this guide.

Work in other countries is not directly relevant for an award, so is not considered on its own, but if applicants can show that their overseas work has helped the NHS and the health of the public directly or has had a direct reputational benefit for the NHS overseas, it may be supported. We do not give awards for standalone overseas work. See ‘domain 5’ below for more details.

How we assess applications

We run the scheme fairly and openly offering every applicant an equal opportunity, and we consider all applications on merit. We include our analysis of each year’s competition in our annual report.  

We assess all applications against the same criteria which you can find below in part 4 of this guide. 

Our sub-committees are regional groups that assess applications for national awards for most applicants in their area. Based on application workload, and to provide balance and a degree of external scrutiny across these committees, we reallocate some sub-committee members to score in other regions.

There are 13 regional ACCIA sub-committees in England:

• 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 Humber

There are separate sub-committees for:

• DHSC and arm’s length bodies (ALBs)
• assessing the highest-scoring regional applicants for N3 awards
• assessing applications for which the initial scores are tied at cut-off points or where governance queries arise - the National Reserve (NRES) committee

Wales has its own sub-committees.

The sub-committees consider all applications in their area except for those from public health consultants and academic GPs contracted by Public Health England and NHS England. These are assessed by the DHSC or arm’s length body (ALB) sub-committee where they can be benchmarked more easily. Each regional sub-committee is allocated an indicative number of awards at each level. This is based on the number of national awards available proportionately distributed based on the number of applications received that year in each region. This means there is an equal chance of achieving an NCIA in all regions.

Sub-committee members come from a range of backgrounds with experience and expertise in many different areas. They assess and score applications independently. All the individual scores for an application are averaged and then ranked against the other applications in that region. The top scoring applications in each region are provisionally allocated an NCIA. To ensure the highest-level awards are granted to those making the greatest national impact, a separate N3 sub-committee will rescore all those from each region falling within the N3 indicative allocation, plus the same number of applicants scoring highest in the N2 allocation. This rescoring provides a national benchmarking for determining who receives an N3 award.  

Each sub-committee is typically made up of: 

• 50% medical and dental professionals
• 25% non-medical professionals and lay members
• 25% employers

Sub-committees may be divided into scoring groups to manage the workload. We ensure there is broadly equivalent diversity of scorers across these groups, to minimise any unconscious bias affecting the scoring.

Each group scores applications consistently against the guidance. We expect there to be up to 600 new NCIAs available each year in England, subject to ministerial agreement and funding impacts during the transitional period. Our ambition is to award 330 x N1, 200 x N2 and 70 x N3 awards each year at a value of £20,000, £30,000, and £40,000 respectively.

If an applicant successfully gains an award, it will last 5 years, backdated to 1 April 2023. For NCEA holders under transitional arrangements, awards will last 5 years from 1 April 2024.

In Wales, the process for assessing applicants is different. For more details contact Chantelle Herbert at the Wales Secretariat at hssworkforceod@gov.wales.

After regional sub-committee scoring has closed and the ranked list has been produced, our chair and medical director review all the provisionally successful N1 and N2 applications that are not being considered for an N3 award. After their review, applications where questions arise, or clarification may be helpful are discussed at the regional sub-committee meetings as part of our quality and governance review. Applications where questions have not been resolved are referred to NRES.

Applications that are tied at the cut-off point for N1 or between N1 and N2 awards are automatically referred for rescoring by NRES.

NRES is made up of the chairs and medical vice-chairs of the regional sub-committees plus other experienced scorers. As a committee of our most experienced scorers, NRES acts as a quality assurance mechanism.

Our chair and medical director recommend applications for awards to our main committee based on the sub-committee and NRES scores.

Following scrutiny from our main committee, English recommendations go to DHSC ministers.

Recommendations from the Wales sub-committee go to Welsh ministers for final approval, after scrutiny from the main committee.

If an award is approved, we will let the applicant and their employer know. Unsuccessful applicants will be informed at the same time.  

Local awards and commitment awards

ACCIA does not have any say in local awards in England or commitment awards in Wales. For more information about these awards, please contact your employer.

Running an open, transparent scheme

More information about ACCIA and the NCIA scheme can be found on the ACCIA home page, with further guidance to be available shortly, including:

• a list of all national award holders
• personal statements from people who have received a new award
• the members of our main committee and our sub-committees
• a guide for applicants - with a supporting ‘quick guide’
• a guide for assessors on how to assess and score applications
• annual reports about each awards round 
• summaries of the minutes for the main committee’s meetings 

Disability

In line with the Equality Act 2010, employers must consider making reasonable adjustments for employees with disabilities. These are changes to things such as equipment or processes to make sure people with disabilities can do their job.  

If an applicant has a disability, where relevant, any reasonable adjustments they have agreed with you should be explained in the job plan section of the application form. You may add explanations about any disabilities or other relevant aspects in your comments.

We treat all applications equally and use the same scoring criteria for everyone.  

Extenuating circumstances

If there are extenuating circumstances that an applicant feels may affect their ability to submit a successful application, we would like them to let us know as soon as possible before the application closing date, so we can provide support and make sure the application is considered fairly. We cannot take any extenuating circumstances into account after the application has been submitted and it has been scored. 

Each case is treated on its own merits, and the outcomes from each case are based on the rules relating to the current scheme. If a consultant applies for an award and believes there are extenuating circumstances, these can be described in the job plan, personal statement and/or the relevant domains of the application form. 

