Anton Joseph

‘Tuning fork’ model needed for excellence awards

The dominance of academic consultants over NHS consultants holding Clinical Excellence Awards is universally recognised. Yet, despite this, there has been little evidence of any attempt to investigate the disparity in any systematic way.

Why has this most contentious problem been ignored?

What I’ve unearthed is a state of confusion and denial. But what is most riveting is that there’s a whole field of psychology that explains this behaviour.

Someone else’s problem (SEP) is a psychological effect where people choose to dissociate themselves from an issue that may be in critical need of recognition.

Such issues may be of large concern to the population as a whole but can easily be a ‘choice’ behaviour by an individual.

Another psychological phenomenon that explains this behaviour is the diffusion of responsibility and/or ‘the bystander effect’ – said to suppress the urge to act in compliance with group inactivity.

A good point to start is to revisit the figures that demonstrate this academic dominance. Or, more appropriately, the lack of them.

While precise figures may be uncertain, the bias has been commented on by organisations in their evidence to the pay review body (the DDRB). “I fully accept that this is a contentious view, and is informed predominantly by anecdote. However, the volume of anecdote suggests that there is likely substance in the assertion.” (Conference of Postgraduate Medical Deans of the United Kingdom in a submission to the DDRB).

The sources providing input into the figures are SACDA, WAG, Medical Schools Council and the ACCEA. However when the DDRB requested clarification:

“Do you have any data that separately identifies the number of clinical academics with CEAs?”

The ACCEA responded: “ACCEA does not routinely report on the number of academic consultants.”

ACCEA can provide some indication of the number of academics holding awards. The vast majority of academics will be working in the NHS on honorary contracts. However, ‘honorary’ is a constructed term and is not consistently applied across the service.  ACCEA has evidence of trusts using the term ‘honorary’ for consultants on secondment or working at other trusts.

The figures provided by the ACCEA thus represented the number of honorary consultants (not academic consultants) holding awards in England and Wales. The ACCEA believes that there is considerable overlap.

The Clinical Excellence Awards guidelines states:

1.1.1 Clinical Excellence Awards recognise and reward NHS consultants and academic GPs who perform ‘over and above’ the standard expected of their role.

There is no recognition of clinical academic consultants. This is probably an admission of the lack of a clear definition of this group. Clinical academics is a commonly used term and the failure to adopt and provide clarification creates more confusion.

If the clinical academics do not exist there cannot be accusations of favouritism.

My impression is that this reflects an undue advantage of the academics and needs to be redressed.

When it was alleged that the ethnic minorities were under represented in the awards, the chairman of the awards scheme (ACDA) assured me that ‘consultants from ethnic minority backgrounds receive fair and proper considerations’, while admitting to the Commission for Racial Equality that the awards committee did not hold any information on the ethnic origin of award holders.

Figures for ethnic minority award holders were only produced at the insistence of the CRE. Conclusion: confirmation of alleged discrimination.

Given this prior experience it is incomprehensible that the DoH has made no attempts to resolve the issue of academic consultant dominance. The silence of the academics is no less explicable.

When the CRE investigated the cause for the fewer ethnic minorities holding awards, they found that there was no evidence to substantiate discrimination. Instead they upheld my contention that the criteria – the need for work of national or international significance – meant smaller DGHs where ethnic minorities worked in larger numbers were ignored and thus suffered indirect discrimination.

The offending criteria were withdrawn. The search for a solution should presume innocence on all sides in seeking an explanation for the dominance of the academic consultants.

The review of the scheme – as part of the ongoing negotiations between NHS Employers and the BMA on the consultant contract – is the ideal opportunity to better define the categories of consultants and ensure a fair outcome both for the academic and NHS consultants. This should be an essential part of the reorganisation. There should not be preconceptions or anticipation of the findings.

I surmise that students with higher grades enter the medical schools higher in the league tables, possibly receive better training and end up working in teaching hospitals – where they benefit from more opportunities to perform research.

A realistic solution should recognise that academic and NHS consultants are not a uniform population on a level playing field. Any new scheme should allow for this.

I propose a ‘tuning fork’ model for any new scheme. I would rather let the imaginative readers work on that one. The physics behind the principle of a tuning fork is a perfect fit. Let the NHS resonate to the contribution of both the NHS and academic consultants.

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