Anton Joseph

Why do academics dominate the higher CEAs?

Since Clinical Excellence Awards (CEAs) were introduced, in 2003, many of discrepancies within the doctors’ awards scheme have been addressed and rectified – particularly around gender and race bias.

The one that seems to defy attempts is the disproportionate number of awards held by the clinical academics. Definition of teaching hospitals and clinical academics is by no means clear or easy. An acceptable description if not a definition would help with the solution. The awards committees believe that the decisions are fair, but do not seem to come forward to justify it.

Most of the discrepancies have been analysed to at least offer a partial explanation, but the preponderance of academic CEAs has probably received the least attention.

One of the underlying problems is the catalogue of promises made to the service-based DGH consultants which were not honoured.

The 2001 consultation document: Rewarding commitment and Excellence in the NHS – proposals for a new consultant reward scheme‘, said: “Clinical Excellence Awards will reward those consultants who contribute most towards the delivery of safe and high quality care to patients and to the continuous improvement of the NHS services including those who do so through their contribution academic medicine.”

The CEA scheme that followed in 2003 stated that: “A majority of awards will go to those who make the biggest contribution to delivering and improving local and health services”. That placated the politicians and gave hope to the consultants.

Even in 2010 the claim was: “The awards process has been repositioned to recognise the excellent work of the consultants for the NHS in non teaching centres.” (guidelines 2010).

The impetus it was said for the creation of CEAs was to recognise to a greater extent the contribution of the service-based consultants. The above are merely a continuation of failed promises made by past chairmen.

Going back a bit further, Prof Sir Stanley Clayton, the former president of the Royal College of Obstetricians and Gynaecologists, said: “Directly or indirectly, there must be good service to the NHS patients without this a consultant however well known he may otherwise be, will have little support for an award.” (Gender wording is interesting!).

It is evident that these were highly misleading promises. Was the DoH not aware of  this all along? Will it be any better this time? Less deception?

Are the discrepancies altogether unjustifiable? I wish to consider the preponderance of the larger DGH consultants first. With medical school intake it is obvious that the more successful students receive entry into the more recognised medical schools and presumably maintain their abilities during their early years of training and obtain consultant jobs in the larger DGHs. That these might end up with more awards is not inexplicable.

Needless to say those with academic interests will seek jobs in the teaching hospitals and the larger DGHs. The perception is that they contribute less to clinical work and patient care, which according to the guidelines is what the awards are primarily meant to reward, but are favoured in the awards scheme. Is it bias or might there be an explanation based on the domains to be satisfied.

ACCEA invites consultants to provide evidence to demonstrate that they:

Deliver patient services which are safe, have measurably effective clinical outcomes and provide a good experience for patients;

Have significantly improved quality of care and the clinical effectiveness of their local service or related clinical service broadly within the NHS;

Have made an outstanding leadership contribution, including within the profession;

Have made innovations or contributed to research, or the evidence/evaluative base for quality;

– Have delivered high quality teaching and training which may include the introduction of innovative ideas.

The universities and the medical schools ensure high standards are maintained and more importantly closely monitor performance: “‘only the best is good enough”.

The service-based consultants perhaps do not have this demand imposed on them. Minimum levels of performance would suffice and it is only those additionally motivated who succeed. The GMC in pitching the appraisal and revalidation scheme at the lowest common denominator have further contributed to this undesirable ethos. This not to say that service-based consultants are not hard working, but there needs to be a more widespread enterprising attitude.

Those who argue for the discontinuation of awards, argue for an even less motivated work force.

The DDRB have pointed out the lack of incentive involved through automatic progression through the incremental pay scale. DDRB recommendations for remuneration with modifications dare I say might be a blessing in disguise. Pardon me if I sound heretical.

It is, however, clear that the academic consultants tend to score on all five criteria. It could therefore be argued it is the scheme that is poorly designed and camouflaged with false promises.

DDRB heard strong support for the recognition of academics in an awards scheme (section 7.14). However several representations were made that the “criteria were weighted to academia” (7.16) and these included the Royal College of Physicians of Edinburgh and the Conference of Postgraduate Deans of the United Kingdom.

Not only are there are differences in the aims objectives and incentives, the clinical academics hold a higher percentage of national awards but they also hold fewer local awards. Strange bed mates in a unified awards scheme.

It is time to face reality. It is time for change. Watch this space!

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