Consultation outcome

Reforming the national Clinical Excellence Awards scheme: response from DHSC and Welsh Government

Updated 9 March 2022

Foreword

We are pleased to present the response to the consultation on reforms to the national Clinical Excellence Awards scheme, to be renamed as National Clinical Impact Awards (NCIAs). This renaming is more than cosmetic, deliberately focusing on recognising the positive national impacts that result from the activities of senior clinicians who contribute above the expectations of their job role.

While the consultation exercise was delayed due to the pandemic, our focus on its objectives to broaden the diversity and number of award holders remains as strong as ever. Our aim is to increase the breadth of the impact of the awards on the retention and recognition of the most highly performing senior clinicians. These clinicians act as teachers, trainers, innovators and researchers; most importantly they are also implementers and disseminators of best practice across the NHS, acting as role models for their peers and colleagues in training.

We expect that increasing the number of awards, and focusing on the diversity of applicants and award holders, will ensure that the awards not only reflect the eligible population of senior NHS clinicians to a much greater extent, but that they will be seen as more relevant and achievable as an aspiration for many more clinicians.

Although not all these reforms can be enacted immediately, as described in the body of the response, we are confident that the new scheme and its operational changes will improve access to higher level awards more quickly, simultaneously improving the number of senior clinicians who will hold a national impact award during their professional career. This will improve the turnover, diversity and agility of the scheme to reflect the modern NHS workforce, its needs and priorities, while remaining relevant to the increasingly varied roles senior clinicians undertake.

National Clinical Impact Awards aim to retain skilled, dedicated clinicians who lead in the provision and improvement of patient care through their innovation and partnership across the NHS, the life sciences industries and through patient involvement. We aim to recognise those impacts that have a national reach to improve outcomes and system efficiencies, especially where health inequalities are addressed.

We very much appreciate the detailed and constructive input from all those who took the time to review and contribute to this consultation, both in the formal consultation and in focus groups as well as other meetings where those stakeholder priorities informed key aspects for reform. We also appreciate the dedication of the ACCEA team and Department of Health and Social Care (DHSC) colleagues in analysing and formulating workable proposals based on the responses received.

Dr Stuart Dollow,
Chair

Professor Kevin Davies,
Medical Director

1. Introduction

National Clinical Excellence Awards (CEAs) are financial incentives, awarded via an annual open competition, to consultant doctors, consultant dentists and clinical academics. Their purpose is to recognise senior clinicians' achievements of national or international significance, beyond what is expected as part of their job plan. Separate schemes operate in England and Wales using the same broad principles and a shared platform. This scheme is part of the consultant reward package and helps to retain talent in the NHS and encourage clinical excellence.

The scheme has seen a number of iterations since its inception in 1948, the most recent being the replacement of discretionary points and Distinction Awards in 2004 with the more graduated Clinical Excellence Awards scheme. The current reforms aim to broaden access to the scheme, make the application process fairer and more inclusive, and ensure the scheme rewards and incentivises excellence across a broader range of activity and behaviours.

Key to the reforms are the recommendations made by the Review Body on Doctors' and Dentists' Remuneration (DDRB) in 2012 in its Review of compensation levels, incentives and the Clinical Excellence and Distinction Award schemes for NHS consultants^{[footnote 1]}.

The reforms also reflect the changing demography of the medical workforce and take into account the views of stakeholders and wider evidence including Mend the gap: an independent review of the gender pay gaps in medicine in England. A series of informal focus groups were held in summer 2020 seeking views from a range of stakeholders including the British Medical Association (BMA), NHS England and Improvement and the Royal Colleges to inform the development of our proposals.

The introduction of a new scheme in 2022 will not affect awards granted in previous rounds, as holders will not enter the new scheme until they apply to do so.

Full details of the final scheme design can be found in section 4, ‘Government response and summary’ below. In summary we will:

• increase the number of available awards – once the transition process has completed, there will be up to 600 awards granted annually in England and approximately 37 granted in Wales

• re-brand the scheme – the awards will be re-branded as the 'National Clinical Impact Awards'

• re-structure the award levels – in England, the new scheme will operate as a 3-level award system: National 1 (lowest), National 2 and National 3 (highest)

• refresh the assessment domains – the current assessment domains will be developed, combining both domains 1 and 2 and introducing a new fifth domain

• simplify the application process – a single level application process will be introduced with self-nomination being retained
• remove pro-rated awards – those working less than full time (LTFT) will no longer have their award payments pro-rated
• remove the renewals process – the renewals process will not continue in the new scheme; awards will be held for a total of 5 years, at which point applicants will need to re-apply
• remove the pensionability of awards – awards will no longer be pensionable or consolidated
• simplify the process for employers – employers will need to indicate their support for an application and will be required to provide a citation for each applicant (employer scoring and ranking will no longer be required)

In Wales, all of the above reforms will be implemented with the below exceptions (for further detail see section 4, ‘Government response and summary’):

• number of available awards – in Wales there will be approximately 37 awards granted per year once the transition process has completed, proportionate to the size of the consultant workforce
• the total number of awards granted will be adjusted each year depending on the level of commitment awards consultants hold as under the new arrangements consultants in Wales will be able to hold a national award and retain their commitment award
• structure of awards levels – in Wales the scheme will continue with 4 levels: Level 0, Level 1, Level 2 and Level 3

In Wales, consultants will be able to access both commitment awards and hold a National Clinical Impact Award concurrently from 2022 onwards.

2. Consultation process and review of responses

Consultation process

The consultation ran from 24 March to 16 June 2021 and was carried out in accordance with the Cabinet Office Consultation Principles.

The consultation was undertaken on behalf of DHSC (HM Government) and the Welsh Government. The consultation was communicated through a variety of platforms, including DHSC’s GOV.UK page and the dedicated ACCEA website, with notifications going to existing award holders, national nominating bodies, specialist societies and the ACCEA sub and main committees across both countries.

The majority of consultation questions focused on the scheme in both England and Wales, however, some of the questions related to Wales only. Section 3, ‘Summary of proposals and analysis of consultation responses’, differentiates between the 2 sets of questions.

The consultation posed questions under 3 key themes:

• broadening access to the scheme
• making the application process fairer and more inclusive
• changing the current application process so that it can better reward and incentivise excellence across a range of work and behaviours

Further context and rationale for the consultation can be found in the consultation document.

The full list of questions are also in the consultation document.

The responses and proposals were shared with the ACCEA main committee on 3 September 2021 for discussion and agreement.

Overview of responses

The department received a total of 439 responses (England and Wales), 40 of which came from organisations. The organisations that submitted responses on behalf of their employees can be found listed in Annex A.

