New NHS Clinical Excellence Award scheme for England
September 2003
Introduction
1. In February 2001, the Department of Health published the consultation document “Rewarding commitment and excellence in the NHS – proposals for a new consultant reward scheme”, setting out proposals to replace the current discretionary points and distinction awards schemes with a single, more graduated consultant reward scheme comprising both local and national elements.
2. This document sets out the framework for the new NHS Clinical Excellence Award scheme for England. It takes into account responses to the Department of Health’s consultation document and discussions with the profession and other stakeholders. The new scheme will start to be introduced later this year with the first awards payable for the 2004/05 financial year.
Principles
3. Clinical excellence awards will more fairly reward those consultants who show the greatest sustained levels of performance and commitment to the NHS. Under the new scheme the majority of awards will go to those who make the biggest contribution to delivering and improving local health services. The importance of teaching and of research to the delivery and improvement of health services will continue to be recognised. We expect the number of consultants in receipt of an award to increase from around one half of all consultants at present to around two-thirds.
4. The new scheme will also:
- be transparent, fair and based on clear evidence and perceived to be so both by the public and the profession;
- be open and accessible to all eligible consultants;
- put a stronger emphasis on quality of care;
- make eligibility dependent on:
- a satisfactory level of performance;
- satisfactory participation in the annual appraisal process;
- meeting standards of best practice in relation to job planning;
- meeting the standards of best practice set out in the ‘Code of Conduct for Private Practice’ (for NHS consultants who participate in private practice).
- ensure fair distribution of awards through appropriate application of the criteria;
- allow early intervention to review an award where concerns or allegations about a doctor’s conduct or performance are upheld through disciplinary or professional fitness to practise proceedings;
- publish information on the distribution of each level of award, the names of award holders and the principal reasons why they have been granted the award. (This will include mini CVs being published on relevant websites, subject to permission being granted by the individual doctor.)
Rationale and objectives
5. The Clinical Excellence Award Scheme will reward those consultants who contribute most towards the delivery of safe and high quality care to patients and to the continuous improvement of NHS services including those who do so through their contribution to academic medicine. All levels of award will be made against the same criteria to reflect nationally agreed objectives.
Objectives
To reward individuals who perform over and above the standard expected of a consultant in their post, and who locally, nationally, or internationally:
- Demonstrate sustained commitment to patient care and wellbeing or improving public health
- Sustain high standards of both technical and clinical aspects of service whilst providing patient-focused care
- In their day-to-day practice demonstrate a sustained commitment to the values and goals of the NHS by participating actively in annual job planning, observing the private practice Code of Conduct and showing a commitment to achieving agreed service objectives
- Through active participation in clinical governance contribute to continuous improvement in service organisation and delivery
- Embrace the principles of evidence-based practice
- Contribute to knowledge base through research and participate actively in research governance
- Are recognised as excellent teachers and/or trainers and/or managers
- Contribute to policy-making and planning in health and health care
- Make an outstanding contribution to professional leadership
6. Individuals will not be expected to meet all these criteria to be worthy of an award. Much will depend on the type and nature of the post.
Structure of the new scheme
7. The NHS Clinical Excellence Award scheme will be a seamless scheme comprising both local and national elements. The lower value awards will be made by local (individual employer) committees. The higher value awards will be decided by a new Advisory Committee on Clinical Excellence Awards (ACCEA) and its sub-committees. However, in contrast to the current discretionary points and distinction awards schemes, all awards under the new scheme will be determined according to a common rationale and objectives. The eligibility and assessment criteria for all awards will be set nationally and there will be a standard nomination form for all levels of award. ACCEA will develop guidance on the minimum standards to be applied by all local committees.
8. The ACCEA’s sub-committees will each monitor the operation of the local scheme. The ACCEA itself will publish an annual report that will include information on the distribution of all levels of award.
Eligibility
9. The scheme will be open to all consultants with at least one year’s service at consultant level. Consultants will normally become eligible for higher awards after having achieved a minimum of four local awards. Clinical academics and public health doctors will be equally able to apply for local awards and local committees will be encouraged to develop criteria to aid their inclusion.
10. Consultants delivering a wholly local contribution will be able to progress to the top level of higher awards. Consultants who have achieved the maximum level of local awards will be invited, subject to sustained levels of excellence locally, to submit a CV questionnaire for consideration for a higher award.
