New pressure to scrap NHS consultants’ clinical excellence awards has come from former GP and Scottish MSP Dr Ian McKee who has been running a sustained campaign against the scheme.
McKee, who represents the Scottish National Party (SNP), has already persuaded Scottish Health Minister Nicola Sturgeon to freeze the awards for consultants in Scotland and to write to all other UK health secretaries suggesting a UK-wide review.
Now he has called on the Scottish government to be ready to go it alone in reforming CEAs.
There have also been calls from the Foundation Trust Network for CEAS to be stopped in England. The proposal was outlined in a paper discussing a range of cost cutting measures leaked last month to the public sector union Unison.
McKee has attacked what he calls an “insidious bonus culture” for consultants. The freeze on CEAS will save the Scottish government £2m this year.
He told the SNP’s spring conference that health ministers in the UK had failed to tackle CEAs for fear of incurring the wrath of consultants and the BMA.
He said: “Why don’t we eventually get rid of these awards altogether or start a new scheme that rewards genuine exceptional merit for all health workers, not just doctors.”
Paul Flynn, deputy chair of the BMA’s consultants committee, said CEAs were an integral part of doctor’s pay and were linked to improving the quality of care for patients and McKee had not put forward any good argument for abolishing them.
“If they are looking for ways to economise in the health service the BMA will be happy to suggest plenty of other ways they can make more effective cuts without affecting the morale of one of the most important parts of the workforce.”
He said the BMA was not concerned about McKee’s attacks because most people accepted that CEAs were a valuable part of consultants’ remuneration.
“I don’t think there is an overwhelming move against them. This is just pressure from small groups who have been looking at the scheme and not taking a terribly wide view of it and not understanding the value it gives to the health service.
“We would, however, prefer it if everybody accepted that CEAs are a worthwhile part of doctor’s remuneration.”
Tags: CEAs
And there was I thinking it was bankers who were benefitting from “insidious bonus culture”, whilst risking all our futures. Silly me, it was those evil doctors all along.
Not appropriate for bankers or doctors. Both susceptible to cliques using other people’s money to reward their pals.
What is wrong in looking at other ways of saving morning for the NHS across the board instead of attacking consultants pay which would likely lead to low morale and impact on patient care? I have never heard of doctors being described as evil before till I read Mr White’s comment. Doctors continue to be held in high esteem and respected compared to other professionals including politicians, journalists and bankers according to recrrent polls by the tabloid newspapers. Leave the pay for consultants alone and allow them to continue to improve care for patients.
The correlation in our large consultant department between those consultants adding value and those recognized in the CEA system is very close and on the whole reflects sustained committment to the hospital, patients, juniors and the profession. If the system isn’t working in your hospital, change it.
The irony of bankers’ bonuses versus doctors’ bonuses is valid, but its not really the point. Our so called clinical excellence awards are now NOTHING to do with clinical excellence…..they’re usually awarded to doctors who toe the management line or worse, become clinical or medical directors and implement policies for the management which are anti-patient and destructive of our profession eg generic referrals, supporting choose ‘n book, turning the screw on new to follow-up ratios and so on. The worst thing that ever happened was when we accepted moving the more remote decision-making process for the old merit awards to a system of in-house decisions for CEA’s where local corruption could then do its insidious work. These awards are a scandal and should be got rid of immediately. They rarely reflect true clinical merit as many hard working doctors will know. Rather they reflect cronyism or the ability to fill out application forms.
We can all identify those we perceive as receiving a CEA inappropriately and those we feel are deserving who are not rewarded. The system is divisive, arbitrary and open to at least the potential for corruption. The depths of conduct I have seen some stoop to in order to land an award has stunned even cynical old me. The system stinks and should go. If those who receive a CEA or aspire to one think that the rest of us will go to war to keep their privilege they are deluded
I agree with AMN’s connent wholeheartedly.