Views within the responses were wide-ranging, from those suggesting the abolition of the scheme through to those arguing for the scheme to be maintained in its current form. However, the majority of responses were in support of our specific proposals and in agreement with our ambitions to introduce a scheme that is fairer, equitable and more inclusive.

Some of the feedback we received from the consultation led us to make changes in the final scheme design. Section 4, ‘Government response and summary’, sets out the final scheme design.

3. Summary of proposals and analysis of consultation responses

This section summarises the proposals as outlined in the initial consultation document and provides an analysis of the answers to the consultation questions. This document reflects many of the comments we received but due to the volume of responses is not exhaustive. Our formal responses can be found at section 4, ‘Government response and summary’.

Number of available NCEAs

The consultation proposed that the current bronze level of national awards in England be dropped.

The proposal outlined that once the transition from the current scheme is complete, in England there should be awards made available to roughly 6% of the eligible consultant population. This would equate to:

• 1% (about 500) holding the equivalent of a current platinum award, worth at least £40,000 per year
• 2% (about 1000) holding the equivalent of a current gold award, worth at least £30,000 a year
• 3% (about 1500) holding the equivalent of a current silver award, worth at least £20,000 a year

As set out in the Introduction and section 2, ‘Consultation process and review of responses’, the national scheme is run separately in Wales. The Welsh Government proposed to retain the 4 levels of award, this means in Wales, the numbers of awards would equate to:

• 1% (26) could hold the equivalent of a platinum award, worth at least £40,000 per year
• 2% (52) could hold the equivalent of a gold award, worth at least £30,000 a year
• 3% (78) could hold the equivalent of a silver award, worth at least £20,000 a year and
• 4% (104) could hold the equivalent of a bronze award, worth at least £10,000 a year

Question: Do you agree or disagree that the number of CEAs should be increased so that 1% of the eligible clinical population could hold a platinum award; 2% a gold award and 3% a silver award?

Analysis of responses

68% agreed with the proposal to increase the number of awards to 6% of the eligible consultant population.

Question: What number of CEAs do you think should be made available, at what level and why, recognising that the costs of the scheme will remain broadly the same?

Analysis of responses

Views were wide ranging with many agreeing that the proposals were appropriate.

Responses also varied between those calling to retain the number and level of awards under the current scheme to those calling to reduce the number of awards and increase the value.

A few respondents suggested that the number of awards to be made available should be increased even further.

A small number of organisations reflected that while they agreed with proposals to make awards more widely available, any increase in the number of awards should be made with an increased funding envelope. Similarly, the BMA suggested that the scheme should revert back to pre-2010 numbers of awards (600) while maintaining existing award values.

Others stated that they would wish to see flexibility built into the system to ensure that a greater number of awards could be offered, based on merit, as opposed to being required to stick to a rigid number.

Some expressed the need to rebalance the awards so they are more weighted towards entry level. Some respondents added that they felt the platinum level award was out of reach to many and therefore should be removed.

Lack of access to local awards for academic GPs was a recurring response throughout the consultation.

Wales specific questions

Question: Do you agree or disagree with the proposed award levels in light that there is no local CEA (LCEA) scheme in Wales?

Analysis of responses

51% agreed and 49% disagreed.

While there was strong support for expanding the number of awards available and the principles behind the 1:2:3:4 ratio, some said that this should not be seen as an arbitrary cap, or lead to an unused resource within the NCEA system.

The BMA raised concerns that this proposal does not fully consider the different pay and reward structure in Wales, and that it could impact on award uptake and accessibility.

The BMA also stated that if the proposals were implemented, it would be important to ensure that Commitment Awards can be held concurrently with NCEAs. They stated that any such arrangements should apply to existing NCEA holders who have previously had to relinquish their Commitment Award.

Question: In Wales we propose to retain the bronze level award scheme because there is no LCEA scheme in place. Do you agree or disagree that this is a good option?

Analysis of responses

76% of respondents agreed.

Question: What alternative scheme would you like to see in place?

Analysis of responses

31 respondents expressed the need for parity in both the national and local schemes that run across England and Wales, to limit any inequality issues when translating award levels and values between work in England and Wales.

Other views suggested that the ratios needed to be less "top heavy" with wider steps between each level so that progression is clearly identified.

Local performance awards and NCEAs

The consultation outlined that when the Clinical Excellence Awards scheme was introduced it had 12 levels, with levels 1 to 9 being awarded locally and levels 9 to 12 constituting the national awards. The overlap at level 9 (LCEAs) and 'bronze' (NCEAs) was intended as the interface between the local and national schemes. However, this had since created some confusion.

The consultation therefore proposed to drop the bronze level of national awards, with the remaining levels being assessed through a single tier application process to reward national and international achievements. The consultation also highlighted that local achievement will continue to be recognised by the local awards scheme, which is currently in the process of being reformed. Subject to the outcome of discussions, the local scheme could also recognise regional efforts.

Our proposal noted that academic GPs will continue to be eligible for a national award but that academic GPs working in England do not have access to local performance pay schemes.

The consultation noted that in Wales there is no local award scheme. However, consultants are eligible to receive Commitment Awards 3 years after a consultant reaches the top of the pay scale. The consultation flagged that holding a national award in Wales under the reformed scheme would continue to cease eligibility to hold a Commitment Award.

Question: Do you agree or disagree with the proposed value at which the NCEAs will be set at the different levels, of at least: silver – £20,000, gold – £30,000 and platinum – £40,000, in light of local performance awards also being available to NCEA holders from 2022?

Analysis of responses

274 respondents answered this question of which 55% agreed and 45% disagreed.

Of those who disagreed most gave the view that the balance should be more weighted towards the entry level. A small number suggested reducing or removing awards at the platinum level.

Some respondents expressed their views about the message that lowering the value of awards would send, with some respondents suggesting that this may discourage applications and reduce the power of the awards to incentivise sustained additional activity.

Others reflected that a reduction in value may act as a disincentive to choosing an academic career path.

A number asked for more clarity on the rationale for removing the bronze level award. Some cited concerns in relation to clinical academics and their difficulty in accessing local CEAs. Similar concerns came from academic GPs for whom local CEAs are not available. Some Royal Colleges expressed concerns that this may disadvantage those medical specialties that have larger proportions of bronze awards. We have clarified our intention here in section 4, ‘Government response and summary’.

Views on enabling applicants to hold both local and national awards concurrently were mixed. Although many respondents welcomed the principle behind this proposal, some argued that it will quite often be the same people who end up holding national and local awards, and that people may get credit for the same evidence twice.

Some queried how funding would move between local and national schemes, concerned about disadvantaging either national or local applicants. Other views focused on the transferring of funding from one scheme to another and the danger that fewer local awards would be made available if this funding was used to increase the number of national awards.

