The Division of Well being and Social Care (DHSC) and the Welsh Authorities are in search of views on reforms to the nationwide Medical Excellence Award (CEA) scheme with the goal of introducing a brand new scheme from April 2022.
This session proposes to broaden entry to the scheme, make the appliance course of fairer and extra inclusive, and to additionally change the present software course of.
Why Medical Excellence Awards are wanted
Advisor medical doctors and dentists and educational GPs are amongst probably the most highly-trained employees within the UK. Their abilities are worthwhile and sought-after each nationally and internationally by personal medical suppliers, educational establishments and the life sciences business, for instance. You will need to retain these specialists’ abilities and information and incentivise them to carry out over-and-above their contractual function; that is for the advantage of the NHS, its sufferers, healthcare employees in coaching, public well being and the influence on the broader UK ‘well being economic system’.
Nationwide CEAs (NCEAs) are an necessary mechanism for the NHS to retain these abilities, permitting the service to keep up its status as a world chief in healthcare supply, scientific analysis, and medical coaching, and enhance effectivity and effectiveness in all these domains. Examples of this have been seen within the extraordinary work and outcomes coming from the NHS through the COVID-19 pandemic.
On an area and nationwide foundation, clinicians reorganised and prioritised companies to diagnose, check, contact hint and deal with the sickest sufferers, whereas growing internationally recognised, evidence-based medication. Equally necessary have been the untiring efforts of clinicians to keep up different scientific companies, medical training and analysis within the face of the competing and speedy pressures related to COVID-19. The present NCEAs are time-limited reward funds obtainable by means of an annual competitors, to guide medical doctors, dentists and educational common practitioners (GPs).
To attain a CEA, candidates should show achievements over and above what they might usually be anticipated to ship within the following domains:
- delivering a high-quality service
- growing a high-quality service
- management and managing a high-quality service
- analysis and innovation
- educating and coaching
The scheme runs in each England and Wales.
The Advisory Committee on Medical Excellence Awards (ACCEA) is the unbiased advisory non-departmental public physique chargeable for the operation of the nationwide CEA scheme in England and Wales and advises DHSC Ministers and the Welsh Authorities (who advise Welsh Ministers) on the granting of awards.
In England, the Secretary of State for Well being and Social Care makes 300 new awards obtainable every year at bronze, silver, gold and platinum ranges (most at bronze, fewest at platinum). Within the 2019 competitors, 956 functions had been obtained from throughout England from the eligible population of around 52,000 for 300 new awards, giving a hit price of 31.4%.
Awards final for five years and may be renewed, topic to an software efficiently demonstrating that requirements are being maintained. At current there are a little bit below 2,200 award holders.
Nationwide CEAs are valued at:
- £36,192 a 12 months (bronze)
- £47,582 a 12 months (silver)
- £59,477 a 12 months (gold)
- £77,320 a 12 months (platinum)
Awards are paid pro-rata for these working lower than full-time (LTFT).
Candidates can progress upwards by means of the award ranges over time, topic to profitable software. Awards are at the moment pensionable, that means that the full worth of the award is greater than the headline figures above. In 2019 to 2020, spend throughout England and Wales nationwide CEAs, together with on-costs, was £131.5m.
In Wales, the Minister for Well being and Social Providers makes 15 to 18 awards obtainable every year, relying on the extent of the awards made. Within the 2019 competitors, 66 functions had been obtained from throughout Wales, from an eligible population of 2,600, giving a hit price of 23%.
There are at the moment just below 100 award holders in Wales and these are valued at:
- £36,924 a 12 months (bronze)
- £48,533 (silver)
- £60,666 (gold)
- £78,866 (platinum)
NCEAs function alongside native CEAs (LCEAs), though NCEAs and LCEAs is probably not held concurrently. LCEAs had been launched in 2004 and function at belief degree in England solely. These awards are contractual, non-consolidated and non-pensionable. Present preparations are in place till March 2022 and in time can be reformed by means of dialogue with commerce unions. Whereas Wales doesn’t have LCEAs, Dedication Awards could begin to be utilized 3 years after a guide reaches the highest of the pay scale, topic to passable efficiency.