Applicants are strongly encouraged to be precise about the timing of any such changes in working pattern, and to provide dates for the achievements that they are presenting for assessment. For example, an applicant may describe periods of absence due to maternity leave or ill-health during the relevant 5-year period. 

We understand that it can be difficult for applicants to share personal information. As employers we expect you to support your employees so that they feel comfortable sharing this information in the knowledge that it will be treated with respect and in confidence. Extenuating circumstances should not put off a consultant applying, but it is important that we know about them in a timely fashion so the sub-committee can take them into account in the scoring process as required. If you are aware of any extenuating circumstances that you want to comment upon, please use the employer section of the form for this.

Transitional arrangements for people with existing national Clinical Excellence Awards

With the introduction of a new NCIA scheme from 2022, existing national CEA holders are subject to prior CEA rules for their awards and tenure. There is a transitional period based on previously agreed schedule 30 arrangements for CEA holders applying for a first new award.

Rules that apply to existing national CEA holders:

• if an application is made for a first new award before an existing national CEA would have been due for renewal under the old scheme and are unsuccessful, the individual keeps their existing CEA until its expiry - they may apply for an NCIA again up to the year before the CEA’s expiry

• if a CEA would have been due for renewal and the application is unsuccessful, the reversion arrangements to receive a legacy, pensionable local CEA will continue to apply. The level of the local award depends on the score obtained in the new NCIA application

• if a consultant applies in the year their national CEA expires, this CEA will lapse before the annual NCIA award round is completed and the applicant will not be eligible for the transitional arrangements

• if an applicant applies in the year their NCEA would have been due for renewal and they successfully gain a new NCIA, their new award will start when their NCEA expires - the value of legacy CEAs and its pensionable benefits are protected for the duration of their first new award at an equivalent level

• if an applicant applies at any other time before their NCEA expires and they successfully gain a new NCIA, the new award will start on 1 April following their application

• if an NCIA is gained at an equivalent or higher level to their national CEA, the payment received will be no less than the value of their existing national CEA

• if an NCIA is gained at a lower equivalent level, the applicant will receive no less than the legacy national CEA payment at that level - there will be an obligation in this case to accept the new NCIA and give up any unexpired NCEA; local awards cannot be held simultaneously with NCIA awards that benefit from schedule 30 protection

The equivalent levels are:

• N1 NCIA - equivalent to silver CEA
• N2 NCIA - equivalent to gold CEA
• N3 NCIA - equivalent to platinum CEA

Any CEA award holders who enter the transitional arrangements will not currently be eligible for local CEA payments. 

Initially, due to the cost of the transitional arrangements, NCIA holders are not eligible for local awards in England at the same time whether or not they held a prior national CEA. This will be reviewed during and after the transition period to see when national and local awards can be held concurrently. You can read more information about this in the consultation response.

Part 2: eligibility for NCIAs

Who can apply for an award

To apply for an NCIA, a doctor or dentist needs to be a fully registered medical or dental practitioner on the General Dental Council (GDC) special list, General Medical Council (GMC) specialist list or GP register.

The applicant must be:

• fully registered with a licence to practise

• a permanent NHS consultant or academic GP in a permanent clinical academic role in higher education at the same level as a senior lecturer or above

Applicants must have met both of these conditions for at least one year, on 1 April in the award year in which they are applying.

This year does not include time spent as a locum, but applicants can give evidence from their achievements as a locum in the same role.

For consultants in a locum role for more than one year, we may consider them eligible for an NCIA if you as their employer confirm that they are employed on terms consistent with a permanent consultant contract.

In all cases, an applicant must be on an NHS consultant contract expressed in programmed activities (PAs), or on an academic contract expressed in an equivalent pay scale.  

Consultants working in Wales must be on an NHS consultant contract expressed in sessions, or on an academic contract expressed in an equivalent pay scale.

If you are unsure about an applicant’s eligibility, please contact us at accia@dhsc.gov.uk.

Qualifying criteria

A consultant will qualify if they are:

• employed by an NHS organisation (in England or Wales), DHSC or its arm’s length bodies, a university, medical or dental school, or local authority. Applications from employees of other organisations may be eligible, including those on consultant contracts providing contracted out NHS services. Those individuals are encouraged to contact us at accia@dhsc.gov.uk before applying if any clarification is required

In Wales, an applicant will also qualify if they are employed by similar Welsh government-associated organisations.

• an academic GP if their responsibilities are the same as consultant clinical academic staff and they are fully registered with a licence to practise. An academic GP can apply for an award if they: 

  • work at least half their hours as an academic GP
  • are a practising clinician providing some direct NHS services
  • do at least 5 PAs or equivalent sessions that help the NHS - including teaching and clinical research

• a consultant or a dental practitioner with an honorary NHS contract who is fully registered with a licence to practise. Whether they qualify for an award does not only depend on their contribution to the NHS in the provision of direct patient care. A full-time academic consultant will also qualify for an award if they carry out at least 5 programmed clinical activities or equivalent sessions that help the NHS. This includes teaching, training and clinical research. An applicant who works less than full time and does fewer than 3 programmed clinically relevant activities (PAs) is not eligible to apply for an award

• a fully registered public health consultant on the GMC specialist register or on the GDC specialist list with a licence to practise

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

• a consultant or academic GP later employed as a dean or head of school in medicine or dentistry, fully registered with the GMC or GDC with a licence to practise. They can apply for an award based on their work in this post

• a consultant fully registered with the GMC or GDC with a licence to practise working as an NHS organisation clinical or medical director, or a similar level medical manager post. We would anticipate consultants working in this capacity clarifying their eligibility with ACCIA prior to application - with particular reference to their contractual contribution over-and-above the expected duties in the role, as well as their contractual status. If the majority of the work is in a management role, an applicant can still qualify if they have an active consultant contract with a specific clinical or clinical leadership role, and maintains their licence to practise. If a consultant moves into general management and/or has a management contract outside the consultant pay scale, they are not eligible to apply for an award

As an NHS consultant, it does not make a difference if they have agreed to the national terms and conditions of service, or other terms with an individual organisation.

