Hospital Dr News

NHS Employers seeks to get CEAs scrapped

Trusts are urging the government to scrap clinical excellence awards.

NHS Employers, their representative organisation, has told the Doctors’ and Dentists’ Review Body in a submission that CEAs should end or be significantly reformed. The DDRB is currently conducting a review of CEAs for the government with a view to making them “more affordable” and will report next summer.

The submission also says that if reformed, the CEA process should include stronger employer control over decisions on pay and reward at a local level.

It admits that employers are divided over the continuance of CEAs. Some accept there is benefit in having a system which rewards outstanding contributions by doctors. “There is broad agreement amongst employers that the current financial and policy framework is not fit for purpose,” it says.

Employers say the awards should not be pensionable, protection should end and any available money – as a result of the reform – should be redistributed directly to employers, to use as part of their pay and reward system.

Stephen Campion, chief executive of the HCSA, commented that the current debate brings the role and function of hospital consultants into a sharp focus.

He said: “NHS Employers seem to imply it wants consultants to work exclusively to meeting the objectives of NHS trusts. The question has to be asked about whether government, and indeed the public, want consultants to act also in the wider interests of the NHS.

“Consultants play a key role in developing professional standards, research, teaching and training. We would hope NHS Employers agree and that any DDRB recommendation will similarly recognise that consultants should be encouraged to work in the national NHS interest. Its narrow view is one that threatens the development of medical practice rather than encourages it.”

Employers also expressed concerns about whether the awards truly award excellence, the requirement to spend an allocated proportion of the pay bill regardless of the number and quality of applicants, the portability of the awards to other employers, the value of the awards and the dominance of the system by doctors.

NHS Employers is calling for a scheme that provides organisations with the flexibility to reward consultants in a way that is integrated into local systems and needs.

The government has already sought to reduce the number CEAs handed out to doctors in the 2011 round prior to the DDRB’s review findings.

In the draft guides for the 2011 round of CEAs from the Advisory Committee on Clinical Excellence Awards, the government agency that administers them, the ratio used to calculate the minimum level of investment for employer based awards has been reduced from 0.35 to 0.2 per eligible consultant.

CEAs have effectively been scrapped in Northern Ireland, pending the review, and distinction awards stopped in Scotland.

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16 Responses to “NHS Employers seeks to get CEAs scrapped”

  1. Offended dr says:

    I don’t think I’ve ever read a more offensive set of proposals in my life. This is a direct threat and slur of hard working hospital consultants. The money used for CEA payments is part of the overall pay settlement- so its ours’ It is not there for managers, nurses, or anyone else in the hospital – sorry. It is there for clinical excellent- not as would be the case if it were given to NHS employers for redistribution amoungst mangement lackeys.

  2. William Westlake says:

    I entirely agree with Offended Dr. This is simply about imposing a pay cut on the Consultant body, and should be strongly resisted

  3. pete says:

    Yes, but the problem is that CEAs DONT reward clinical excellence. They reward committee stalkers, self-publicists, networkers and those who tend to desert their clinical posts. Most of all, in todays ‘look over your shoulder’ hospital trusts, they reward those who toady to management. Thus its disingenuous of employers who say they should be retained, because what they really mean is “we can use the prospect of these awards to keep our clinicians in line, and troublemakers will get zilch”.
    Is there anyone who reflects on the history of merit awards and doesn’t think that the greatest mistake was to repatriate them to local level where all manner of shenanigans now come into play in the decisions? At least when they were made remotely there was less local politics involved.
    No, these awards are irrevocably soiled and should be ditched. Managers are oh so fond of telling us consultants that we work ‘in a market’. Then let them feel the heat of that market and analyse our output for quality. Those who have the least wound infections, the most efficient throughput and the least complications should be the ones rewarded. So should those who do the longest hours. And when we’re asked to do extra lists, we should insist absolutely on a decent rate of enhanced remuneration. Professionalism is dead, and doctors connived at its death too. Lets move on.

  4. Mark says:

    Coal owners say miners’ salaries are too high and time at the pit face needs to increase. They should also buy their own picks, shovels and Davy lamps. The pit is such a healthy environment they shouldn’t need any sick pay and there really isn’t any point in paying a pension to someone who after all is too old to do any useful work – what precisely does the coal owner get for it? Nor should we have to pay for expensive pit head baths – they’re used to being scruffy and cold water washes just as well as hot.

  5. ace-of-hearts44 says:

    Scrap CEA’s. This is an excellent proposal. The previously named Merit Awards system is both corrupt and divisive. It is based neither on “Merit” nor “Excellence” but on the “old boy network”. If you are not a member of the club you will never be no matter how many papers you have published, books authored, Councils sat on. Many Academics are given huge awards despite the fact that they are never to be seen in their own medical school let alone the associated NHS hospital (which funds the awards) but spend their time travelling the world, fully funded by Big Pharma or industry, lecturing on their PhD fellows’ topics, in medical school time and often for a hefty fee – not to mention untaxed airmiles by the million. The money should be accessible by the DDRB and distributed equitably among all hospital consultants not a mysteriously selected few. CEAs. What a misnomer. Scrap them!

  6. ace-of-hearts44 says:

    Oh and I forgot to mention that the original Merit Award System was based on a bribe. “I have stuffed their mouths with gold” said Aneurin Bevan to persuade the body of Consultants to support the new NHS in 1948.

  7. ace-of-hearts44 says:

    William Westlake is mistaken. It may be a pay cut for a select few but could be a pay rise for a very large number of others if the money was used fairly and transparently.