The case for change
The present CEA scheme changed Distinction Awards in 2004 and whereas there have been incremental modifications since there have been no main reforms. On this time, the guide workforce, and the best way by which consultants work, has advanced. We need to make sure the nationwide CEA scheme is updated, affords good worth for cash and rewards the highest-performing consultants.
Reflecting a modified guide inhabitants
The guide inhabitants has grown significantly: from 31,000 consultants (by headcount) in England in 2004[footnote 1] to 52,000 in 2019[footnote 2]. The variety of CEAs obtainable every year has been held at 300 since 2009 (600 till 2009).
The gender composition has modified from 31% feminine consultants in 2010 to 38% in 2020[footnote 2]. There has additionally been a slight improve within the numbers of consultants working part-time from 19% in 2010 to 21% in 2019.
Range points are lined in additional element beneath.
Reflecting altering work patterns
Within the 17 years for the reason that nationwide CEA scheme was launched, eligible clinicians have moved jobs extra steadily and, in lots of circumstances, developed extra different, portfolio careers as job planning processes have continued to evolve and enhance.
A reformed scheme to modernise CEAs ought to take account of those new methods of working, together with improved recognition of those that are working LTFT, and recognise and reward excellence throughout a broader vary of scientific, educational and management contributions.
Desk 1: guide workforce development
|12 months||Full-time equal||Headcount|
Supply: NHS Digital Workforce Statistics
Feminine and black, Asian and minority ethnic candidates are under-represented in any respect award ranges; this impact will increase on the greater ranges.
Desk 2: nationwide CEA holder demographics as at 21 July 2020 for England and Wales
|Male||860 (76.58%)||585 (83.81%)||191 (83.541%)||79 (86.81%)||1751 (80.10%)|
|Feminine||263 (23.42%)||113 (16.19%)||38 (17%)||12 (13.19%)||426 (19.90%)|
|White||874 (77.83%)||576 (82.52%)||188 (82%)||71 (78.02%)||1709 (79.82%)|
|Black, Asian and minority ethnic||213 (18.97%)||112 (16.05%)||34 (15%)||15 (16.48%)||374 (17.47%)|
|Not acknowledged||36 (3.21%)||10 (1.43%)||7 (2%)||5 (5.49%)||58 (2.71%)|
Girls and black, Asian and minority ethnic consultants have been persistently under-represented as a proportion of candidates. Nevertheless, the place girls do apply, their success charges are actually corresponding to these of their male counterparts.
Desk 3: new award success charges by gender 2014 to 2019
For black, Asian and minority ethnic candidates, the image is extra blended.
Desk 4: award success charges by ethnicity 2014 to 2019
|Black, Asian and minority ethnic||13.90%||29.90%||26.10%||25.70%||23.30%||28.24%|
The publication of Mend the Gap – the independent review into gender pay gaps in medicine in England in December 2020 discovered that CEAs, each nationwide and native, are a contributory issue for the 20% of the general gender pay hole in medication. They highlighted quite a few causes girls are much less more likely to maintain a CEA. For instance, feminine consultants usually tend to be youthful and usually tend to work in under-represented specialisms comparable to palliative medication and geriatrics. They’re additionally extra more likely to take profession breaks, making it tougher to compile 5 years’ price of CEA proof. Nevertheless, they discovered that these components collectively didn’t absolutely clarify the hole.
Desk 5: gender composition of Well being and Care Professions Council (HCPC) medical doctors throughout main areas of labor, September 2018
|Major space of labor||Feminine medical doctors||Male medical doctors|
|No space of labor specified||56.9%||43.1%|
|Obstetrics and gynaecology||66.3%||33.6%|
|Occupational well being||52.1%||47.9%|
|Public well being medication||72.6%||27.4%|
Supply: Digital Employees Information (ESR), NHS Digital, Mend the Hole overview.
The overview additionally discovered that girls had been extra reticent of their pursuit of maximising earnings and cited taking part in a self-selection course of as a possible cause; at the moment, software for nationwide CEAs is thru self-nomination. We all know that some are inspired to place themselves ahead by their managers, however this isn’t normal observe throughout the NHS and needs to be actively inspired by employers by means of the method of appraisal. Suggestions from our focus teams held in Autumn 2020 bolstered this, suggesting that girls, significantly these working LTFT discover it tougher to acquire profession recommendation, mentorship and employer help for functions.
