Hospital Dr News

National CEA awards likely to be suspended

The Department of Health has asked the advisory body on doctors’ pay, which is currently reviewing the Clinical Excellence Awards system, to consider closing the scheme in England for new awards.

The move has come to light because ACCEA, the independent body which manages the CEA scheme, has contacted medical societies warning them that there may be no 2012 round if the pay body (the DDRB) heeds the government’s prompt.

A letter from ACCEA medical director Dr David Lindsell and chairman Professor Jonathan Montgomery says: ‘The Department of Health has recently submitted a further paper to the DDRB asking them to consider whether the 2012 round should include applications for new awards. The alternative is that the 2012 round is run for renewal applications only. The DDRB have been asked to make a recommendation on this when they report.’

The DDRB – which has a history of listening to the government – is expected to submit its report to the DoH in July, with its recommendations on the way forward for the CEA scheme in England.

Stephen Campion, chief executive of the HCSA, commented: “Until the DDRB reports to government in July 2011 it would be quite premature for trusts to depart from the Clinical Excellence Award Scheme which is currently available to all eligible consultants.

“By making the 2012 scheme available only for renewal applications the very independence of the DDRB is undermined. If this request from the Department is accepted within the NHS it would send the signal that amendments to the scheme are not driven by the DDRB but overly influenced by the Department of Health.”

In its submission to the review, the Department of Health proposed a ‘slimmer’ system of national awards with trusts being given control of local awards from 2012.

The DoH said then: ‘Trusts will be able to choose whether to have a local scheme, the criteria for making awards and how much to spend on their scheme. This approach responds to the wishes of employers to have greater freedoms to design processes that reflect local priorities and considerations.’

This followed a submission by NHS Employers to the DDRB saying that 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.

The ACCEA letter to registered medical societies suggests that following the review submission in July there will be ‘a further period during which the Department will consider its response to the recommendation’.

It continues: ‘We are aware that some of you will be thinking about starting your processes for the 2012 round, with some of you possibly having already done so. We wanted to make sure you were aware of the request by the Department.’

Dr Mark Porter, chairman of the BMA’s consultants committee, said: “This reminds me of the pause in the [Health] Bill, where the NHS just carries on restructuring regardless. Here, the Department of Health has referred CEAs for review, and has now told everyone not to await the review but just get on with cutting consultant pay.

“It’s as if they no longer value the professional effort and excellence that consultants bring to the NHS. We will make strong representations on behalf of our members.”

Consultant pay has been frozen over a three-year period, and a review of the NHS pension is likely to result in an increase in contributions for doctors with a reduction in benefits.

Read more on the government’s view of CEAs.

Read more on CEA levels.

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19 Responses to “National CEA awards likely to be suspended”

  1. Dr Zorro says:

    Long long overdue.

  2. chrissa says:

    so right zorro! clinicians should simply get on with clinical work – smthg that is undermined when committee lurkers and cv polishers spending vast amounts of time to create a shiny version of themselves on paper get rewarded.

  3. Dr Grumpy says:

    Fine but with hospital managers coming down hard on those with more than 10PA’s where will the extra work come from?
    Less teaching, less admin who wants to work for nothing given thats what we have been doing for years!
    Yet another bunch of politicians who have no idea how the NHS works! how reliant the NHS is on medics goodwill and this was in return for local CEA’s & a good final salary pension. Take that away and I for one will be working to the letter of my contract and job plan
    lansley & co. need to wake up before its too late or is this part of the plan to destory the NHS so that the private sector can take over?

  4. Knowsalotstroppyscot says:

    Interesting development, and, in effect a unilateral alteration in terms and conditions. For those of you who think that they are morally indefensible, I would say for every person who has a relatively undeserved national award (and I acknowledge that there are some) there are ten who have more than earned their award. COI: not been awarded one but have an application in at the moment. In our trust you only get recognised for outstanding quality and for stuff that you can clearly identify has been done outwith your job plan. In essence as fair and transparent as it is possible to be.

  5. Dr Zorro says:

    “where will the extra work come from?”
    It’s called overtime. Extra pay for extra work, at a mutually acceptable rate.
    As opposed to extra pay as a reward for licking the right arses.

  6. Knowsalotstroppyscot says:

    Dr Zorro, that is offensive and as anyone who knows me will attest. I do not lick arses I work damn hard to try and make things better. I know a platinum award holder who thoroughly deserves it and he doesn’t lick any arses either. I reiterate, the vast majority of people that I know with a national award thoroughly deserve it and have produced loads of work and benefit to the NHS. However, your post holds a grain of truth and it will cost the NHS far far more in the long term and, in all probability, individual doctors if subscriptions to colleges have to go up to pay their officers properly. Be careful what you wish for as they say.

