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CEAs essential to incentivising NHS consultants

Clinical Excellence Awards are essential to incentivising consultants to improve the NHS, recognise their excellence and retain their expertise in the UK.

These are the conclusions of the Academy of Medical Royal Colleges in its submission to the pay review body – which is currently reviewing the CEA system on the behalf of the government.

Commenting on the national awards, the AMRC said they provide an important incentive for doctors to get involved in work which benefits the wider NHS and, without this extra work, the health system would cease to function effectively.

It said: ‘The NHS and UK medicine depends on the participation and contribution of doctors to the wider NHS, beyond their own trust, not only for its development but also for its practical functioning.

‘For example, the roles of senior doctors in the development of NICE guidelines, developing and updating the 58 specialty curricula, setting and applying professional standards through College exams, setting clinical standards or reviewing and conducting clinical research all underpin the day to day operation of the NHS. Such work is vital to the future of healthcare but would not be regarded as a priority by all trusts.’

The academy also argues that national CEAs are an important retention tool, with basic earnings being much higher in Australia and the US. It says: ‘The danger of losing high performers is greatest in academic, educational and research posts since it is in these fields that there is greatest movement between countries. Any serious erosion of the availability of national awards would risk triggering the loss of national medical excellence overseas.’

NHS Employers recently called for them to be scrapped in its submission, or the budget given to employers to control. CEAs have already been suspended in Scotland and Northern Ireland and the budget reduced in England.

However, the AMRC says there has been a ‘vast improvement’ in the operation and application of the system at local and national level over recent years.

It says: ‘Criticisms that the scheme is divisive, besides being self-evident, miss the point. Any scheme rewarding excellence on a competitive rather than a universal basis creates a division between those with and those without the reward. Equally, if the scheme is genuinely intended to reward excellence “over and above the standard expected” all doctors are not going to meet this criteria.’

Forty three per cent of consultants receive a local CEA, while 11% receive a national award.

The pay review body is due to report to the government this summer, and it’s widely anticipated it will recommend a ‘cheaper’ system, less focused on consultants.

Consultants are currently experiencing a two-year pay freeze, and the government is being lobbied over a corresponding freeze in pay increments.

See the CEA reward levels.

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11 Responses to “CEAs essential to incentivising NHS consultants”

  1. chrissa says:

    there is no need whatsoever for cea’s to “incentivise” consultants. they get paid a salary for doing a job and if any extra-contractual work needs to be done: that will have to be honestly labeled as locum work and paid accordingly.
    cea’s are not just totally unfair and “incentivise” the wrong people (committee lurkers) but also a financial time bomb due to their superannuability. the nhs pensoin is already a financial nightmare with a generation retiring at the moment that will claim their full final salary pension for 30 years.

  2. Dr Zorro says:

    Agree entirely with Chrissa.
    What do you suppose is the proportion of CEA holders in those in the AMRC who produced this report? <100% perhaps?

  3. chrissa says:

    hi zorro – the whole topic of cea’s is exclusively the domain of committee lurkers and what but a committee is the amrc … ?? the sooner this whole cea system is scrapped the better.

  4. pete says:

    So when did the Academy of Royal Colleges do anything concrete about halting the shocking decline in training standards over the past 10 years? Never. And now they bleat about Clinical Excellence Awards maintaining standards. What a cheek. The doctors who get any kind of award should be those who have the least complications from their treatments, the lowest infection & death rates, are most trusted by their patients, work extra hours without allocated payments and who run their depts with the minimum waste. And who score highly with those they teach and who stimulate their staff to a spirit of enquiry and improvement. And that’s NOT the hallmark of many CEA holders. Scrap the awards.

  5. john says:

    i disagree. the doctors get paid a lot however they work so hard. cea is for those who work above their contractural requirements. stopping thier incentive will cuase decline in their motivation to do development of services and if the patient care decline, we will have nobody else but the government to blame. in america everything is money driven, if the incentives will go in uk, the quality of care will go down, good doctors will go away.

    ask your grand parents or parents how would they like to be treated..

  6. ace-of-hearts44 says:

    The means by which Consultants are selected to receive an award (at an un-minuted secret committee) are secretive and divisive. No criteria have been published. It is definitle a case of “who you know”. I recall some years ago a committee member proudly boasting that he had “stuffed so-and-so’s A plus application”.
    “Clinical excellence” is not relevant. For example I have a graph which clearly shows an inverse relationship between the number of patient episodes/operations/procedures per unit time and the level of award (£ per annum). It is a nonsense that academics receive the Award to make up for loss of private practice. As stated in a previous blog, the nature of their PP work is just different not any less rewarding.
    For clinicians (non-academics) publications are also irrelevant. Many humble consultants have numerous publications but tiny CEAs.
    CEAs do not incentivise. In fact their mere super-selectiveness dis-incentivises those who repeatedly apply for but are denied a CEA!

  7. thekipdr says:

    With the exception of Chrissa’s last sentence-and-a-half from his/her first contribution, naive and utter nonsense. Innovation, process change and service development are essential and will never be deemed worthy of locum payment by Trusts since the benefits are unpredictable and immeasurable.

    Removing CEAs would ensure that many Consultants invest their motivation and energy in private practice or other activities rather than striving to improve patient care within the NHS. It would augment the unprofessional tendency toward work-to-rule illustrated by other articles within this issue (not that I would support SPA reductions either). Furthermore, it is specifically stated within CEA guidance that evidence of contribution is required rather than committee membership per se.

    If we want our Consultants to turn up to work, do their clinical work and go home leaving patient care improvements to the management- scrap CEAs.

  8. General Surgeon says:

    As these comments, and others published elsewhere, illustrate CEA’s are a divisive issue among consultants. They tend to be awarded to those who are spend most of their time in various committees and the least time at the coalface.

    CEA’s SUCK and should be scrapped completely and immediately. Consultants are already amongst the highest earners in the NHS. The funds should be redistributed across ALL healthcare professionals.

  9. chrissa says:

    as far as research goes: the truly smart ones do research that ends them up with a patent earning millions while academic glory and consulting contracts with perks are achieved by many. however – cea´s are not supposed to reward research anyway, the clue is in the title … clinical excellence awards … scrap the shambles this system is stat.

  10. chrissa says:

    zorro, pete, ace-of-hearts44 and general surgeon agree with me while john and thekipdr disagree – this 5 to 2 majority could well be representative …

  11. ace-of-hearts44 says:

    “thekipdr” has got it wrong. The consultants “who turn up to work, do their clinical work” would (and do) continue to do so without big CEAs. Is he suggesting that CEAs are needed to motivate doctors? I thought medicine was a vocation. It’s sad that some doctors apparently need to be bribed to practice their “art”. Scrap CEAs and perhaps we will rid the NHS of that kind of doctor. Oh, and there’s nothing wrong with private practice provided it is properly scheduled and part of a transparent job plan – which it is these days.

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