Levels of award
11. There will be twelve levels of award, the first eight of which (Levels 1-8) will be awarded by local committees and the last three of which (Levels 10-12) will be awarded by the national ACCEA and its sub-committees. Level 9 may be awarded by either the ACCEA or the local committees – this will depend on the type of achievement being recognised. The values of the awards at 2003/04 levels will be as follows:
| Awarded by Local Committees: | Awarded by ACCEA: | ||
| Level 1 | £2,617 | ||
| Level 2 | £5,234 | ||
| Level 3 | £7,851 | ||
| Level 4 | £10,468 | ||
| Level 5 | £13,085 | ||
| Level 6 | £15,702 | ||
| Level 7 | £20,936 | ||
| Level 8 | £26,170 | ||
| Level 9 | £31,404 | Level 9 | £31,404 |
| Level 10 | £41,290 | ||
| Level 11 | £51,613 | ||
| Level 12 | £67,097 | ||
All levels of award will be pensionable and will be paid in addition to consultants’ basic salaries; higher awards will subsume the value of any award (discretionary point, distinction award or clinical excellence award) previously held.
- Awards for part-time consultants will continue to be paid on a pro rata basis.
- All awards will be annually up-rated, subject to the recommendations of the Doctors’ and Dentists’ Pay Review Body.
- Local award committees will be permitted to make awards which advance consultants by more than one level in one year. (For example, a consultant on level 2 could on the next occasion be awarded level 4.)
National Committee
12. The national ACCEA will apply the criteria against which candidates will be assessed. It will be responsible for setting up and administering the process by which all nominations will be judged. In making those decisions, the ACCEA will rely heavily on the advice of its sub-committees for awards at Levels 9-11. The ACCEA will itself consider all nominations for Level 12 awards but will receive advice from the sub-committees on the local view of the consultant’s contribution to the NHS. Ultimately, the ACCEA will be the body with over-arching responsibility for all national awards, and for controlling the quality of the new award scheme more generally.
ACCEA Sub-Committees
13. The national ACCEA will establish sub-committees. There will be at least one sub-committee covering the geographical area of each of the nine Regional Government Offices (each Office has a Department of Health Regional Public Health Team). The sub-committees will have lay chairs and membership drawn from consultants (including representation from academic medicine) covering a wide range of specialties (around 50% of the membership), NHS employing organisations through a mix of chief executives, medical directors and HR directors, and lay representatives with a strong patient focus. Each sub-committee will link with NHS employers within its geographical boundaries and will be supported by local feeder groups and individual employers that have personal knowledge of candidates. The committees will include appropriate representation from members who are women and from minority ethnic groups and most members should have diversity training.
14. The sub-committees will consider and make recommendations to the national committee on Level 9 awards, where the nomination is on the grounds of national or international excellence, and all Level 10 and Level 11 awards. All nominations will be considered strictly against the set criteria (see paragraph 37). The sub-committees will produce a clear audit trail for all nominations. The sub-committees will have delegated powers, where appropriate, though in the case of awards for national/international excellence, these will be subject to moderation by the national committee.
15. The sub-committees will monitor the quality of awards procedures and the distribution of awards made by their local awards committees through the receipt of an annual report from each local committee taking appropriate investigative and/or other action as necessary to address perceived imbalances.
16. The sub-committees and local awards committees will liaise about individuals who are at the top end of the local awards (with a view to them progressing through the system) and those who have been nominated for a Level 9 award (and might be more appropriately rewarded locally). The annual report from local awards committees will help to facilitate this.
Local Awards Committees
17. The membership of local CEA committees will be agreed locally subject to national guidance. Most members will be expected to have received training in valuing diversity. The committees will include appropriate representation from the general body of consultants, and it is expected that they will include members who are women and members drawn from minority ethnic groups as well as patients, users and representatives from the local PCT. At least 50% of members will be doctors. Where appropriate, the committees will have university representation. Members of the national ACCEA and its sub-committees will be eligible to attend meetings of local awards committees.
18. NHS employers will implement decision-making procedures which are appropriate to their Trust and agreed locally. PCTs and other employing bodies with only small numbers of consultants will need to consider appropriate arrangements e.g. linking with a neighbouring Trust. The local committees will be expected to measure consultants strictly against the criteria and to ensure that their decisions are properly documented. The ACCEA will develop good practice guidance to assist local committees in ensuring that their decision-making processes are transparent, fair and based on clear evidence. The ACCEA sub-committees will ensure, through employer reporting arrangements, that there is an appropriate and auditable approach locally to decision making.