Other respondents expressed concerns that trusts may have divergent views on what equates to excellence, which may increase the variation in implementation and recognition at a local level. GPs and doctors with portfolio careers, for instance, might be less likely to receive employer recognition, despite developing diverse skills and interests that benefit patients and communities.

Changes to domains for assessing NCEA applications

The consultation set out that the current evidence 'domains' have not been substantially reviewed since national CEAs replaced Distinction Awards in 2004. As such, the consultation proposed to refresh and modify them.

In summary, the proposals were to:

• combine domains 1 and 2 to cover both the development and delivery of service
• emphasise the role of leadership in demonstrating excellence in domain 2
• place a stronger focus on education, training and people development in domain 3
• address both innovation and research in domain 4
• introduce a new fifth domain^{[footnote 2]}

Question: Do you agree or disagree with these modified domains?

Analysis of responses

79% of respondents agreed.

Views indicated that the new domains gave the right level of focus on requirements for both national impact and delivering 'over and above' what is outlined in job plans.

Organisational responses expressed concerns that the proposals may not fully capture the breadth of practice in the context of increased portfolio-based careers.

This was reinforced by others stating that developing the descriptors would be key to ensure a broad, inclusive focus.

Other concerns were about whether requiring evidence across all 5 domains might pose a disadvantage for those who work LTFT, or who have roles which do not provide opportunities to provide evidence under one or more domains. As such some suggested that applicants only be required to demonstrate evidence over 3 or 4 domains.

A small number of respondents suggested that we should retain and develop the existing domains as opposed to changing and adding a new fifth domain.

Question: What domains would you like to see and why, and/or how would you modify the descriptors provided for the proposed 5 domains?

Analysis of responses

45 respondents expressed views and these are summarised below.

Domain 1: developing and delivering your service

Consultation response:

• there was support for the merger of domains 1 and 2 with respondents saying that this would help remove some of the overlap in the current domains between providing evidence on 'developing' and 'delivering' a high-quality service
• there were concerns that domain 1 may be perceived as more heavily focusing on work delivered locally as opposed to regionally or nationally, and that clear guidance around evidence was necessary
• others emphasised the need to be clear that 'service' is not always clinical or patient-facing – they said that a lack of clarity may put some applicants off from applying

Domain 2: leadership

Consultation response:

• extending the focus on leadership was broadly welcomed
• organisations noted the benefits of how leadership of training can drive clinical effectiveness and efficiency
• asking for evidence on how the applicant has been actively involved in driving inclusivity and diversity was welcomed
• a requirement for applicants to demonstrate how they might have developed or influenced changes which reflect the expected and aspirational culture and values of the NHS at a regional or national level was considered to be useful
• others expressed the need to require evidence of how contributions have helped to establish multi-disciplinary teams and the delivery of new ways of working to improve patient care
• some respondents suggested that that the Medical Leadership Competency Framework may be helpful to identify areas of excellence linked to working with others, managing services and improving services

Domain 3: education, training, and people development

Consultation response:

• organisational responses suggested the need to ensure that this domain recognises effective transformational education
• there was also support for ensuring that this domain recognises those applicants who are driving innovation in postgraduate medical education (PGME) and in optimising and enhancing training opportunities

Domain 4: innovation and research

Consultation response:

• a small number of respondents expressed views that this domain was too heavily skewed towards academia and may disadvantage or put off clinicians on the front line
• views also reflected that research was often a 'paid' activity compared to an 'NHS activity' and that additional clarity would be required in guidance to ensure that individuals were not rewarded for paid activity

Domain 5: new domain on nationally or internationally recognised quality improvement

Consultation response:

• 12 respondents stated that although they agreed with the principles behind including a 'catch all' domain, they would have concerns about the subjectivity of scoring and that clear guidance would be needed to ensure equity and fairness in assessing and scoring
• a number of respondents sought clarity on whether the focus of this domain was to allow applicants to amplify or extend what they had already submitted across the other 4 domains, or whether it was to capture wider national priorities that did not fit elsewhere
• some expressed that they would like to see this domain include work supporting medical and health charities in order to improve patient outcomes

Improving access to the national scheme

The consultation set out that both DHSC and the Welsh Government wanted to explore options for improving the current application process. With both organisations' key objectives being to encourage the most deserving applicants to apply for an award and to be fair and equitable, and not disadvantage any eligible group of applicants.

DHSC and the Welsh Government want to encourage employers to ensure that applicants from their organisation reflect the diversity of their consultant workforce, with support for more female and ethnic minority consultants. As part of this, they should consider encouraging applications from traditionally under-represented speciality groups, with reporting of application diversity against appropriate benchmarks.

The consultation drew on recommendations from the Mend the gap review and proposed taking on board its recommendations to:

• more closely monitor applications and improve reporting mechanisms to help facilitate applications from specialties that are generally in receipt of lower awards and
• pay awards at the full value regardless of whether applicants work LTFT

Question: Do you agree or disagree with our proposals for improving access to the NCEA competition?

Analysis of responses

80% agreed.

The approach to assessing applications was welcomed as helpful in addressing the gender and ethnicity gap in CEAs.

Respondents raised the importance of ensuring the future online system is compatible with assistive technologies.

Question: Do you have suggestions on how we can improve access to the scheme for women and those with protected characteristics?

Analysis of responses

There were 139 responses to this question.

A large number expressed the need for more detailed recording of protected characteristics which extended beyond gender and ethnic minorities.

Other views reflected that analysis should not be limited to solely assessing the diversity between successful and unsuccessful applicants, but that analysis should also be conducted on the diversity of all applicants compared against the diversity of the eligible consultant workforce.

The BMA noted that as things stand all ethnic minority doctors are classed under the BAME umbrella. They said that, where possible, this data should be broken down further as 'BAME' may conceal ethnic minority groups.

Responses from organisations supported the proposals to implement fairer, more transparent mechanisms for measuring, recognising and rewarding excellence. They said that the proposals would be helpful in addressing some of the historical award biases, and in increasing reach to those with protected characteristics.

Other responses supported the need to undertake a detailed equality impact assessment to better understand the potential impact of the proposals on those with protected characteristics.

Some responses to the consultation discussed education for scorers on recognising and counteracting unconscious bias, particularly surrounding citations and employer support for applications.

Another suggestion in the responses was name-blinding applications to address unconscious bias.

There were mixed views about eligible applicants continuing to self-nominate. Some respondents felt that this was helpful to remove any biases that might be associated with an employer or other means of nomination. Others suggested that applicants from under-represented groups, especially where English is not their first language, may be discouraged by having to self-nominate.

There was a strong view that guidance should be strengthened to emphasise the role of employers in proactively encouraging and supporting applications. Some suggested that applicants who are not successful in attaining an award should receive feedback on their application and be given encouragement and assistance to help them reapply.