  8. Matt says:

    This all boils down to whether you believe in performance related pay or not. Despite being a beneficiary of (a few) CEAs, I don’t believe they work. They disincentivise those who don’t get them, as much as they encourage those who do, and they are unarguably divisive. Far better to rely on professional pride to raise quality. The problem with scrapping them at this moment in time, is that we will lose a substantial part of the consultant pay pot. The money won’t reappear in our pay packets, evenly distributed amongst all consultants. That would look too much like a pay-rise.

  9. Gandhi would approve says:

    This is just a proposal at this stage and may be watered down. I suppose that in the current climate of ‘bonus’ resentment stirred up by politicians, we might lose our CEA points (I have 2 and sweated hard for them). I think that we (the consultant body) should concentrate on our core clinical responsibilities and be unable to find those countless extra hours for ‘non-core’ meetings that management demand. I am more than happy to strictly adhere to my job plan and I hope that all of us will do the same.

  10. General Surgeon says:

    CEA’s MUST be scrapped with immediate effect. They are extremely divisive and do NOT reward those who work hardest at the coal face trying to keep the system running despite all the obstacles we have to face. As consultants we are very well remunerated and the CEA funds should be redistributed to ALL healthcare workers. The current system SUCKS!!

  11. Mr G says:

    CEAs will be reformed undoubtedly and the reform will be an opportunity to save money and claw back some of the money that the DoH feel they overpay to the medical profession following the pay settlements of recent years. The other driver will be the breaking of the national payscale allowing local pay negotiation within Foundation Trusts using the CEA monies. The background to all the changes is a wish to see healthcare privatised in the belief that this will reduce the cost and allow the government to shift the blame for the difficult healthcare rationing decisions that are inevitable in the medium term.

  12. siggers1000 says:

    This seems a slightly self absorbed discussion – unsurprisingly everyone loves CEAs if they have a lot and vice versa…
    Its worth noting that the Welsh contract has the equivalent of level 1-8 CEAs as seniority payments, so that after 24 years a a consultant, virtually everyone has 8 points (leaving the ‘merit’ award part to the higher awards). It always seemed to be a more equitable agreement.
    It now looks as if the Welsh system will pay more as well as being fairer (unless it is also butchered). It should have the advantage of increasing recruitment to Wales though…

  13. Baby Boomer says:

    If all pay control is given to the Trusts, no-one will leave the Trusts for a minute. There will be no national overview or co-ordination of training.
    Who is going to organise or examine in professional examinations [quality control]?
    Actually if training is rubbish, followed by a rubbish exam, even just a few in-experienced and dangerous new ‘consultants’ will make me look good by comparison.
    Who is going to want to be a clinical teacher, or do clinical research? It will be such a waste of time, compared with meeting a few more targets.
    If productivity is rewarded, I could stop training straightaway. What’s in it for me?
    The employers, most of whom are less able than ourselves, will have gained complete control over everything within their little silo.They would just love to pay themselves more than us. In a generation the bright kids will go into NHS management, not into medicine. Will that be an improvement?

  14. chrissa says:

    pete – WOW. you woke up and smelled the coffee. the word “professionalism” has been abused to the point of having become a joke. professionalism is nowadays touted as a synonym for being a doormat. wrong move. if they want extra work – real professionals sell them this extra work as a locum through a trusted locum agent because that is the only way to get one’s money, the correct amount, in time. THAT’S professionalism. picking up the pieces for free certainly is not “professionalism”

  15. Thinking_guy says:

    To get into medical school, you need to be among the brightest and most able of kids. Medicine is one of those courses which needs extremely high A level results to get in and is an astonishingly hard slog to get through to taking the degree. Then, the doctor in training faces postgraduate exams of such difficulty that would make the man in the street, who has not in general slogged their way through the immensely arduous on call duties that characterise medicine, squirm.

    Medicine is competing for the best school leavers with career options which pay much more, especially in the financial world, and unlike a banker a doctor can end up losing it all if they screw up and never be able to work again. There are no financial bonuses, no company cars and no perks – all that you can hope for is that if you work more you will get the chance to earn more. A consultant can only work for the NHS – the NHS has a monopoly and calls the shots – as the UK’s private medical sector is so small that virtually no doctor could make a living from working full time within it.

    Doctors in, for example, the USA, Singapore or Hong Kong can earn at least £300,000 annually per annum with relative ease – check it out if you don’t believe me. There are virtually no UK doctors who get anywhere near this annually. The tiny tiny handful of doctors who eventually got a platinum merit award (in their 50s) can earn a total of around £160,000 per annum – in comparison, there are people in the world of business, finance and corporate law who would not think it worth getting out of bed for that, and most would not have had to work anything like as hard as the average doctor to get to that stage, and none carry the same level of life and death responsibility.

    The above comments sound as though they emanate from a feeling of jealousy or irrational hatred of doctors – and misplaced jealousy at that.

    What is wrong? Why not reserve such bitterness for wifebeaters, rapists, murderers or terrorists? Why begrudge doctors their wages? If you pay peanuts, you get monkeys.

  16. Uzume says:

    Thinking_guy said ‘Doctors in, for example, the USA, Singapore or Hong Kong can earn at least £300,000 annually per annum with relative ease – check it out if you don’t believe me.’

    I do believe you and having lived in the USA, I can tell you a) many don’t deserve that amount and b) the healthcare system in the USA is all about appeasing pharmaceutical companies and is the worst system I have ever had the misfortune to experience.

    That the merit payments were introduced just to stop consultants reneging on the already agreed national Health Service Act (1946) speaks for itself, a way to pander to the clinical elite and stop them putting people at risk!

    That said, if the system genuinely rewarded talent and research in medicine, i would be all for a new and improved system where the already too fat cats didn’t have a monopoly on the money due to a corrupt and unmanageable system.

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