  7. Jojo says:

    The message is clear then. If the powers that be wish to unilaterally alter contracts all those activities which were previously done in the vague hope and aspiration that one day they might be recocgnised by a grateful nation will now need to be paid for. Already any suggestion to more recently appointed consultants that they might wish to undertake some little extra duty is greeted with the question, “How many PA’s will I get?”

    So with a strict fee for service payment regime and a bit of Mr. Lansley’s privatisation, with consequent loss of central direction and planning, health will soon be consuming 16% of GDP.

    What is the message the government is trying to give to trainees? It could be construed to be forget about the teaching, training, research, service development, innovation etc. If you have financial committments the best way to look after your interests is to cultivate your private practice.

  8. pete says:

    Zorro is basically right. Let salary be commensurate with work done and proven quality achieved. CEA’s are unrelated to clinical excellence, secretive, and pernicious. Give me a clock card and I’ll queue up with the porters…far more honourable, far more accurate and by God, the NHS will discover soon enough how much more work we do than they give us credit for. They already scored huge double whammy’s when bringing in the GPs’ and Consultants’ contracts and they’ll find out again that to have destroyed professionalism was an extremely costly error.

  9. Dr Zorro says:

    If you want to present anecdotes as evidence perhaps you could explain why females, ethnic minorities, and certain specialities are significantly under represented in the ranks of CEA holders. Your comment “loads of work and benefit to the NHS” implies that those who do not receive an award contribute less somehow than those that do. With a few exceptions that is not my perception and it is an implication that I find offensive. For every recipient there are many more deserving but unrecognised individuals. This system can never be made fair, equitable, and free from corruption and patronage. It should go.

  10. OldFart says:

    It may be a foretaste of what is to come that in the recent voluntary contribution to the national colonoscopy audit, the region which, uncharacteristically, was slowest to recruit colonoscopists to the cause was Scotland. Could this be entirely unconnected to the fact that North of the border the abolition of new discretionary points and CEAs has already happened, and an attitude of ‘why should I?’ is now rushing in? Many in positions to know are now finding that invitations to supervise juniors’ training, to examine, to interview for entrance to medical school, to meet with PCT’s in their last death throes to arrange next year’s contracts are now being met with greater than usual hostility and refusals. Stroppyscot is right. I just wonder whether he works in England.

  11. dr ? says:

    can see both sides here, but have to agree with Dr. Zorro- there are lots of consultants who work very hard who do not have CEAs.

    It is unfair however if the government stops the scheme now, as it disadvantages newer consultants, while older consultants, who may not be working to the same level, get to keep theirs- maybe when their CEAS are reviewed, they should also be told that there is no money, particularly as (I believe, may be wrong) they are pensionable

  12. joshek says:

    Zoro is right. Overtime pay for overtime worked is needed. The current CEA system consists of a lot of paperwork and buffing of CV’s – not patient contact – and to give people (superannuable!!) rewards for that is ludicrous. Jojo seems to get the message at last: If you want to earn money – you need to make crystal clear arrangements. This opaque CEA system is not useful and any notion that smthg like that indicates “professionalism” is ridiculous.

  13. Disappointed UK says:

    Zorro and joshek – you need to read what CEA awards are for . They are NOT for working hard at your day job – that is what you are supposed to do for your pay- but are for all the extras to support and develop services, education ( and please don’t go on about how we are all expected to do more with no extra time or pay- that’s the same for all of us, even the ones with the awards), research, etc. I have looked at many applications over the years, and I think you would be amazed at just what colleagues do to deserve and get awards – they aren’t off skiving their NHS duties in favour of “sexy” external bits, they do both.
    I agree with knowsalotstroppycot – the system is about as transparent and fair as it can be, and I also agree that it is outrageous that the DoH should in effect close it down before the “consultation” (well known civil service joke) or negotiation.
    As one of the most demoralised of colleagues, I think it is very likely that the profession as a whole ( at least those of us in hospital practice who have not benefitted from the DoH negotiation cock up which led to the GP “quarter of a million club” ) will eventually get stroppy, and start to work the sessions they are paid for and no more. Goodwill has gone, and it’s about time the DoH got to know just what they have destroyed with it.
    I will be advising my daughter, who is about to qualify, to think very hard about what she wants out of life, as a lifetime of vilification and abuse by a notoriously bad, monopoly employer, without the sweetener of a good pension seems to me to be a very bad deal, and with her talents, she could do much better.
    Pity for the NHS and our fellow citizens, but enough is enough.