19. Local awards (Levels 1-9) will be payable to those consultants making an outstanding contribution at a local level against nationally set criteria. Clinical academics and public health doctors must be included in the local awards process and should be considered on the basis of their overall contribution to the NHS.
Number of awards to be granted
20. The annual level of investment in new awards at local level will be at least the same as would have occurred under the previous system of discretionary points. The ratio of new local awards to eligible consultants will be a minimum of 0.35 per annum.
21. The annual number of awards to be made by the ACCEA and its sub-committees will take into account the number of awards released through retirements and resignations, withdrawals and progress to a higher award in the previous year and recommendations from the Doctors’ and Dentists’ Review Body on the number of new awards to be made available. The geographical distribution of the available awards will be broadly pro rata to the consultant population.
22. The number of awards available each year will be necessarily limited, particularly at the highest levels. Awards will be decided on a competitive basis, based on the relative merits of individual cases.
Balance in service and academic achievement
23. Clinical excellence awards are intended to reward those who make a significant contribution to the NHS Many consultants contribute to the NHS through academic and research work in a variety of settings and such work will continue to be recognised within the CEA scheme.
24. Through appropriate application of the assessment criteria, the ACCEA will ensure that there is a fair distribution of awards, including a balance of awards between consultants holding substantive NHS contracts and those with honorary NHS contracts.
Equality of opportunity
25. Award committees will be expected to demonstrate that there is equality of opportunity and openness in the operation of the awards scheme. Individual awards must be decided on grounds of merit, but the distribution of awards will be monitored so that unjustifiable imbalances can be identified and addressed.
26. The commitment to equity will be supported by a move to encourage more use of self-nomination:
ACCEA will be expected to monitor awards at all levels, against the criteria for award, to ensure that:
- There is a fair distribution of awards between specialties
- There is a fair distribution of awards geographically
- There is a fair distribution of awards between types of hospital
- Groups, such as female consultants and consultants from minority ethnic groups, who have in the past received disproportionately small numbers of awards, are being fully and fairly considered.
27. Any consultant nominated for an award may seek a review of the process with regard to the consideration of that nomination, for instance with regard to the way in which a consultant’s CV has been assessed. Any appeal against the process will be considered by a committee set up for each round of awards and constituted differently from that which took the original decision, or which provided the original advice to the central committee.
Review and renewal criteria
28. Awards will be reviewed at five-yearly intervals to ensure that the consultant is continuing to fulfil the criteria for the award. The expectation will be, as now, that CEAs will be renewed throughout a consultant’s career although the review will have a range of options:
- Straightforward renewal for a further period of five years where the criteria continue to be met;
- Renewal for a period of less than five years where there is a cause for concern but where the evidence suggests an ephemeral problem as the cause;
- Removal of the award or substitution of a lower award where the performance no longer merits the higher award with payment at the higher level continuing on a mark-time basis;
- In very extreme circumstances, removal of award AND removal of payment.
30. Awards will be reviewed at other times at the request of an employer in cases where disciplinary or professional proceedings have upheld concerns or allegations about the consultant’s conduct or performance. Employers will be expected to notify the ACCEA if an award holder is subject to disciplinary or professional fitness to practise proceedings.
Retirement of award holders
31. Awards will cease to be paid with effect from a consultant’s retirement date or, in partial retirement cases, the date their NHS pension is paid. In the case of awards made by the national ACCEA and its sub-committees, the award will then be made available for reallocation to other consultants in the next available awards round.
Academic, aalaried general practitioners
32. Salaried academic general practitioners, employed by Universities and/or the Medical Research Council who hold Honorary (unpaid) contracts with a recognised NHS organisation, and who undertake at least five programmed activities of NHS work, will be eligible for the awards. In the case of academic GPs, all levels of award will be decided by the ACCEA and its sub-committees. There will be no reduction in the number of awards to consultants as a consequence of increasing the number of eligible doctors.
Postgraduate Deans and Deans of Medical and Dental Schools
33. Consultants who become Postgraduate Deans or Deans of Medical and Dental Schools in England and Wales will retain eligibility for any existing award, and for consideration of new or higher awards.
34. The eligibility criteria for all categories of Dean will be strengthened to ensure that it is clear when a Dean is required to hold an (unpaid) honorary contract with a NHS employer and when their employment with the Deanery is sufficient for eligibility purposes. In the case of Deans, all levels of award will be decided by the ACCEA and its sub-committees.