Question: How far do you agree that those working less than full time (LTFT) should be in receipt of the full award values as opposed to the current pro-rata award payment?

Analysis of responses

265 respondents answered this question with a strong consensus that it was important to ensure those working LTFT are not penalised.

There were mixed views about whether LTFT applicants should be awarded the full award value as opposed to being pro-rated – with 42% in agreement and 36% disagreeing. 22% did not indicate a strong view one way or the other. Those in agreement argued that the pro-rata award was a contributing factor in escalating issues for gender inequality.

The BMA stated that following a survey of consultants in Wales asking what impact particular proposals would have on their likelihood to apply for CEAs, 1 in 8 male and 1 in 5 female respondents said they would be more likely to apply for CEAs if the pro-rata element was removed. Similar views were reflected by the Academies. Some respondents said that it would be important to have clear guidance for scorers to make sure achievements were assessed with applicants' job plans in mind. This would avoid unfairness if applicants were judged on volume rather than quality of work resulting in an element of unfairness.

Some responses argued against ending the pro-rated award, saying that the standard of excellence may be unattainable to LTFT consultants, so a balance should be struck in ensuring the amount paid is fair to those working LTFT while ensuring that those working part time are not disadvantaged in securing awards.

2 respondents asked us to consider the disparity for those who may work LTFT in the NHS but have a paid role elsewhere, versus those who work LTFT and do not.

Maintaining excellence during the period covered by a national award

The consultation set out the ambition that clinical excellence is maintained for the period that the CEA is in place.

The consultation proposed that as part of the application process applicants are asked to provide an outline plan covering the period for which, if successful, the CEA would be paid.

Question: Do you agree or disagree that this is an appropriate way of incentivising the maintaining of excellence during the period covered by a CEA?

Analysis of responses

255 respondents answered this question. 48% agreed and 52% disagreed.

There was general agreement among respondents about the importance of continuing to demonstrate excellence throughout the award period.

Those who disagreed had reservations about the additional administrative burden of providing more material. There was a strong view that the awards scheme was intended to recognise and reward excellence already achieved rather than future outcomes, with concerns that it would not be possible to make this more than a 'tick- box' exercise.

There were also views that contributions which go 'above and beyond' were often time-limited and in response to the changing needs of the NHS.

Question: What proposals do you have to ensure CEA holders maintain clinical excellence throughout the time they hold the award?

Analysis of responses

130 respondents made suggestions in response to this question.

A large number of respondents suggested that stronger links to annual appraisal, peer review and revalidation might be one way to assure clinical excellence was maintained, and indicated a need to emphasise the role of employers in achieving that within any guidance.

Other views included only requiring award holders to demonstrate continued excellence in their strongest domain or domains, or judging achievements attained since their last award.

An end to the renewals process

The consultation proposed to retain the 5-year award period but to end the current renewals process for awards, proposing instead that clinicians would be required to apply for a new award at the point of expiry.

The aim of this proposal was to set clearer expectations that all applicants compete with each other at the time of application, and incentivise existing award holders to maintain high standards if they wish to obtain an award in the next round. The consultation suggested that this may serve to improve diversity, and enhance access to higher level awards for younger high-performing consultants.

The consultation explained that under the present scheme the procedure for applying to renew a national CEA is essentially identical to the process for making an application for a new award. However, maintaining the separation between new and renewal applications is administratively burdensome and requires a separate scoring process.

Question: Do you agree or disagree that the 5-year award period should be retained, but ending the renewals process for awards, with clinicians applying for a new award at the point of expiry?

Analysis of responses

72% of the 253 who responded agreed.

Respondents supporting this proposal reflected that under the present scheme the procedure for applying to renew a national CEA is essentially identical to the process for making an application for a new award. Therefore these respondents felt that it was immaterial as to whether clinicians formally make a new application or a renewal.

There were mixed views regarding the award period. Some suggested requiring applicants to reapply more frequently to encourage continued excellence. Others feared this would disincentivise applications, particularly from women and other under-represented groups.

The pensionable status of NCEAs

The DDRB, in its 2012 review, stated that it was no longer appropriate for the awards to be pensionable. They saw this as a legacy from a time when they were treated as permanent salary increases.

The consultation set out that the pensionable status of NCEAs no longer fits with the idea of a modern, non-consolidated reward scheme. The current pensionable status of CEAs has tax implications for some higher-level national award holders of long standing. This has resulted in some award holders surrendering their CEAs for financial reasons or reducing their hours or retiring early. It may also have dissuaded applications and reduced the ability of the scheme to promote the retention of high performing senior clinicians within the NHS.

However, we recognise that making CEAs non-pensionable may affect consultants at the earlier stages of their careers. However, the consultation set out that we expect that this would be offset by increased access to the award scheme of a much greater proportion and number of women and black, Asian and minority ethnic consultants, where they are currently under-represented.

As such, the consultation said that both England and Wales agreed with the DDRB recommendation that awards should be non-consolidated and non-pensionable.

Question: Do you agree or disagree that NCEAs should be non-pensionable?

Analysis of responses

257 responded to this question. 57% agreed and 43% disagreed.

There was wide acknowledgement of the intent to make national awards non-pensionable to increase the number of awards available. However, some felt that the scheme would be devalued.

Responses from organisations reflected that their members had mixed views on this proposal.

Others raised concerns about the impact on those who are closer to retirement age for whom this may prompt them to retire or leave the NHS prematurely. We do not believe this is the case – see section 4, ‘Government response and summary’.

The BMA were strongly opposed. They argued that making awards non-pensionable would entrench the gender pensions gap as younger consultants (a higher proportion of whom are female and from ethnic minorities compared to older consultants) will no longer be able to access pensionable NCEAs.

There was a general lack of clarity on whether this would apply retrospectively to current NCEA holders or whether this would purely impact on new award holders under the new scheme. To clarify: all accrued rights will be protected.

The role and value of rankings and citations in the award process

The consultation document set out that in the present scheme employers are required to score and sign off all applications from their employees, providing an employer statement and stating their level of support (supported, qualified support, not supported). Certain employers also provide rankings of their supported applicants. This was modified in the 2021 round with employers simply indicating their level of support.

The consultation outlined that certain national nominating bodies (NNBs) and specialist societies (SSs) are accredited and permitted to provide rankings and citations for their members. Accredited organisations are allotted a number of 'ranking places' based upon the size of their membership and their national standing. The 28 NNBs are mainly Royal Colleges. There are around 130 accredited SSs of various sizes, covering a wide range of specialties and subspecialties. In 2019 there were over 1,600 nominations made for the 300 awards available.

The consultation also set out that applicants are able to solicit supportive third-party citations from any other individual or organisation should they wish to (noting that the ability to seek third-party citations was removed temporarily in the 2021 round).