We wish the brand new scheme to be extra accessible and one which encourages functions from those who have gone past their ‘day job’ no matter their background and traits. The findings and proposals of the Mend the Hole overview have knowledgeable our proposals.
Guaranteeing an efficient incentive for excellence
Nationwide CEAs are at the moment pensionable, a legacy from after they had been handled as wage will increase. This doesn’t align with the idea of a contemporary, non-consolidated reward and recognition scheme.
CEAs’ pensionable standing additionally has implications for taxation. Potential future tax legal responsibility for the accrued worth of their NHS pension is one thing which has led important numbers of award holders to contemplate surrendering their CEAs for monetary causes, scale back their hours, or ‘retire and return’ (typically particularly relinquishing scientific obligations) and can be more likely to have dissuaded functions.
Lastly, the present scheme was transposed from its paper format onto the present on-line portal and isn’t designed as a ‘digital first’ service. The supporting IT is now 14 years previous, not user-friendly and more and more outmoded with restricted replace potential and help. The proposed new scheme represents a possibility to construct a extra environment friendly and efficient fashionable service, decreasing burden on candidates, scorers and directors alike.
Our proposed modifications fall below 3 overarching themes:
- broadening entry to the scheme
- making the appliance course of easier, fairer and extra inclusive
- guaranteeing the scheme rewards and incentivises excellence throughout a broader vary of labor and behaviours
In 2012, UK well being ministers requested the Evaluate Physique on Docs’ and Dentists’ Remuneration (DDRB) to ‘overview compensation ranges and incentive techniques and the assorted Medical Excellence and Distinction Awards schemes for NHS consultants at nationwide and native ranges’. In its consultant compensation levels report, the DDRB beneficial modifications to each the native and nationwide CEA schemes.
In growing our proposals, we have now additionally consulted broadly with employers throughout the NHS, common medical practices, specialist associations and faculties and the British Medical Affiliation (BMA). Lots of our stakeholders, together with the Royal Schools and the BMA, have had sight of the proposed reforms and have offered useful feedback immediately and thru focus group discussions.
A modernised CEA scheme can be instrumental in serving to ship the Long Term Plan in England, alongside the People Plan 2020 to 2021,which units out speedy priorities for attracting and retaining extra individuals, working otherwise in a compassionate and inclusive tradition within the NHS. The Lengthy Time period Plan gives a strategic framework for a way new fashions of care can be remodeled over the course of the following 5 years to enhance outcomes for our populations.
A brand new scheme will help the Lengthy Time period Plan and the NHS Folks Plan by recognising contributions of consultants and educational GPs that ship at a nationwide degree:
- innovation in digital and know-how or effectivity enhancements that launch time for care
- higher well being prevention and/or personalised care that narrows well being inequalities
- advances in medical analysis to enhance future affected person outcomes
- fashionable multi-professional training and coaching – participating, main and implementing strategic change
- enhancements for NHS employees, by means of management, mentoring or in any other case making the NHS an awesome place to work
For Wales, a modernised CEA scheme would assist ship A Healthier Wales, the long run plan for well being and social care that units out a long run future imaginative and prescient of a ‘complete system strategy to well being and social care’ focussing on well being and wellbeing, and prevention.
Proposed modifications to the nationwide CEAs scheme
With the aims above in thoughts, we’re consulting on:
growing the variety of new CEAs, with this made attainable by making them non-consolidated and non-pensionable
eradicating time-based ‘development’ between the award ranges, with the extent of awards linked to the influence of feat
modifications to the domains for assessing nationwide CEA functions
the function of citations and rating by accredited nationwide nominating our bodies (NNBs) and specialist societies (SSs)
retaining the 5-year award interval, however ending the present renewals course of for awards, with clinicians making use of for a brand new award on the level of expiry
how to make sure award holders preserve excellence through the interval lined by a CEA
whether or not you’ve got any additional feedback on future preparations for the nationwide CEA scheme
In parallel with the formal session course of, Nationwide Institute for Well being Analysis (NIHR) are supporting analysis centered on ACCEA’s scoring and evaluation processes. This can be beginning shortly and the investigators will report within the autumn.