  14. Jaz says:

    Clinical Excellence award is a misnomer! It awards non-clinical excellence. It is taken for granted that vast proportion of Consultants in England are clinically indistinguishable from each other (clinically excellent).
    As posted above, the award is for stuff people do over and above the ‘day job’! This includes research and Management. Many of these things are already accounted for in the Job Plan.
    It is true that doctors like all humans need the right incentives to take on those extra jobs (this is what the SPA is for!). Vast proportion of our colleagues get recognised with CEA for sitting on committees etc. while our colleagues (without the CEA) continue to hold the fort. This is unfair. Many people take on posts e.g. audit, governance etc only to ‘polish up’ their CEA appliation form. These jobs therefore do not get done properly.
    In addition, medicine is a team sport. How do we justify only consultants getting these awards? Once you get an award how comes the award and the pension stays with you year on year! This is a bizzare system which does not exist anywhere else. The scheme reduces moral of more people than the number of people it incentivises.
    It is time for CEA to go. Incentives for high performing teams is welcome.

  15. joshek says:

    Thank you Jaz for your eloquent comment! The current CEA system is probably well described as “by dinosaurs, for dinosaurs” and should go the way of all dinosaurs – extinction!

  16. Joe Perkins says:

    This may well backfire on the DoH and other government organisations/committees, including the Deaneries if they still exist, as the incentive to assist them, both directly and through work done for them through the Royal Colleges and Specialist Associations, will have evaporated. Why should consultants get involved in this work any more?
    For everyone I know who is heavily involved with ‘national work’ it is no sinecure. It takes up time, involves a lot of travelling time, and is done over and above normal day-to-day clinical duties: the days of skiving off and leaving the registrar to do the work are well gone.

  17. joshek says:

    @Joe Perkins: What you describe would be excellent news. At the moment, a lot of non-clinical activity is done in a very amateurish way – because it is done by clinicians who should rather do what they are trained to do: see and treat patients. With the bread of “committee seat collecting” amateurs gone because they can no longer hope to get a “clinical excellence award” for it (fingers crossed!), there may be a chance for this work to be done by doctors who specialise in this non-clinical activities, for correct fees, which is the chance to get it done in a truly professional way. Yet another reason to get rid of the current cea system rather sooner than later!

  18. professor clot says:

    Its a system that has had its problems but is probably better than the alternative – a seniority payment or a management toady award.

    Probably best advice to junior docs is:
    1.You won’t get extracontractual work recognised – just work to the contract
    2.Choose a specialty which has private practice and leave nhs asap!

  19. The Thinker says:

    Get real.

    Consultant medical salaries in the UK are poor compared to the equivalents overseas, and there are other disadvantages (see later).

    Consult a currency converter web site (e.g. http://www.xe.com/) and take a look at:

    – New Zealand – NZ$180,000 to NZ$260,000 (= £94,000 to £135,000) (http://www.imrmedical.com/NZsalaries.htm)

    – Australia – A$200,000 to A$400,000 (= £132,000 to £264,000) http://www.imrmedical.com /australiasalaries.htm

    – USA – average salary US$219,000 (= £139,000)(http://www.healthcaresalaryonline.com/surgeon-salary.html)

    – Ireland – a salary of €200,000 is not unusual (= £175,000) (http://www.finfacts.ie/finfactsblog/2007/04/irish-hospital-consultants-mickey-mouse.html)

    – UK average salary £ 72,000 to £94,000 (BMJ)

    What do you think of that?

    If you are one of the 12% or so in the UK who eventually manage to get to bronze level (usually in your very late 40’s or well into your 50’s), add an extra £35,000 to the above. Silvers, golds and platinums are as rare as undiscovered Beethoven Symphonies.

    The truth is that the only reason why doctors look as though they are doing well in the UK is because the UK is, by first world standards, a low-wage economy

    Also consider
    – our tax system takes away nigh on 40% of the above, much more than the comparator countries
    – you are yoked to the NHS (and hence working for the public sector) for life – it has a monopoly and there simply isn’t anywhere else a medically qualified person can work full-time in the UK (apart from cruise ships or drug companies) – compare this to the USA, where you can always move from one employer of doctors to another

    The real issue here is that consultants in the UK get what they get financially because they have no choice who their employer is (the NHS or nothing) and have no leverage on that employer (i.e. they cannot withdraw their labour). The clinical excellence awards at least gave a doctor something to try to work towards to improve their lot. Private work can’t fill the gap – many specialities can’t earn very much. Irish and US consultants/attendings laugh at us in the UK.

    Need some more money? Try getting a second job as a pole dancer or serving in Burgerking?…

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