The consultation noted that there are instances of applicants with multiple, often duplicative citations that do not add to the triangulation of evidence and that there was a strong case to reduce the workload for applicants, scorers and citation providers alike.

The consultation therefore proposed to:

• retain employer sign off, confirmation of support and the provision of employer statements. In addition, employers would be asked to provide ACCEA with a statement of their process, to ensure equality and diversity and balanced representation of applicants from their eligible population of senior clinicians. The consultation proposed to remove any ranking of applicants by employers

• review the list of accredited NNBs and SSs to ensure no specialty or sub-specialty is represented by multiple different bodies, potentially over-leveraging its influence and that any accredited NNB or SS is of national standing and influence. As above, the consultation proposed that NNBs and SSs will be asked to provide a statement of their process to ensure equality and diversity and balanced representation of applicants from their membership and the wider specialty

• limit the number of third-party citations – the consultation noted that in many cases we see identical citation text from different sources, there being no quality assurance process possible for such 'personal' citations

Question: Do you support the changes proposed for the role of employers?

Analysis of responses

250 responded to this question. 81% agreed.

Question: Do you have any other comments on the role that employers should take in a new national award process?

Analysis of responses

87 respondents provided additional comments.

There was support for removing the requirement for employers to rank and score applications, with some respondents reflecting that this was a factor which often discouraged applicants from applying, encouraging inequality.

The majority of respondents did, however, strongly support the need for employers to validate the accuracy of information provided by the applicant.

Some respondents raised issues relating to academic GPs who may not have easy access to a medical director and therefore support and endorsement may be more challenging, suggesting more guidance was required.

Concerns about the variance in processes and levels of support given by employers were raised, this was reflected as an issue from organisations.

Many reflected the importance of the employers' role in supporting applicants given that governance and appraisal structures sat at a local level. This would be particularly important in encouraging applications from under-represented groups.

There was also some suggestion that the proposals as outlined did not go far enough to prevent the possibility of poor practice in sub-committees, entrenching problems that exist around equality.

There was a shared view from both individuals and organisations that the ACCEA should require employers to be more transparent about their reasons for not approving applications, and for this to be audited to assure fair consideration and support have been provided by employers.

Some raised the question of who should sign-off applications, suggestion it should be a clinician, or someone familiar with the work of the applicant, enabling them to countersign and validate the veracity of statements made in the application

A number of responses supported continuing of the process that had been introduced in the 2021 award round, saying that it should be kept as straightforward and simple as possible.

Question: Do you agree or disagree with the changes proposed for identifying who should be an accredited NNB or SS and reducing potential over-representation of specialties and sub-specialties?

Analysis of responses

247 responded. 84% agreed.

Respondents in agreement also expressed that it was important to ensure no one specialty was over-represented.

Responses from organisations that agreed reflected that the current selection of accredited bodies was historical and did not reflect the range of activity which many consultants provide to the wider NHS.

Out of the 16% who disagreed, a small number suggested that NNBs and SSs reduced the transparency and fairness of the scheme, and while proposals to reduce their influence was a positive step, they proposed removing them from the process completely.

Organisations that disagreed stated that NNBs and SSs had an important role in assessing the impact of an applicant's work. They said that many applicants work in relatively niche areas and it is not always possible for scorers to fully appreciate the significance and national impact of their work.

A small number of respondents asked for the list to clearly outline accredited bodies for academic GPs.

Question: What criteria should determine whether an NNB or SS should be accredited?

Analysis of responses

94 respondents provided comments in response to this question.

There was strong support for having a consistent process for accrediting NNBs and SSs.

Some suggestions on the criteria base that should be used for accrediting NNBs and SSs included them:

• being a body of national standing and influence and be officially recognised as such by its members
• being able to show the proportion of eligible consultants in membership
• being able to demonstrate fair and equitable process for nominating and be able to provide data on diversity and inclusion
• being selected on the basis that equal weight can be given to generalists as to specialists
• having a membership base which is proportionate to the total number of consultants in that particular specialty
• being defined by outputs, for example on education, research, leadership and so on
• being a body or society which any gender, race or religion could join, that is, is not a representative group predominantly based on any one of the protected characteristics
• being able to evidence clear criteria for assessing member applications with appropriate EDI data to demonstrate they are being considered fairly and openly

Of the responses from organisations there was broad support for requiring NNBs and SSs to publish their data, scoring methodology and justifications, to provide the necessary assurances that processes are transparent and fair.

Others supported the need to standardise processes to ensure scoring panels were reflective of their membership base and had appropriate training in equality and diversity.

Some said that NNBs and SSs should continue to produce ranked lists and assess the overall contribution of the applicant to their specialty and the wider NHS to remove any biases or leaning towards prioritising work that has a direct impact on their own organisation.

Question: How far do you support the changes proposed for third-party citations?

Analysis of responses

252 responded. 66% agreed. 25% of respondents neither agreed or disagreed. 9% of respondents disagreed.

There was a general consensus that these bodies had an important role in quality assuring applications.

Limiting citations to a maximum of 2 was widely welcomed, with others suggesting that applicants should only be able to refer to one NNB for a citation, saying that this could reduce any potential advantages for those who may be connected to multiple national bodies over those who are only affiliated to one.

It was also felt that it would be helpful for ACCEA to reclarify the purpose of citations within any new guidance, as there was a lack of understanding around whether these should be used to verify the statements made by a candidate, or in making a judgement of their application.

There was also suggestion that further guidance should outline the type and level of weighting that should be given for third-party citations.

Any other comments on the future arrangements for NCEAs

Question: Do you have any additional proposals or further comments on future arrangements for the NCEA scheme?

Analysis of responses

156 respondents provided comments in response to this question.

A total of 17 respondents were of the view that Clinical Excellence Awards should be abolished, with some challenge as to why we did not ask this specific question in the consultation.

There was a request for greater clarity around the process for considering national awards including the single-tier application process and how the regional scoring process would be used to determine what level of award the applicant received. In particular, the Royal Colleges and Academies wanted to understand whether the new process would replace or run alongside their current arrangements for platinum awards.

Many respondents suggested the need to raise awareness of the scheme, for example through raising with professional groups and member bodies.

A small number of respondents suggested the need to remove self-nomination which has also been cited under ‘improving access’, particularly for women or ethnic minority groups who arguably may be less likely to self-nominate.

A number of respondents expressed concerns that we have referenced consultants but not academic GPs, and raised the perception that this group of people have been omitted from engagement or have not been consulted.

4. Government response and summary

This section summarises the government's response to the proposals as outlined in the consultation document. It sets out how we will deliver a new scheme that rewards the highest performing consultants, while being more inclusive and reflecting the new ways of working across medicine.