We wish to hear from medical and dental consultants and educational GPs, medical doctors in coaching, NHS trusts and basis trusts, Medical Royal Schools, consultant organisations, commerce unions, the Nationwide Institute for Well being Analysis, Well being Training England and different medical and health-focused establishments who may additionally be excited by responding to this session.
Annex A – eligibility standards for nationwide CEAs
Senior medical doctors are eligible for nationwide Medical Excellence Awards, as set out in ACCEA’s applicants’ guide, if they’re:
- a totally registered medical or dental practitioner on the Common Dental Council (GDC) specialist record or Common Medical Council (GMC) specialist register. They will need to have a licence to practise and have been a everlasting NHS guide for a 12 months on 1 April within the award 12 months. The 12 months doesn’t embody time spent as a locum, however they can provide proof from their achievements as a locum in the identical function
They may qualify in the event that they:
1. are employed by an NHS organisation (in England or Wales), DHSC and Welsh Authorities or its arm’s size our bodies, a college, medical or dental faculty, native authority, or are employed by related Welsh Authorities-associated organisations. Purposes from staff of different organisations could also be eligible
2. are a tutorial GP, if their obligations are the identical as guide scientific educational employees. They’ll apply for awards in the event that they:
3. do at the very least 5 programmed actions or equal classes that assist the NHS, together with educating and scientific analysis
4. are a guide or a dental practitioner with an honorary NHS contract, who’s absolutely registered with a licence to practise. Whether or not they qualify for an award will depend on their contribution to the NHS for greater than direct affected person care
5. are a totally registered public well being guide on the GMC specialist register or on the GDC specialist record, with a licence to practise
6. are a postgraduate dean absolutely registered with the GMC or GDC, with a licence to practise, who competed for the function in opposition to GPs and consultants, and is chargeable for postgraduate trainees throughout all specialties
7. are a guide or educational GP later employed as a dean or head of college in medication or dentistry, absolutely registered with the GMC or GDC, with a licence to practise
8. are a guide absolutely registered with the GMC or GDC, with a licence to practise, working as an NHS belief scientific or medical director, or an identical degree medical supervisor submit. In the event that they virtually all the time work in medical administration, they will nonetheless qualify if they’ve an energetic guide contract with a particular scientific management function and proceed to resume their licence to practise. In the event that they transfer into common administration and/or have a administration contract exterior of the guide pay scale, they don’t qualify for an award.
Annex B – pay safety provisions
Members of the 1995 and 2008 sections of the NHS Pension Scheme can apply to guard their pensionable pay whether it is decreased, as set out in regulation R9 of the 1995 NHS Pension Scheme Regulations and Chapter 2.D.12 of the 2008 NHS Pension Scheme Regulations.
Below the present CEA scheme, if a member’s award is just not renewed following their software, or whether it is due for renewal however they select to not apply, pensionable pay safety is offered. These pay safety provisions be sure that members who obtain an award however should not near retirement should still have the award counted in direction of the ultimate wage that’s used to calculate pension advantages at retirement.
Pay safety would even be in place for:
those that maintain a nationwide CEA below the present scheme and efficiently apply for a brand new award below the brand new scheme. It is because Schedule 30 of the guide contract has provision for monetary compensation for award holders who transition to any new nationwide scheme, requiring that the brand new nationwide award is pensionable for the primary cycle and the distinction in worth between any equal degree new award and their current award be paid to them within the type of a pensionable LCEA; and
those that maintain a nationwide CEA below the present scheme and unsuccessfully apply for a brand new award below the brand new scheme, as they might profit, topic to their scores, from the present mechanism below Schedule 30, whereby they might revert to a pensionable native award below the now-replaced native scheme.
The provisions set out in Schedule 30 have been collectively agreed with the BMA and might solely be altered by means of a negotiated settlement with medical commerce unions.
Below the brand new CEA scheme, new-style awards wouldn’t be pensionable and can be non-consolidated. As these new awards wouldn’t be thought of in direction of a member’s last wage, there can be no requirement to make use of the safety of pay provisions.