The Ministry of Defence runs its own award scheme, but we also recognise eligible NHS employee contributions over-and-above the expected standards to military medical and dental services. 

If a consultant works LTFT, they can apply for an award if they undertake a minimum of 3 clinically relevant contractual PAs. If an applicant is eligible based on this minimum PA requirement and is successful, we will pay the full award. However, if a consultant is working LTFT and in a transition provision from a national CEA based on schedule 30 legacy award values, they will receive a pro-rated award.   

Our chair and medical director determine ‘clinically relevant’ eligibility by considering clinical care, teaching, training and clinical research PAs in job plans.

Retirement and pensions arrangements

If an applicant retires and ceases any work for the NHS in a substantive or honorary consultant role they are no longer eligible for an award. Their award will be paid up until the last day of employment.

If an applicant retires during an awards round before we announce the results, we will take this to mean that they have withdrawn their application unless they are returning to work without any employment gap and maintaining the same job plan.

If an NCEA would have been due to renew in 2023 and the holder expects to retire up to 6 months after their award is due to expire in March 2023, because of changes in pension legislation from 1 April 2023 we will no longer consider extending their award. We will need to confirm if their award will be valid until they retire. If retirement plans change, applicants should let us know as soon as possible, as we may need to review or withdraw their award.

NCEAs are consolidated with pensions, which means it is taken into account when pensions are calculated. Because of changes in pension legislation from 1 April 2023, these awards no longer automatically stop if holders retire or claim their pensions after that point. If an award holder takes all or part of their pension (from the NHS Pension Scheme, Universities Superannuation Scheme or transferred-out benefits), they may still qualify for their existing NCEA or transitional-arrangement-protected NCIA if they remain otherwise eligible. We will review any new job plan and may shorten the period before an NCEA expires. If an award holder has an employment gap and does not immediately recommence a new eligible contract their award will cease. If they then subsequently return to work on a permanent NHS consultant contract, retaining or regaining full registration with a licence to practise, they can apply for a new NCIA based on work delivered after they retired.

NCIAs are not consolidated with pensions. If a holder retires with an NCIA, their award will end as they are no longer eligible. If an award holder retires in receipt of an NCIA that is not subject to any transitional NCEA arrangements and they return to work without a gap between their employment and their new contract, we may shorten the period before their NCIA expires. We will aim to allow them at least a year in any new role to retain their NCIA, but it will not be extended if it was due to expire within a year of returning to work. If there is a gap between retirement and returning employment contracts, any award will cease, and individuals will need to apply for a new award based on work delivered after they returned.

If an individual holds an NCIA and expects to retire up to 6 months after their award is due to expire, we will not extend their existing award.

Flexible retirement or partial drawdown of pension benefits

As of 1 April 2023, if a consultant begins receiving pension benefits up to 100% of their allowance, but continues in eligible employment, their award will continue until its scheduled expiry date, provided they continue to meet the standard eligibility criteria. They must inform us of any changes to their contract agreed as part of any such arrangement, and as per other job plan changes there may be an impact on the duration of their award.

Holders of NCEAs, or NCIA holders subject to transition arrangements, who reduce their contracted PAs with their employer will have their award paid pro-rata in the same way as any award holder working less than full-time.

For example:

• if a consultant drawsdown pension benefits and makes a small reduction in their contracted PAs, we may pro-rate their award accordingly
• if they drawdown pension benefits and make a significant reduction in their contracted PAs and job plan, we may shorten the duration of their award and ask them to re-apply early
• if they drawdown pension benefits and make a significant reduction in their contracted PAs which takes them below the minimum eligibility requirements, we will cease their award

If an agreement is reached on a combination of pensionable and non-pensionable PAs, the total number of PAs determines their eligibility for an award.

Reasons that individuals may not be eligible for an award

A consultant is not eligible to apply for an award if they are: 

• not on the consultant pay scale as expressed in PA or an equivalent
• a locum consultant - though if an applicant then becomes a permanent consultant, they can potentially use evidence from the locum role in their application if it is relevant 
• a consultant who primarily works in general management, such as a chief executive, general manager, chief operating officer, or a senior university office-holder without a specific clinical role 
• not fully registered with a licence to practise

Investigations into a consultant’s work and disciplinary or legal action against an individual can affect their award or application. This includes interim, temporary or final court orders or penalties relating to professional or personal conduct that may reflect badly on their judgement, or the expected standards of the profession.

Consultants must let us know about any investigations or sanctions by an employer or professional regulator (GMC or GDC) and their progression, interim and final decisions and any sanctions. We will look at each case individually, but we may remove an award if there are adverse outcomes following investigations or disciplinary measures, or if we believe a doctor has failed to notify us appropriately or in a timely manner. If this happens, any over payments will need to be repaid. If you as an employer become aware of such matters, you are also expected to notify ACCIA. 

We also ask about an organisation’s latest inspection outcome. If your organisation is in special measures, we expect a consultant to comment on any relevance of this to their role. We will also ask you to check that you are happy with any response when you sign off the application. If a consultant is on the board of an organisation in special measures and is recommended for an award, we will inform our main committee.