Rebranding of the scheme

The new awards will be called National Clinical Impact Awards (NCIAs) from 2022. In due course, ACCEA will become ACCIA (Advisory Committee on Clinical Impact Awards).

Pay protection and its impact on the scheme

In 2018, the government approved Schedule 30 of the English 2003 consultant contract, negotiated and agreed between NHS Employers and the BMA. The schedule provides transitional pay protection where a new National scheme is introduced that has lower award values. This protection is costly, peaking at over £30 million in 2025 to 2026. The NCIA scheme must remain affordable within the annual budget available and so pay protection will have consequences for the money available new awards in the short and medium term.

The contractual arrangements for pay protection can only be altered by collective agreement with the recognised trade unions. To date the BMA have not been willing to enter discussions to renegotiate the terms, however we remain open to reconsidering the pay protection arrangements in partnership should their position change.

The cost of the pay protection arrangements has been factored into plans for the reformed scheme, altering the scheme design in some places for the transitional period. However, there is uncertainty around these costs. The actual costs of pay protection will be reviewed periodically, with adjustments made each year, for example to the numbers of awards available, as a result.

The government's response to the consultation outlines both the intended final outline of the scheme and, where applicable, the arrangements which will apply while the financial impacts of pay protection have a limiting effect.

Please note that this does not apply to Wales.

Broadening access to the national Clinical Excellence Awards Scheme

Increasing the number of awards

In England, our aim is to award up to 600 awards per year.

The pay protection provisions described above mean we may have to adjust the number of awards at each level, or may not be able to award the full 600 awards in the first few years of the scheme, taking into consideration the actual costs of pay protection as they become clear each year.

Following discussion with NHS England and Improvement (NHSEI), we have agreed the budget for these awards over the next 5 years. This provides planning certainty for the NHS and for ACCEA.

Year	2022 to 2023	2023 to 2024	2024 to 2025	2025 to 2026	2026 to 2027	2027 to 2028
Scheme budget (£m)	127	128.5	130	131.5	133	134.5

We will review the numbers of awards available in 2025 with a view to increasing the number, acknowledging that the consultant workforce is likely to have grown. Whether this is possible will depend on the cost of pay protection, which we anticipate will start to fall from 2026 to 2027 onwards.

In Wales we will increase the number of awards to approximately 37 per year once the transition period has concluded. In the meantime, the numbers of awards available will vary during transition as they will be dependent of awards from the previous scheme expiring and money becoming available to fund the reformed awards along with the costs of new award holders retaining commitment awards.

Value of awards

Increasing the number of awards is made possible by lowering their value. We recognise views expressed about the decrease in the value of awards and whether this may discourage applicants from applying. However, we would anticipate that in increasing the number of awards made available and the stability offered by the 5-year award period will offset this.

These awards are prestigious, to reward consultants making significant national contributions, and to indicate their professional standing. This prestige is, and will remain attractive to potential applicants. The award values will be subject to recommendations from the DDRB, and will be kept under review.

The award names and values in England will be:

• National 1 – £20, 000 per year for 5 years
• National 2 – £30,000 per year for 5 years
• National 3 – £40,000 per year for 5years

We anticipate the split between levels being:

• National 1 – 330
• National 2 – 200
• National 3 – 70

This incorporates feedback offered through the consultation that award numbers should be weighted towards National 1. These proportions and numbers may change depending on annual financial limitations as described above.

Wales will operate a 4-level scheme, and would expect to make the following number of new awards available each year by the end of the transition period:

• National Level 0 – £10,000 per year for 5 years. 20 awards available each year
• National Level 1 – £20,000per year for 5 years. 10 awards available each year
• National Level 2 – £30,000 per year for 5 years. 5 awards available each year
• National Level 3 – £40,000 per year for 5 years. 2 awards available each year

Following consideration of the consultation responses, along with stakeholder engagement, consultants in Wales will be allowed to hold both a NCIA and a commitment award concurrently. As a result, the number of awards available in Wales has been reduced to enable consultants to hold both awards in future.

The number of awards available will vary slightly year on year depending on the commitment award point successful consultants will be on.

Please note that consultants who hold both a commitment award and a NCIA will continue to progress through their commitment award scale. While the NCIA’s are non-pensionable, commitment awards will continue to be pensionable.

Local performance awards and NCEAs

The link to the local scheme

As set out above, the new national scheme in England will operate as a 3-level award scheme. The use of current award names and a reference to devolving the bronze level award into a new local performance scheme combined to produce an unintended impression in the consultation that these reforms would reduce access to awards. On the contrary, the new scheme improves accessibility to awards, including at the entry level, and we want to offer assurances that this is our approach.

Work continues with the relevant bodies leading on the negotiations to develop a new local performance scheme, to recognise links and interdependencies between the schemes. We will continue to work to ensure that local, regional, and national impact are recognised and rewarded in the most appropriate way.

We acknowledge the concerns raised about differential access to local and national awards for academic GPs based on different contract agreements. Academic GPs have access to the national scheme; issues relating to the local scheme were out of scope of this consultation.

A small number of respondents raised that academic GPs had not been explicitly referred to during the consultation, and felt they may have been excluded. We referred to 'consultants' or 'clinicians' generally throughout the consultation for ease of reading, and these terms should be seen to include academic GPs.

National awards and local awards to be held concurrently

The intention behind the proposal to allow consultants to hold a local and national award concurrently in England was to motivate individual excellence both locally and nationally. Many consultants contribute both to the functioning of their local provider and on the national stage, and these individuals should be rewarded accordingly. The 2 complementary systems were planned to be designed to encourage and reinforce excellence in impact and behaviours right across a broad range of consultant activity, resulting in a flow through between the 2 schemes.

In feedback to the consultation some respondents expressed concerns around individuals using the same evidence for both schemes and being 'double paid' for the same work. However, we think that these concerns would be surmountable with good applicant and assessor guidance and appropriate assurance processes.

Making national award holders eligible for local awards would have to be supported by a transfer of funding from the national to local scheme. In the context of a fixed national funding position, and where there is a pre-existing commitment to provide pay protection for existing national award holders, this would further reduce the funding available for new national awards.

Taking this into consideration, the decision has been made to continue with the current eligibility criteria. This will mean that a consultant cannot hold both a local and national award concurrently during the transition period.

We intend to review this position once the financial position of the schemes is clearer, and once the cost of protections is starting to reduce, to determine whether it will be possible to realise the intended benefits stemming from consultants being able to hold both types of awards. This will be no earlier than 2025 on the basis of current financial modelling.

Changes to domains for assessing NCIA applications

Both England and Wales will review the descriptors across all domains to provide clarity that evidence must describe what has been delivered and its national impact, relate to work that is over and above the job plan, and include dates. An updated online application system will provide improved support to applicants and assessors, helping reduce the likelihood of repetition or the unintended omission of supporting detail.

