I’m guessing that the 2010 round of clinical excellence awards is going to be the most hotly contested yet. Why? Because there’s every chance it could be the last.
CEAs are to be reviewed and the government has questioned their affordability. It follows a near halving in the number of national awards handed out in the 2009 round.
While the review will not be submitted until next summer, you don’t need the powers of Nostradamus to predict the ensuing proposals.
CEAs are set to become like any other modest bonus scheme. Smaller sums will be handed out to more participants and they will become time limited. It’s likely that consultants will have to compete with other health professionals to secure one in a broadened scheme. The big, national awards will be consigned to history and I’d be surprised if the ‘bonuses’ remained pensionable.
The main problem with this is, of course, that CEAs are not some financial frippery aimed at cheering up the odd hard-pressed consultant, but part of the essential terms and conditions of all consultants.
Without them, the government would have had to offer a higher basic salary for consultants in the 2003 contract.
This is what I told a researcher from Panorama the other week when they rang to discuss whether doctors should receive “big bonuses” at the public’s expense. They’re pulling a programme together on the issue of doctors’ pay and I doubt it’ll be supportive.
I also told them that scrapping CEAs will make the government’s job of raising standards in the NHS much harder. While no consultant embarks on a service- or practise-improving project because of the potential to receive an award, there’s no doubt it helps to compensate for the extra work this demands.
There’s also a real risk for the NHS that some consultants will seek to grow their private work instead. Consultants are currently facing a three-year pay freeze and having their SPAs squeezed. Pensions and CEAs are now both subject to high profile reviews and likely to be compromised.
Does the government really believe that a bit of talk about clinical autonomy is going to make up for this, particularly when it wants raised quality and improved outcomes?
The CEA system isn’t perfect but it’s a lot better than it was. It’s more equitable and transparent than ever. If the review concentrated on improving accessibility and ensuring that awards were better linked to ongoing performance then it might even receive professional support. But if it’s just about saving money then I doubt it will receive any (with the possible exception of those who haven’t received a CEA).
There’s an enormous challenge here for the BMA. Can they protect the contract they negotiated? It’s looking difficult. Not only are they going to have to be vocal and vociferous, but they’re going to need the profession to start raising their voices as well.
Who received a national CEA in this year’s round? Read more.