Part 3: the application process

Filling in the application

A consultant must fill in their own application form - nobody else can do it for them. 

Applications can only be made online at the ACCIA application portal. Detailed advice on how to make an application is available in the applicants’ guide on the application guidance page.

On application, a consultant must first select the NHS or arm’s length body that holds their substantive or honorary contract and their specialty, so that the right sub-committee considers the application. The employer is selectable via a ‘Pull-down’ menu in the new online application form. If an individual is employed by more than one body, they are asked to state all of their employers and roles - being clear which is the main employer based on who pays their salary.

Supporting applications

We cannot accept applications without your sign-off. In order to sign off your employees’ applications, you need to complete the shortened ‘part 2’ of the application form. Joint sign-off from all employers is required if an applicant holds a contract with more than one.

If you are signing off an application for a consultant who also works for a university (clinical academic) as the chief executive of the NHS organisation where they hold an honorary contract, or their nominated deputy, you should complete this section. It is ACCIA’s expectation that both the relevant NHS organisation and the university or medical school will be involved in the approval process and the preparation of any supporting citation, and that an up-to-date job plan has been agreed by both parties.

Many membership and specialty organisations can provide assistance and general guidance with applications using tools made available to them by ACCIA. Organisations must not proofread, review or directly critique any part of an application. Applicants can indicate on their form if they have sought advice from any such organisations.

From 2023 the process of some applicants receiving citations and rankings from these organisations (previously known as National Nominating Organisations) has been discontinued. This is because the favouring of some applicants by allowing the inclusion of additional information, does not align with ACCIA’s equality objectives.

Timetable for 2023 national awards

Consultants must submit their online national Clinical Impact Award application to us by 5pm on 5 May 2023. They will not be able to apply after this, regardless of the reason that they missed the deadline.

The indicative timetable for the 2023 national awards round is below. This may change based on the impact of the COVID-19 pandemic and other operational factors. We will review it regularly:

• 10 March to 5 May 2023 - applications open
• 9 May to 29 June 2023 - first round scoring
• 3 July to 4 September 2023 - N3 scoring
• 3 July to 6 November 2023 - governance review
• 5 September to 6 November 2023 - NRES scoring
• end November 2023 - main committee finalisation of recommendations
• December 2023 - recommendations to and sign-off by ministers
• mid-January 2024 - notifications sent to successful applicants and finance processes initiated to back pay awards
• mid-January to mid-February 2024 - appeals window

General advice for supporting applicants

As an employer you should advise applicants to start their application early enough for your sign-off. They should be encouraged to make you aware they are intending to apply as early as possible to avoid instances where the employer section is not completed in time.

When a consultant fills in their application form, they are advised to follow the steps indicated in the applicants’ guide. Knowing what advice has been provided to applicants should help you support your employees in knowing what makes a good application and where problems and inconsistencies may arise.

We make it clear that if there are special circumstances that could affect an application such as ill health, we are keen to know as soon as possible before the deadline as we may consider extending an award. You should support employees in feeling comfortable to provide further information on any extenuating circumstances, and if appropriate with their agreement, you may provide additional relevant information.

Part 4: the assessment process

We have moved to a non-stratified system of scoring with no renewals. As explained above, an online application form will be submitted for competitive scoring in the first instance to one of the 13 regional sub-committees or to the ALB committee, with separate arrangements in place for applicants in Wales and for the armed services. 

The number of awards potentially available for each region is calculated based on the total number of awards available in any year at each level, allocated proportionately in line with the number of applications. This ensures that applicants have an equal chance of success in each region.

More details can be found in part 5 of the applicants’ guide on the application guidance page.

Regional sub-committees

A regional sub-committee (RSC) has a lay chair, medical vice-chair (MVC) and typically between 15 and 30 members. These roles are voluntary and regularly refreshed. Applications are vetted and approved by the ACCIA chair and medical director. A number of new chairs and MVCs have been appointed in 2023.

Further information on the responsibilities and structure of RSCs can be found in the assessors’ guide which will be available shortly.

Scoring

Clinical impact is about providing high quality services to patients that go beyond the applicant’s immediate remit that improves clinical outcomes for as many patients as possible, use resources efficiently and make national services more productive.  

Applicants need to show assessors evidence of how they made these services more efficient and productive, and improved quality at the same time, as well as demonstrating their role as an enabler and leader of:

• health provision
• prevention and policy development
• implementation

Assessors need to be sure all achievements are relevant and need to know when they occurred, or if these activities are continuing or stopped. It is essential that the dates of achievements are clear, as without dates they cannot be scored highly - when discussing any applications with your employees we would advise emphasising this point.

Applicants do not need to show they have achieved over-and-above expected standards in all 5 domains - a lot will depend on the type and nature of their post and job role. Excellent local or regional contributions can score well if they have been disseminated and had an impact on the wider NHS. This is especially true when there are direct national and international impacts  

Our assessors score the domain sections according to the following:

• 10 = an application is excellent with clear and sustained national and or international impact
• 6 = the work is over-and-above contract terms and has at least a regional impact beyond the local area
• 2 = the applicant has met the terms of their contract or may have contributed more, mainly within their locality
• 0 = the applicant has not met the terms of their contract or there is not enough information to make a judgement

Summary of domains

Domain 1: delivering and developing a high-quality service 

In this section, give evidence of what has been achieved in relation to:  

• providing and developing a safe service with measurable, effective clinical outcomes, based on delivery of high technical and clinical standards of service that provide a good experience for patients, and how these have been cascaded more widely to colleagues who have implemented improvements based on the experience
• consistently looking for, and introducing, ways to improve their service; sharing the learning and seeing it embedded in wider NHS or national or international practice

Applicants should explain which activities relate to their clinical services where they are paid by the NHS, and to other aspects of their work as a consultant.