After consideration, we will retain the requirements to submit evidence across all 5 domains, rather than asking for evidence in only 3 or 4. Reducing the number of domains in this way would increase the complexity of assessment, as well as increasing the risk of applicants underestimating the relative strength of the evidence in each domain and potentially losing scoring opportunities as a result. It is possible in the current scheme to achieve an award through excelling in 2,3 or 4 domains. Our new guidance will ensure that this is made expressly clear and be supported by case studies of such award holders.

Further clarity about developments under each domain descriptor and guidance are summarised below.

Domain 1: developing and delivering your service

We are satisfied that there is strong support for merging domains 1 and 2 which will remove the potential for confusion or duplication of evidence around 'delivering' and 'developing' a service. More emphasis on the national impact will be captured in the new guidance with additional clarity around the term 'service', which is intended to relate to the individual's job plan.

Domain 2: leadership

We believe that the shift to 'leadership' as opposed to 'management' is more appropriate to capture impact, and our guidance will strengthen this. We will include a stronger emphasis around equality and diversity in this domain with appropriate wording on demonstrating the values of the NHS.

Domain 3: innovation and research

Academic roles and associated job plans are variable, some having a greater emphasis on teaching and others on research. Much high-quality NIHR-supported research and clinical trials work is delivered by NHS consultants, who score highly in this domain. Clearer guidance will be provided on what is considered 'above' role expectations, taking account of what is already paid through research funding.

There will be a focus on the output and impact of research as relevant evidence, rather than the granting of funds for research, and on the personal contribution of the applicant to research and innovation projects. We will also provide clearer guidance relating to the relevance and impact of publications, as well as additional space on the form for their citations, with an explicit emphasis on quality rather than number.

Domain 4: education, training, and people development

We will provide more clarity in the descriptors and guidance on what constitutes evidence in this domain – in particular, the importance of providing context around audience, impact, calibre, learning and knowledge, including any feedback that might have been received on what has been delivered.

We have acknowledged responses which emphasised the need to encourage individuals to undertake postgraduate medical and inter-professional education, training and assessment activities and will capture this within our guidance.

New domain 5: additional national impact

We will provide clarity in guidance on what constitutes excellence and impact under this domain to ensure there are no unintended consequences, such as disadvantaging some applicants if they have limited additional evidence.

We will want to enable applicants to include any work for charitable organisations, alongside work which may have more of a patient or public focus, that is of clear benefit to the NHS, for example:

• tackling health and workplace inequalities
• fostering interprofessional teams-building
• new ways of working
• international work in training, research or recruitment

Improving access to the national scheme

Simplifying the process

Both England and Wales are satisfied that the responses from the consultation support the shift towards a single-level application. We will develop improved guidance materials, alongside a communications strategy to raise greater awareness of the scheme. The introduction of a new IT system which will enable us to provide additional guides and prompts within the online application form will ensure greater clarity and transparency in the application process.

Improving access for women, black, Asian and minority ethnic groups

England and Wales recognise the need to review assessor training and guidance to ensure the anchor statements, assessment criteria, and benchmarking of assessments is clear and transparent.

Responses were clear about the importance of ensuring that the new scheme is communicated and promoted more widely, particularly to those under-represented in the current scheme. Both England and Wales will work closely with employers and other stakeholders to promote the new scheme.

England and Wales also acknowledge comments from the consultation which suggested the need for name-blinding. There are challenges for the assessment of applicant's evidence if all identifying information is removed, however we continue to consider how best we can reduce the potential for unconscious bias during assessment. The introduction of new additional training and guidance for scorers will help alleviate these issues, and we continue to strive to increase diversity of our regional scoring groups.

Both England and Wales agree with feedback regarding the need to improve collection and monitoring of equality and diversity data. We agree with the view that the term 'BAME' is not reflective of all ethnic minorities, however, this is hard coded into NHS systems and is not something the ACCEA can directly influence. We are therefore reliant on the willingness of applicants to provide information to us. To encourage greater disclosure, we will revisit our data protection obligations and provide further guidance and reassurance justifying why we need to collect this type of information. We will be collecting more diversity data than at present and will continue to report and expand this to provide greater transparency by region and speciality where possible. We will also consider developing guidance to include requirements for employers to publish their data on diversity of applicants using NHS Digital diversity data as a benchmark.

The University of Exeter has been commissioned by NIHR through a competitive process to undertake research into our scoring mechanisms. This will inform decisions on the format and operation of many components of the new system. The review should help us to ensure that our scoring processes are fair and non-discriminatory, reflect the right balance of breadth and depth of achievement and that the scoring process as used in the current scheme is understandable to both applicants and assessors. The research outputs will help to inform our assessment and validation of any revised scoring processes in the new scheme.

Less than full-time (LTFT)

We are satisfied that the consultation response supports our proposal to remove the pro rata element of the awards for those who work LTFT. This is aligned to other recognition schemes where awards are not pro-rated. This was a particular area of importance for the ACCEA main committee.

Both England and Wales acknowledge the need to carefully consider this shift to ensure our approach does not have any unintended consequences of scoring the achievements of LTFT applicants differently to those who work full time. To alleviate this, new guidance will be provided to clarify that the assessment process will be the same for both full time applicants and those working LTFT. However, greater emphasis will be given on the need to assess the quality of the contribution and its impact in the job plan and whether it is over and above what is contractually required.

Guidance will stipulate that in order to be eligible, candidates require a minimum of 3 clinically relevant PAs and 5 PAs in total, ensuring the importance of contributing directly to the NHS. Noting comments on LTFT applicants who may have other roles, we will continue to request information on other paid work from all applicants. We will also consider extending the requirement to provide evidence over a modified period in particular circumstances, that is, to tackle potential issues around parental leave and sickness.

Maintaining excellence during the period covered by a national CEA

We have considered feedback to the consultation and, while we still believe that there is merit in requiring applicants to outline aspirations in a job plan, we agree that aspirations and future outcomes cannot be used as an indicator of excellence or impact and should not be scored. We also acknowledge views around the difficulty in ensuring such information does not influence decision making. We will not be progressing with the proposal to ask candidates to outline their future plans as part of their application.

An end to the renewals process

In England and Wales will remove the ability for award holders to renew, meaning that current award holders will need to apply for a new award before their current award is due to expire. We believe that this, alongside no longer requiring individuals to escalate through incremental award levels or state which level of award they aspire to attain, will expand opportunity for those who may otherwise not apply for an award because of the current complexities around renewal, allow individuals to progress through the award levels more easily, and potentially to receive a top-level award earlier in their career.