I have been a consultant for 17 years and probably have another 10-15 years to run. If the CEA system is scrapped what will it be replaced with? Unlike many other professions, including some other health care professions, in medicine you can achieve consultant status in your early 30s and stay at that status for over another 30 years! Question is…is that wise?!
The CEA system was introduced to give a fairer chance and more recognition to those who work hard at the coalface and who may have not, otherwise, self-promoted their contribution.
The domains on the application are clearly not in line with those aims and are much better populated by those with Academic jobplans.
The idea was good, the potential for local corruption, toadyism and nepotism is not.
Scrap them - but replace with an automatic decent incremental payrise for all except that small minority who fail to provide a good service (oh yes, tha’s just been stopped also..)
The truly excellent and altruistic will still continue to rise and be recognised.
Consultants pay is reflecting their standard work for a trust. If doctors are doing significantly more (over and above their jobplan agreement) locally, regionally or nationaly that they are not paid for to do but that improves our healthcare system, why not give these people recognition by rewarding them financially.
If a local system is not running well, rewarding who-knows-who rather then true work, it needs to be improved locally and made more transparent, rather than abolishing it where it works well and encourages good work.
I don’t mind a system where this is implemented across professionals, but this is no reason to scrap a system that encourages excellence over mediocracy. Otherwise why should I spend my time for the NHS instead of doing private work if there is no recognition whatsoever (except from CEA pay there is none).
Conflict of interest:
I am a consultant who has CEA points. I have been doing a lot of national work outside my contracted working hours during my specialist training and since becoming a consultant 5.5 years ago.
As usual an inordinate amount of hot air. In my experience, those who whinge the most about the system are unsuccessful applicants who simply dont fulfil the criteria for CEAs and think that putting in their day job should get them points while refusing to manage, engage in research, teach above and beyond the call of duty etc etc. You should not be rewarded for working hard - that is your job. CEAs are for those who work long and otherwise thankless hours working outside their job plan, using precious out of hours time to fulfill these added committments. SHendrick’s got it right.
Dr Ian McKee is right to call for scrapping of this anachronistic nonsense – Bevan in 1948 commented how he bought the backing of the consultants by “stuffing their mouths with gold” when he introduced the merit system modified to CEAs by New Labour.
The consultant’s focus becomes discretionary (brownie) points rather than patient care.
In my experience, the public are largely unaware that this iniquitous system exists rather than accepting it as part of a consultant’s salary as suggested by Paul Flynn.
The system seems to reward doctors who spend the majority of their time attending meetings and taking on management roles and neglects those who spend time with the patients and work at the coal face. I converted my whole practice to local anaesthetic, freeing up the much needed anaesthetists to work elsewhere and freeing up beds. I managed to get the department to perform GA’s in the morning so they could be recovered in the daycase unit and free up beds, allow the doctors to see the patient in one place and not have to search the wards for them. This also removed the delay in the patients arriving in theatre or being cancelled as a bed was not available. I also took part in a large multi centre international research project. Then I applied for a local award and did not get it. I have been told by people it is because I am on the old contract and awards are not issued to people on the old contract and other people have said they go preferentially to physcians as they have the time to attend meetings and little availability to get private practice unlike the surgical specialities. Whatever the reasons it seems a very warped system. The people with the higher awards on the whole having spent most of their time siding up to management and increasing the beaurocracy in the national arena. Not the people who put the time and dedication into looking after their patients and making an efficient service. Surely they are called CLINICAL excellence awards, not management or beaurocratic awards. I have recently been given advice by someone who has attained several and it seems to be playing a system. Surely people should be awarded on merit and not on ploughing through the paperwork and having to sell themselves, it should be obvious who should get the awards, but apparently not.
I say until the system is fair and transparent it should be scrapped. Infact scrap the system and pay all doctors fairly with regular pay progression through out their career. Not just the ones who play the system, which makes for a very divisive environment. To take time away from your patients, paid by the hospital to be gaining points for awards elsewhere is wrong. People who attend these meetings should be paid by another body for attentding the meeting, not a bonus that lasts for life and is pensionable.