Applicants should include quantified measures - like outcome data - where they can. These need to reflect the whole service they and their multi-professional team provide and how they have collectively disseminated their experience. Applicants should use validated indicators for quality improvement or quality standards, and other reference data sources in England, or the Health and Care Standards for Wales, ideally providing performance data against benchmark or national indicators for their specialty, showing local and wider improvements as a result of their work.

For good patient experience, applicants should show how they ensured patients are cared for with compassion, integrity, and dignity, and how they have demonstrated commitment to their safety and wellbeing and have disseminated approaches more widely.

Further information on evidence that applicants could provide for this domain and some examples can be found in the applicants’ guide.

Domain 2: leadership

In this section, assessors will look for a significant personal contribution to leading and developing a service, health policy or guidelines with national or international impact. Consider work that had delivered against objectives within the ‘NHS Long Term Plan’. 

Applicants should describe the impact and outcomes generated in the specific roles they list. They should also include evidence of contribution, the source of any data and relevant dates, including evidence of personal leadership in the impact of change management and service innovations. National impact through committee membership should reflect the personal contribution and the impact of any output. Membership of committees alone is not sufficient evidence.

Further information on evidence that applicants could provide for this domain and some examples can be found in the applicants’ guide.

Domain 3: education, training, and people development 

In this section, evidence can show contributions to wider education and training across the professions and to patients. If any training or lecturing is externally or separately remunerated, this should be stated. 

We do not expect examples for all categories - the list set out below is not exhaustive and further detail can be found in the applicants’ guide. Give evidence of the impact of work that supports the ‘NHS People Plan’ or falls into any of the following categories:

• teaching 
• leadership and innovation in training
• educating and informing patients and public
• college or university success in teaching audits
• personal commitment to developing teaching skills
• unexpected or non-mainstream contributions

Further information on evidence that applicants could provide for this domain and some examples can be found in the applicants’ guide.

Domain 4: innovation and research  

This section is intended to look at innovation and its impact in any relevant setting, and could include more evidence than activities traditionally considered as research. It can include new care pathways that have been developed and implemented, improved ways of working and process efficiencies that have been adopted widely, and have demonstrably made more cost-effective use of NHS resources. It can also include benefits of digital technology or other activities from projects with external partners that have demonstrated a benefit to the wider NHS, or that support the GMC’s objectives of promoting research for doctors. 

Applicants must be clear what evidence is over-and-above any research, academic or other expectations of their role and give evidence of the wider impact of the research and/or innovation. This includes developing the evidence base for measuring how quality has improved. 

In the section on references, achievements such as published peer reviewed papers should be detailed - not the names of referees. The majority of any publications listed should be from the last 5 years. Evidence should include the relevance of these publications and wider impact they have had. Providing the number of citations each paper has had or its academic score is not sufficient without further explanation of its impact. 

On a separate line, applicants should explain what they have achieved to date and how their innovation or research has quantifiably improved health outcomes. They must give supporting evidence.

They should be clear how their research is relevant to the health of patients and the public. 

Domain 5: additional national impact 

This domain gives applicants an opportunity to provide evidence of wider beneficial impacts that have not been captured elsewhere on their form in domains 1 to 4. They can also demonstrate the wider effect their work has had in areas that are national clinical priorities. In some cases, this may relate to work within their job plan, but as is the case in other domains, applicants should endeavour to demonstrate impact ‘over and above’ the expectations of outcomes for which they are already paid. There is added value if appropriate metrics can be included and, as usual, accurate dating is critical.

This domain can include work for charitable organisations, and work with a more direct patient or public focus, for example fostering patient involvement in research, or informing patient groups of new developments in disease management or prevention. Expanding on the national impact of research work or educational activities mentioned in (but not repeating) domain 4 or domain 3 can score well. This is particularly true if it is clear how the impact of the work has been re-enforced through social media or other channels, and how it has demonstrably influenced the quality of healthcare delivery or preventative medicine. However, applicants must not merely repeat or list activities that have been described elsewhere on the form, as repeated evidence will not score any points. This domain could also describe work on how applicants have addressed health and workplace inequalities and delivered interprofessional team building and new ways of working.

Particularly important areas are NHS priority disease areas, or other areas where there is outstanding need, or identified health inequalities or disparities. Unpaid innovative work with health and social care providers outside the NHS may also be cited in this domain, but clear evidence of positive impact must be provided.

The detailed applicants’ and assessors’ guide will contain further information on the domains and examples of evidence that applicants could provide. We would suggest familiarising yourself with this guidance in order to fully support applicants from within your organisation in line with ACCIA expectations.

Part 5: your role as an employer

Encouraging applications

As an employer, you should be playing an active role in encouraging your eligible staff to apply for an award - ensuring that you have paid due consideration to the applications fairly representing the demographics of your eligible membership. Encouraging high performing consultants to make applications for NCIAs should be discussed at their annual appraisals. We will ask you to confirm you have procedures in place to ensure equality and diversity of your employees to access and be supported for national CIA applications.

The new ACCIA IT system will allow for better monitoring and reporting on the diversity of applicants for CIAs by organisation. We will be working closely with employers to report on the numbers of applicants and successful applications by organisation.