Approach to Honorary Contract Holders
35. The current requirement for six NHS sessions per week to be undertaken to establish full eligibility for an award will be amended in the light of the Follett Report. Eligibility for awards will be based on the contribution made to the NHS defined in wider terms than direct care to patients. The entitlement to full eligibility for an award will be based on five programmed activities in the jointly agreed job plan being devoted to activities beneficial to the NHS including teaching and clinical research.
Eligibility criteria
36. The new scheme will have the following eligibility criteria.
NHS consultants and NHS honorary consultants will be eligible for awards provided that:
- Satisfactory appraisal process signed off by employer(s) and consultant
- Job plan and contractual obligations are fulfilled
- Observance of private practice ‘Code of Conduct’
- No adverse outcome for the consultant following disciplinary action by employer or General Medical Council or General Dental Council
- No adverse outcome for the consultant following disciplinary action by employer orGeneral Medical Council or General Dental Council.
Assessment criteria
38. Decisions on all levels of award will be based strictly on clear published criteria. The nomination form for all awards will be structured to focus tightly on the objectives of the scheme and the specific criteria that need to be satisfied.
Area 1: Delivering a high quality service:
- Evidence of outstanding commitment to achieving NHS service priorities and objectives including flexibility in adapting to changing priorities and demands.
- Evidence of practical application of high standards in the technical and clinical aspects of their service.
- The provision of patient-centred care, valued by patients and colleagues alike (or, in the case of public health, population-based service valued by stakeholders and colleagues alike).
- Evidence of active participation in clinical governance, leading to a major role in the continuous improvement and innovation in the organisation and delivery of services.
- Evidence of outstanding commitment to evidence-based practice, which is taken forward appropriately for the benefit of patients through clinical audit and/or other evaluative tools.
- Evidence of notable additions to the knowledge base of the NHS through research and discovery.
- Evidence of a strong commitment to patient safety, learning from error and promoting safer systems and clinical/research processes.
- Evidence of commitment to the development of effective multi-disciplinary team working.
- Evidence of excellent contributions to policy-making and planning in health and health care, either at a local or national level.
- Evidence of excellent achievements in change management.
- Evidence of managing a patient-centred service.
- Evidence of excellent achievements in research and development.
- Evidence of active participation in research governance.
- Evidence of excellent performance as an educator or trainer.
Quality assurance
40. There will be quality assurance processes to ensure that;
- there is probity, transparency and openness in the interests of both participants and of the general public given the significant public investment in the scheme
- nationally and locally, there are clear processes to operate the scheme with auditable procedures and outcomes that can be monitored
- there are uniform procedures and application of criteria
- there is sufficient equal opportunities monitoring
- the processes for making nomination and for making decisions on awards are published
- there is a proper and clear opportunity to appeal against the process leading to a decision on an award
- the decision making process is equitable and does not favour particular specialties or types of NHS organisation etc
- the contribution of consultants who do not receive an initial award for three consecutive rounds is properly considered.
41. Analyses of the distribution of awards and the list of consultants receiving each level of award will be published in an annual report. This will indicate the principal reason(s) for which each award was granted. If successful candidates have given their permission, their abridged curricula vitae will be published on a website so that the public and other doctors are aware of the types of contribution for which awards have been made.
Transition to the new scheme
42. Distinction awards and discretionary points will continue to be awarded for the year 2003/04 but when the new scheme is introduced no further awards will be made under these existing schemes. The value of distinction awards and discretionary points will continue to be uprated in line with the recommendations of the Doctors’ and Dentists’ Pay Review Body. Consultants in receipt of a distinction award or discretionary points will keep them, subject to existing review provisions, and will be eligible to apply for awards under the new scheme in the normal way. All consultants currently on the top of the consultant pay scale will be eligible for clinical excellence awards, regardless of number of years’ service. The award of a clinical excellence award will subsume the value of any discretionary points or distinction awards held by the consultant.
43. As consultants move from their current level of discretionary points to a new level of clinical excellence award, this will result in some awards that are worth less in incremental terms than the normal unit of a clinical excellence award. To ensure no reduction in the overall investment deployed on clinical excellence awards each year, there will be further guidance illustrating how employing organisations should calculate the total funding available for new awards in a given year.
Next steps
44. The first clinical excellence awards round will commence later this year for awards payable for the 2004/05 financial year. This document sets out the framework for the new scheme.
45. The ACCEA will publish operational guidance on the scheme, together with the documentation to support the first awards round. This guidance will include guidance for local employing organisations on:
- assessing CVs against the criteria for the new scheme
- weighting the contribution of academic work
- selection of local award committees.