Make NCEAs non-pensionable

We acknowledge the comments made about the possible impact on consultants who currently hold national awards at the earlier stages of their careers, in respect of their legacy final salary benefits. It is important to recognise that from April 2022, all members will be in the 2015 career average pension scheme and the impact of final pensionable pay on overall pension benefits will reduce as the proportion of overall pension savings made up by legacy final salary benefits reduces.

We disagree that making awards non-pensionable could create an incentive for those close to retirement to retire early. The protection set out in Schedule 30 of the consultant contract will mean that doctors in receipt of pension protection will have full pensionability for up to 10 years (as existing awards will continue for the remaining term) and CPI-linked protection after that until taking their pension.

Under the new scheme, in England and Wales we will make NCIAs non-pensionable and non-consolidated. Although making new awards pensionable may provide a benefit to a more diverse group of consultants, we anticipate that removing pension benefits for new awards offsets this by broadening access to the scheme. We believe that improving access to the scheme is of primary importance to these reforms.

This is consistent with practice across the public and private sectors and is aligned to local awards which have not been pensionable since 2018. Also, given that many consultants are affected by pensions tax policy, it makes sense to offer non pensionable reward with the employer pension contributions being made available to enable more awards.

It is open to those consultants who wish to increase their pension savings to buy additional pension with the value of their awards.

Non-consolidated awards will be counted as taxable income and as such may still have annual allowance implications for some award holders. However, as a result of the government increasing the annual allowance taper thresholds from 6 April 2020, award holders can earn £200,000 in taxable income before having their annual allowance limit reduced.

The role and value of rankings and citations in the awards process

It is vital that the scheme retains a robust and effective means of assuring the information being submitted by an applicant is true and accurate, while balancing the need to improve the applicant experience. We have therefore agreed the following in England and Wales:

• in order to improve and streamline processes, we will remove any requirements for employers to score and rank applications, but will retain the requirement for them to provide validation that the information presented by applicants is a true and accurate reflection of their contribution and achievement
• guidance will provide clarity around employer responsibilities to proactively encourage and support applications for awards and require employers to provide the ACCEA with a statement outlining their processes. This statement should help to ensure equality, diversity and a balanced representation of applicants from their eligible population of senior clinicians
• we have reviewed the list of accredited NNBs and SSs (following publication of a questionnaire seeking feedback from current and potential NNBs and SSs on their processes and membership criteria). We will ensure no specialty or sub-specialty is represented by multiple different bodies and that only one NNB or SS ranking is provided per applicant
• as with employer requirements, NNBs and SSs will be asked to provide a statement of their processes to ensure equality and diversity and balanced representation of applicants from their membership and the wider specialty
• we have recognised the difficulties in obtaining reliable and objective citations and the potential conscious and unconscious biases that may sometimes play out. To address these concerns and the questionable value of many of these 'third party' additional citations, we will remove the option for any third-party citations to be submitted

Scoring processes

ACCEA have continued to work with scoring sub-committees to improve the representation of women and those from ethnic minorities, with membership increasing year on year. We will continue to work with Medical Royal Colleges, Specialist Societies and NHS employers to encourage greater gender and ethnic diversity of sub-committee professional, employer and lay members to ensure that they are more representative of the NHS and wider population.

An interim report has been prepared by the University of Exeter who have undertaken an NIHR-funded research project to evaluate the implications of different scoring schemes and how they perform with non-stratified applications and the proposed amended domains. This will inform the implementation of an appropriate and sensitive scoring scheme and will assist us in developing guidance that helps achieve valid, fair and equitable assessments of all applications.

We will retain the facility for rescoring applications by our National Reserve Sub-committee (NRES) where applications that are tied at acut-off point,or have outstanding queries that cannot be resolved. This process will be retained as part of our quality assurance processes.

We will ensure enhanced training is in place to support all those who will be involved in the new scheme. This will be mandatory for all sub-committee members. This will also inform employers, applicants and nominating bodies how to navigate the new scheme and IT user system.

Governance

New scoring and governance arrangements appropriate to the new scheme design will enable us to effectively manage the increase in applications, while still ensuring fairness and transparency in the scoring process. National governance will continue to be through the Main Committee; its oversight remains an important and established quality assurance tool and oversees the final stages of the awards round before recommendations are made to Ministers.

Annex A: organisations who responded to the consultation

Academy of Medical Educators (AoME)

Academy of Medical Royal Colleges (AoMRC)

Academy of Medical Sciences

Association of Anaesthetists

Association of British Clinical Diabetologists (ABCD)

Association of Dental Hospitals

British Association of Urological Surgeons (BAUS)

British Dental Association (BDA)

British Hernia Society

British Medical Association (BMA)

British Society for Haematology (BSH)

British Thoracic Society

Cambridge University Hospitals NHS Foundation Trust

College of General Dentistry

Conference of Postgraduate Medical Deans (COPMeD)

Dental Schools Council

ENT UK

HEART UK – The Cholesterol Charity

Health Education England (HEE)

Hospital Consultants and Specialists' Association (HCSA)

Medical Schools Council

Medical Women's Federation

Newcastle University

Public Health England (PHE)

Royal College of Anaesthetists (RCoA)

Royal College of General Practitioners (RCGP)

Royal College of Obstetricians and Gynaecologists (FCOG)

Royal College of Pathologists

Royal College of Psychiatrists

Royal College of Radiologists (RCR)

Royal College of Surgeons of Edinburgh

Shelford Group

Society for Academic Primary Care (SAPC) (responding in capacity as Chair)

Society for Endocrinology

Standing Group on Local Public Health Teams in England

The British Association for the Study of Community Dentistry (BASCD)

The Intensive Care Society

The Royal College of Paediatrics and Child Health

The UK Faculty of Public Health

Universities and Colleges Employers Association (UCEA)

The Whittington Hospital NHS Trust

Out of the 40 organisations responding, 71% indicated that they were representing a UK-wide response, 26% indicated England only and 3% Scotland only.

1. The DDRB’s recommendations and proposals included: changes to the number and value of NCEAs and committee composition; revisiting domains and weightings for assessing NCEAs; making NCEAs non-pensionable; that NCEAs should be more strongly linked to sustained performance and commitment to the NHS and should recognise achievements of national or international significance; that the system and application process should be transparent, fair and equitable; that award holders should be able to hold NCEAs and LCEAs simultaneously; and that awards should only be held for a period of up to a maximum of 5 years. ↩

2. The consultation proposed that the new fifth domain would recognise excellence in areas such as patient-public involvement, wider health promotion or health inequalities. The domain would also allow applicants to more freely include their impact in areas of other national strategic priorities, such as delivery of the NHS People Plan and development of integrated care systems in England, or working on the Healthier Wales commitment in Wales. ↩