ACCIA, working with NHS Employers, have produced resources to assist employers in encouraging eligible consultants to enter applications, and address key concerns and queries. These resources will be available shortly.

Signing off applications

When an applicant begins their application, they must identify their NHS employer in order to inform ACCIA of the chief executive (or nominated deputy) that will be providing the essential sign-off of their application. Academic clinicians or others who have multiple employers should select their main NHS employer, but can add the names of other employers with whom they have employment contracts.

Once the applicant is content with the information they have included within their application, it will be submitted to you for sign-off. Employers are no longer required to rank or score applications. Instead, you will only need to fill the online form confirming whether you are supporting an application, and if not, why - providing your citation. Employer citations primarily serve to confirm that the applicant’s job plan has been agreed, and that they are meeting their contractual obligations as defined in that job plan. If you wish to return the application for revisions before signing off, you will need to provide an explanation first, this will help the applicant address the issues identified before they resubmit.

Your sign-off is required to validate the evidence presented in the 5 domains and confirm to ACCIA that all the information included is accurate. Without your sign-off, applicants are unable to submit their application, therefore it is important you conduct this process promptly and with sufficient time in advance of the deadline. If an applicant has more than one employer, each employer is expected to contribute or validate the assessment.

You should complete the sign-off for all applicants objectively and should not compare information that is provided with others that you are also supporting. Considering that an application has not demonstrated national impact sufficiently is not justification for refusing to support an application; the processes set out above determine what level of impact has been evidenced on an application.

You have a duty of candour and are obliged to inform ACCIA of any misleading information in the application form. You may wish to refer back to the information provided in part 4 of this guide. Further information is included in the applicant guide and the assessor guide (which will be available shortly) on the application guidance page to inform the sign-off process.

The default sign-off for employers is ‘support’. We would expect all applications to be supported unless there is good reason for not doing so, such as:

• fitness to practice
• poor performance
• unresolved complaints
• failure to agree an appropriate job plan
• inaccurate information within the form

Once you have selected your sign-off option, you must provide a citation with input from any other of the applicant’s employers. if you have decided not to support an application you must explain why here.

Once your sign-off has been completed, the form will return to the applicant. Only they can submit their application to be assessed. ACCIA will inform the applicant that you have reviewed their application and that they are now required to submit - you may also wish to do your own internal communications with employees to inform them.

Performance and disciplinary actions

You should tell us about any factors such as ongoing contractual or professional difficulties.

You must inform us on the application form of any ongoing or upheld investigations or disciplinary procedures against the applicant from the last 5 years. This would include any investigations by external bodies such as the GMC, GDC or National Clinical Advisory Service. It would also include any restrictions on practice, complaints against performance or conduct that the employer is formally investigating.

You should inform ACCIA immediately if an applicant becomes the subject of any such action whilst we are considering the application. We will note any active disciplinary process and await the outcome so that any appropriate action can then be taken in light of any rulings in consultation with you and the applicant as needed.

If your NHS organisation is in special measures, as determined by the Care Quality Commission, your consultants and academic GPs remain eligible to apply for awards. However, in deciding whether to support an application, you should pay particular attention to the contents of the ‘ratings and inspections’ section of their form. In the event that a scoring sub-committee recommends an individual with board-level responsibility, such as an eligible medical director in an organisation in special measures for an award, we will submit a paper to our main committee for decision.

If your organisation is in special measures under the NHS Wales Escalation and Intervention Arrangements, your consultants and academic GPs are eligible to apply for awards.

However, in deciding whether to support an application, you should pay particular attention to the contents of the ‘ratings and inspections’ section of their form.

Organisations who employ clinical academics should liaise with the appropriate universities to ensure that their views can be considered.

To be eligible for an award, consultants must have an annual appraisal. You will be asked to confirm whether the applicant has had a satisfactory appraisal during the previous 12 months. If an annual appraisal exercise has not taken place, you will need to confirm that the applicant has made reasonable efforts to have an appraisal or that it has been delayed due to the pandemic.

Although we do not need information about the appraisal itself, we expect employers to confirm that applicants:

• participated satisfactorily in the appraisal process
• have fully participated in job planning
• met contractual obligations and complied with the Private Practice Code of Conduct

An applicant may have met the required standard of job planning without necessarily having an agreed job plan in place, for example where mediation is taking place.

Employer sign-off must be completed online on the ACCIA application portal before the application window closes on 5 May 2023. You should follow the steps below to complete the process:

1. Access the ACCIA system. If you have not been involved in the process before, contact accia@dhsc.gov.uk. The main employer contact for the 2023 round should be the person responsible for signing off applications.

2. If you’re registered as an employer contact, you’ll receive an email stating that a consultant has identified you as their employer - you are required to sign off their application.

3. Once you’ve logged on, you’ll see the applications that require your validation - review each one objectively in turn. You’ll be required to verify the information within the application by completing the short form. In doing so you must confirm that the applicant is working to professional and personal conduct standards and has had a formal appraisal in the last 12 months agreed a job plan, fulfilled their contractual obligations, and complied with the Private Practice Code of Conduct.

4. You must also confirm if you are aware of any disciplinary or professional proceedings or investigations against the applicant, both inside or outside of your organisation, and if so, what they are.

5. You’ll need to confirm whether you ‘support’ the application or not. If not supported, you’ll be asked to explain why. You’ll also need to provide your citation. As set out in part 3 of this guide, if you’re signing off an application for a consultant who also works for a university (clinical academic), it is ACCIA’s expectation that both the relevant NHS organisation and university or medical school will be involved in the approval process - including the preparation of any supporting citation. You should ensure that the other employer is content before submitting your citation.

