Dr Blogs

If you want to keep CEAs, you’ll have to speak up

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.

Bookmark and Share

16 Responses to “If you want to keep CEAs, you’ll have to speak up”

  1. Imran says:

    Good luck to the government – it’s time we had a fairer system that better rewarded solid clinical practice (and, ‘yes’, I’ve never received a CEA).

  2. MikeS says:

    This is a bizarre system, which I have never attempted to use as I believe it is fundamentally corrupting. Doctors are not underpaid and if they only remain motivated because of bonuises they may be in the wrong profession.

  3. Malcolm Brown says:

    Would the whole issue not be fairer if the monies were used as seniority payments as consultants progress and fulfill the appraisal process? CEA’s in Northern Ireland have a significant geographic distribution in that the closer you are to Belfast the greater the chance of obtaining a reward in the external scheme. They do not reflect achievement in the clinical environment or those providing services with intense rota’s who cannot therefore take part in committee activities which seem to be how CEA’s are obtained. Providing clinical excellance and service seems to be a minor consideration in the application process at present and having a position in the larger institutions in Belfast increase your chances of success considerably

  4. Paul says:

    There are many consultants with no private practice who have worked hard to earn those CEAs – and yes I have some.

    The system, although better than it used to be perhaps, still does not reward clinical excellence and really does need an overhall but there will be profound unhappiness if doctors overall pay is greatly reduced. A dangerous strategy I would suggest.

  5. Khan says:

    Imran hear hear. Let’s have a system that rewards the guys who do the work rather than fly off to meetings every 5 minutes

  6. Colin says:

    CEAs are an important part of the recognition of good and sustained performance above the usual NHS commitment. Without it how do you reward people who go out of their way to get involved in non clinical work, research, service development, teaching/ education. There are more doctors including surgeons as I am who do no private practice out of choice but do undoubtedly contribute a lot to the NHS above and beyond their contracted hours. I do have CEAs and feel that truly reflect the extra effort I put in and do help to keep me motivated through difficult times in the current NHS.

  7. Colin says:

    I agree with the comments above. CEAs are currently awarded for anything other than clinical excellence. In fact they detract from clinical excellence and productivity – in stead of hard work and staying at the cutting edge by continually reading around cases consultants would rather sit on some relatively meaningless committee for which they will be rewarded handsomely because it ticks the necessary boxes for their CEA application. The system actually works to demoralise consultants who are clinically excellent but get no reward in the current system.

  8. Orthopod says:

    An award, certainly; clinical, rarely, more usually administrative; excellence, perhaps. If we are to have a system of rewarding those who contribute above and beyond their contracted duties it should be seen to be transparent and non corrupt. There is a preponderence of awards given for committee and administrative work, and only in exceptional circumstances is clinical work rewarded.

    It would help if any new award did what it said on the tin. The current awards should simply be called non-clinical extra-curricular awards.

  9. General Surgeon says:

    CEAs for consultants should be scrapped and the funds redistributed to all groups of healthcare workers.

  10. Baby Boomer says:

    I admit I have an award. Yes I go off to meetings in London, only some of them are a waste of time, many are valuable and allow me to represent colleagues. When I come back I do extra operating lists so last year I still did more elective operating lists than any of my colleagues.
    I didn’t get an award until I’d been a consultant for ages, on a busy on-call rota – so I have paid my dues. This idea that they are awards for shirkers is pretty insulting.
    I’ve also bothered to audit my clinical results to show that they are as good as anywhere else, and in one case better than anywhere else. And I innovate. I don’t have a private surgical practice.
    I think CEA’s are a good thing obviously. In the past I probably wouldn’t have one – not being in the right sort of hospital etc. I think they are fairer now, and take into account clinical results. From the NHS point of view, there are some people who can’t be motivated, some who don’t need motivating, and some who respond to this sort of motivation. If you don’t like them, don’t participate. If you are noble and don’t need motivation -fine. However about ten times as many people apply as get one -so there are a lot of people out there [3-4,000 people?] who are motivated to some extent by them.

  11. Saravanan says:

    CEAs are the cheapest way of getting hospital consultants to do NHS management and innovation work. It is post-paid, inequitable and not every one who puts in the extra evening at work applies for the CEA. By comparison, the NHS spends £300 million a year of external consultancies.

    If all NHS consultants can form consultancy consortia we can charge the NHS what we like for all management, innovation, service & guideline development work. And guess what, it will be more expensive.

    CEAs, SPAs, NHS pensions reforms..whatever. Bring it on. My orthopaedic colleagues won’t bat an eyelid as they will be lining their pockets at the local Spire or the Nuffield. It is muggins like you and me who winge about small change.

    If we really care about our work life balance, we should all clock in at 9 and clock out at 5! And stop worrying about pay and pensions.

  12. Bertie says:

    ‘If you want to keep CEAs, you’ll have to speak up’
    Responses so far are very mixed -the Health Secretary would be encouraged! Divide the ‘have CEAs’ from the ‘have-nots’ and conquer. Clearly, the process is more transparent than in the past but still viewed by many as unfair. In my hospital, the anaesthetists run the show and take the Lion’s share of the CEAs – something to do with SPA time and all the other ‘effective SPA time’ you can have during DCC when you’re at the head of the table! Now they will have to resort to ‘day trading’ on their I-pads to supplement the pension. No – not a surgeon -in fact haven’t been to theatres for a couple of decades since as a house officer, I upset the hIp surgeon who had absolutely no sense of humour but did have a National Award!

  13. Trevor says:

    I will be speaking up to have CEAs scrapped. They are not transparent and reward anything other than quality patient care. A stipend should be paid for colleagues who spend their days at committee meetings in London in the same way the CD receives extra pay. When they resign from the committee the money stops being paid – what can be fairer than that?

  14. drsupport says:

    Applying and not getting an award can be very demotivating, especially when you find out you had lukewarm support from management! Bring on the reform. Instead, remunerate people for efforts in training, admin and management through proper funding of SPA time. These CEAs reward compliance with managerial agendas, not clinical excellence.

  15. fez says:

    I spent 9 years in full time education to get a PhD and then when I qualified I earned £700 for a 100 hour week. Medicine was a vocation to me and I didn’t count the money. I did get on by giving my best every minute of every day. I did get national level awards early in my career. This is performance related pay not a bonus, and unlike bankers bonuses only comes after years of sustained achievement. To get the right ethos of commitment we need more not less performance related pay. Excellence awards should be extended not minamized, every other walk of professional life has more performance related pay than medicine we need to move with the times.

  16. Peter says:

    They should be scrapped. They are an iniquitous system which mostly rewards those who do the least clinical work

Post a Comment

Enter this security code

Submit Comment for Moderation