6. Once you are content with your sign-off, you should confirm this by submitting it. The applicant will then receive notification that you have validated their application and it is ready for formal submission.

Change in circumstances of current award holders

You must tell us if an award holder’s circumstances change.

Award holders and their employers must tell us if there are any changes to their employment, as it may affect their award, by filling in the change in employment circumstances form.

If they do not tell us when their circumstances change, it could affect whether they can keep their award or what they and your organisation are paid. Any payments made since the change in circumstances may be reclaimed.

Some of the main changes you need to tell us about are set out below - this is not the full list, and you should tell us if anything else significant changes. Award holders should let us know if:

• they stop practising in the field they got their award
• they change job or employer
• there is a significant change to their job plan - including fewer sessions

Award holders should tell us as soon as the change has been agreed locally. We will consider how it affects their award.

If an award holder does get a new job plan, they should send us a copy to consider and approve. If they do not tell us their job plan has changed, it could put their award at risk.

If they no longer meet the criteria in part 2 of the applicants’ guide, their payments will stop. If they go back to clinical work after a full-time general management role, we may consider reinstating their award after a review.

Unpaid leave

We do not pay any awards during unpaid leave. If an award holder takes unpaid leave for more than a year, our medical director will decide whether their award can be reinstated.

Maternity, parental and adoption leave

If an award holder takes maternity, parental or adoption leave, they will get their award payments during any period of paid leave from their employer.

Secondments

If an award holder is on full time secondment to a post with an employer that does not qualify under the NCIA scheme, we will suspend their award.

We would advise award holders to speak to their human resources (HR) department before they start their secondment to make arrangements for protecting their award and start collecting it again after their secondment has finished.

If they are on secondment for less than a year, they will resume receipt of their award once the secondment has ended.

We will use the same criteria as we do for people who retire and return to work. This is at the discretion of ACCIA and each case will be judged on its merits and any precedents.

Sabbaticals

If an award holder is planning a sabbatical, they should speak to their HR department and contact us to agree what happens with their award. To retain the award, they must prove their sabbatical will be of benefit to the NHS. If it is not, we will consider suspending their award until they return.

Prolonged absence from the NHS

If for any reason an award holder has been on a prolonged absence and not practised their specialty in the NHS for more than a year, we will review whether their award can be reinstated.

Leaving the NHS during an award round

To qualify for an award, an applicant must be employed as a consultant in the NHS on 1 April in the award year.

If they are made redundant or they retire during an award round before we announce the award results, we will withdraw their application.

Pensions and GMC or GDC investigations

Please tell us if an award holder in your organisation retires - including retire and return, or claims their pension

If award holders are in receipt of any pension payments, they may no longer qualify for an NCEA. This includes payments from the NHS Pension Scheme, University Superannuation Scheme or transferred-out benefits. See part 2 for full details.

They must also tell us the date they retire or claim their pension.

NCIAs are not consolidated with pensions. If an award holder retires with an NCIA, the award will end. If an award holder retires in receipt of an NCIA that is not subject to any transitional NCEA arrangements and returns to work without a gap between employment contracts, we may shorten the period before the NCIA expires. We aim to allow at least a year in a new role, but it will not be extended if it was due to expire within a year of you returning to work. If there’s a gap between retirement and returning employment contracts, the award will cease and the consultant will need to apply for a new award based on work delivered after their return. 

You must tell us if they start being investigated. As set out in part 2 of this guide, award holders and their employers must tell us as soon as they know of any investigations, disciplinary procedures or legal action against them.

You must keep us up to date about any developments and the outcomes of any investigations. We will decide if they will affect the application or award. We always use an innocent unless proven otherwise approach.

Part 6: appeals

Appeals for national awards

All appeals for NCIAs are handled by ACCIA.  

To appeal, applicants will be able to log into their account to begin the relevant processes.

They will be required to tell us why they believe the assessment process was unfair and provide supporting evidence.  

An appeal for a national award must be submitted within 4 weeks of when the appellant was informed of their award results. If our dates change, this will be updated in the portal.

Reasons an appeal can be requested

An appeal can be requested if the applicant believes we did not follow the right processes when we assessed their application. An appeal cannot be requested because an applicant disagrees with our judgement.

An appeal can be submitted if:

• the applicant believes the committee did not consider all the supporting information or documents sent with their application

• irrelevant information was taken into account

• the applicant believes they were discriminated against due to characteristics such as gender, 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

How we handle appeals

Our chair and medical director will look at the evidence and the processes that were followed to decide if an appeal is justified. They will then ask a panel of 2 sub-committee members - one medical and one non-medical - who were not involved in reviewing the application originally to review their proposed decision to ensure it is robust. If it is decided that there are no grounds for appeal, we will write to the appellant to confirm why.   

If there are grounds for appeal and we cannot resolve the problem informally, we will set up a formal appeal. 

A separate panel of people who did not assess the original application or the decision to progress the appeal will consider this. The panel will include:  

• a medical or dental professional

• an employer

• a non-professional member as chairperson

They will look at:  

• the appeal

• the documents that set out our agreed assessment process

• a written statement of what the committee did when they considered the application

Appellants can see all the documents the panel considers. They can also send more written statements about the appeal and what they believe happened. 

The panel does not usually hear oral evidence. However, an appellant can apply in writing to have an oral hearing. The panel chair will decide whether one would be suitable. 

The timeline for appeals

We try to resolve appeals in line with the process set out below - if there are delays, we will let appellants know.

If an appeal is successful

If an appeal is successful, our chair and medical director will consider the best way to put things right. Their decision will be consistent with other similar appeals.  

Even if an appeal against the process is successful, the appellant may not get a new award. If this happens, we will write to you to tell you why. 

The national appeals process

An outline of the process with indicative timelines is set out below:

When we get a request to appeal, we will contact the appellant within 5 working days to acknowledge its receipt.

Our chair and medical director will review the case and decide whether there are grounds for a formal appeal.

Within approximately 20 working days of the date we got in touch, our chair and medical director will let the appellant know if there will be a formal appeal.

If there is a formal appeal, we will set up a panel and agree a date for them to meet, usually within 20 working days.

When our chair and medical director hear what the panel has decided, they will let the appellant know the final decision, usually within 20 working days.

In all cases, the panel’s decision is final.

Annex: transition and reversion arrangements for NCEA holders

Transition arrangements for NCEA holders in England

Schedule 30 of the consultant contract sets out the transition arrangements for holders of NCEAs moving to any reformed national scheme. There are 2 key provisions set out in the schedule:

• a consultant who successfully receives an NCIA for an equivalent or higher level of performance but attracting a lower value of award than paid under the NCEA scheme will receive an additional payment so that they are paid no less overall than the cash value of their NCEA

• a consultant who receives an NCIA for a lower level of performance will receive an additional payment so that they are paid no less overall than the cash value of the equivalent lower award in the NCEA scheme

The NCIA scheme has 3 award levels, and for the purposes of managing transition arrangements their equivalent to the former award levels is as follows:

• National 1 (N1) - equivalent to silver

• National 2 (N2) - equivalent to gold

• National 3 (N3) - equivalent to platinum

This results in NCEA holders who hold a full award (that is, not pro rated) having the level of protected pensionable pay shown below, for up to the first 5-year period in the NCIA scheme.

NCEA held	NCIA granted	Total pay	Pensionable pay
Bronze	N1	£36,192	£36,192
Bronze	N2	£36,192	£36,192
Bronze	N3	£40,000	£36,192
Silver	N1	£47,582	£47,582
Silver	N2	£47,582	£47,582
Silver	N3	£47,582	£47,582
Gold	N1	£47,582	£47,582
Gold	N2	£59,477	£59,477
Gold	N3	£59,477	£59,477
Platinum	N1	£47,582	£47,582
Platinum	N2	£59,477	£59,477
Platinum	N3	£77,320	£77,320

In order to be eligible for transition arrangements, NCEA holders must successfully apply for an NCIA no later than the application round before their NCEA expires. For example, for an NCEA expiring in 2024 an application must be submitted in the 2023 award round. If no successful application is made, the NCEA will expire and any subsequent NCIA granted will not be eligible for transition arrangements. Should an NCEA holder apply earlier than the year before their current award expires, their NCIA and the 5-year transition period will commence on 1 April following the granting of their NCIA.

All payments, including any ‘top-up’ payments and employer pension contributions for those in transition, will be paid by NHS England through the same route as NCEAs and NCIAs. It remains the responsibility of employers to ensure the correct payments are made, and to advise ACCIA if there are any changes in circumstances of award holders, including if they join or leave a pension scheme.

Although NCIAs are paid at full value for award holders working less than full time, payments to award holders in transition arrangements will continue to be paid pro rata where appropriate as per the NCEA scheme rules. If an award holder in transition reduces their contract so that the pro rata transition payment is less than their NCIA, the NCIA value will be paid in full, but pension contributions will only be paid up to the pro rata value.

Schedule 30 does not apply to consultants in Wales, so there are no transition arrangements for NCEA holders in Wales.

Academic GPs in England are employed on different terms and conditions to consultant doctors and dentists. Schedule 30 does not apply so there are no transition arrangements for academic GPs.

Changes in circumstances of NCIA holders in transition arrangements

If an NCIA holder in transition arrangements changes their employer, makes a significant change to their job plan, begins to receive pension benefits, or makes any other change to their employment circumstances they should inform ACCIA in the usual way.

In these circumstances we may review awards earlier, and any second or subsequent NCIA granted will not be subject to transition arrangements. For full details on the rules concerning changes of employment, unpaid leave or secondments, maternity leave, and retirement see part 8 of the Applicants’ guide ‘If your circumstances change when you have an award’.

Reversion arrangements for NCEA holders in England

If an NCEA or NCIA holder applies in the award round before their current award expires, but their application is unsuccessful, the reversion arrangements set out in schedule 30 apply. These specify that in these circumstances the holder will be granted a pre-2018 Local Clinical Excellence Award (a legacy LCEA) according to the following conditions:

• re-application score equal to or greater than 27 - legacy LCEA level 8
• re-application score between 14 and 26.99 - legacy LCEA level 7
• re-application score equal to or less than 13.9 - no award

Any legacy LCEA will commence on 1 April, immediately after the expiry of the prior NCEA or NCIA. Where no legacy LCEA is granted, the NCEA will continue until its expiry date after which there will be no award payments.

If an NCEA holder fails to apply at the latest by the award round before their NCEA or NCIA expires, their award will continue until its expiry date after which there will be no award payments. Any subsequent NCIA will be granted as a new award and backdated appropriately.

Academic GPs in England are employed on different terms and conditions to consultant doctors and dentists, so there are no reversion arrangements for academic GPs.