Advisory Committee on Clinical Impact Awards: annual report for the 2022 awards round
Updated 13 December 2023
Applies to England and Wales
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Foreword
We are pleased to present the 2022 report for the Advisory Committee on Clinical Impact Awards (ACCIA). This was the first year of the new 3-level scheme recognising delivery of national impact. The revised scheme was agreed by ministers in 2021, following a formal consultation, building on recommendations made by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB).
The aim of the reforms was to increase applicant and recipient diversity by doubling the number of awards, while providing the opportunity to obtain higher level national awards more quickly. This was achieved by making applications unstratified, so no longer potentially determined by age or time served. Additionally, the ability for awards to be renewed was removed. A completely new application will be required on expiry of an award. The value of a new award will no longer be included in a recipient’s pension under the new scheme. Less-than-full-time awardees are now eligible to receive full value awards.
Increased accessibility was aided by simplification of the application process, with removal of ‘additional evidence’ forms and reductions in the number of national nominating organisations’ (NNOs) citations and their rankings, as these were not useful differentiators. While analysis of 2022 did show a small positive association with the presence of a citation, a diversity imbalance in those receiving citations, compared to those applying for an award, led the main committee to agree to remove citations and rankings for subsequent award rounds.
We received fewer applications than hoped for in 2022. Thus, with more available awards we have seen higher success rates. We believe this has delivered increased opportunities to gain awards for those who may have previously been unsuccessful, or would not have considered applying. As awareness of the new scheme grows, with its increased opportunities and accessibility, we expect more applications.
An important aspect of accessibility is enhancing diversity. While comparison to prior years is difficult, we are pleased to see increased applications from both female applicants and those who identify as being from an ethnic minority. Application and success rates currently still lag behind their male and white counterparts. However, we will continue to focus on these aspects with our NHS colleagues to encourage greater diversity in applications, with appropriate coaching to improve application quality. Our new IT system allows us further to analyse this by award level and intersectionality of characteristics, and these are presented within the report.
As we operate within fixed budgets, the increased number of awards has resulted in reduced financial values, emphasising national recognition as the retention tool for role model clinicians. Contractual, transitional financial provisions, including pay protection for existing award holders, have limited our ability fully to implement all the reforms of the new scheme at this time. This prevents us allocating the full 600 awards and allowing award holders to retain local and national awards concurrently. ACCIA will evaluate its costs annually to assess when these aspects of the reforms can be fully implemented.
It is our hope that ACCIA continues to play an important role in staff retention, incentivising participation in teaching, training and research, all of which are critical to the future of UK healthcare. For this reason, revised evidence domains have been designed to provide opportunities to describe impact in these and other areas, in addition to the key clinical domains.
The scheme’s overall operation has been greatly enhanced by our new IT system and portal. The secretariat deserves great credit for successfully commissioning, testing and implementing it for 2022. We must also recognise the exceptional efforts of our small secretariat and all our sub-committee scorers in supporting the new scheme. The continuing drive to recruit scorers, chairs and medical vice-chairs with diverse backgrounds by the secretariat is essential, as is the reallocation of scorers across regions to balance workload and scorer diversity. Significant work was required to organise 16 interactive online training sessions for nearly 400 assessors to accredit them as scorers in the new scheme.
The secretariat’s work is not always seen but is essential for effective functioning of the scheme. On behalf of all applicants, assessors and from ourselves, we are most grateful.
Stuart Dollow, Chair
Kevin Davies, Medical Director
Context
It is widely recognised that the NHS is under unprecedented pressure from demand for healthcare with limited resources. The ability to satisfy demand relies on a skilled, trained and motivated workforce. The NHS holds the distinction of being the largest employer in Europe and the world’s largest employer of highly skilled professionals.
The NHS workforce is highly diverse, as evidenced by the NHS Workforce Race Equality Standard 2022 data analysis report. Black and minority ethnic staff now account for nearly a quarter of the entire NHS workforce data. NHS Workforce Statistics show that, as of March 2022, female representation among NHS consultants in England stood at 39% and minority ethnic groups at 39.4% (with 4.9% preferring not to disclose).
It is crucial that ACCIA maintains its support and contribution to the retention of talent and innovation within the NHS by recognising and rewarding clinicians, across the multiple and diverse characteristics it represents.
What is ACCIA?
The Advisory Committee on Clinical Impact Awards (ACCIA), formerly known as the Advisory Committee on Clinical Excellence Awards (ACCEA), is an independent, non-departmental public body. ACCIA advises ministers in the Department of Health and Social Care (DHSC) and the Welsh Government on the granting of national Clinical Impact Awards (NCIAs), to NHS consultant doctors, dentists and academic general practitioners via an annual competition. ACCIA is not responsible for local awards.
The purpose of the awards scheme is to recognise senior clinicians’ achievements of national or international significance, beyond the expectations of their job plan. Separate schemes operate in England and Wales using the same broad principles, utilising a shared application platform. Eligibility for the scheme is part of the NHS consultant contract and contributes to the retention of talented and innovative clinicians within the NHS.
ACCIA is responsible for the operation of the scheme and is led by a publicly appointed chair and medical director. Secretariat support throughout the process is provided by a small team of civil servants within DHSC.
The 2022 awards round was the first iteration of the NCIAs (previously the national Clinical Excellence Awards (NCEAs)) following the reforms introduced following the 12-week public consultation in 2021.
Reforms
The scheme was reformed in 2022 to broaden access, make the application process more inclusive and equitable, and ensure the scheme retains, rewards and incentivises high-performing clinicians. Following a 12-week public consultation, significant changes were made, including the following.
Re-structured award levels
In England, the new scheme operates on a 3-level award system, doubling the number of annual awards from 300 to 600, with a target of:
- 330 National 1 (N1) awards (£20,000)
- 200 National 2 (N2) awards (£30,000)
- 70 National 3 (N3) awards (£40,000) per year
Awards are granted for 5 years.
Wales has one additional tier, National 0 (N0) (£10,000) and determines their own award numbers at each of these 4 levels annually.
This replaces the previous bronze, silver, gold and platinum award system and increases the overall number of awards granted. These reforms have contributed to a substantial increase in success rates. In 2022, applicants achieved a 46.7% success rate compared to an average of 29.5% over the last 6 years.
Refreshed assessment domains
The current assessment domains have been developed, combining domains 1 and 2 (delivering and development) and introducing a new fifth domain (additional national impact), encouraging a wider scope of evidence to be submitted.
Simplified application process
A single level application process has been introduced, with self-nomination being retained. Award levels are determined based on ranking of regional sub-committee scores against the indicative numbers of awards available in each region following an unstratified assessment.
Pro rated awards have been removed
Those working less than full time will no longer have their award payments pro rated and will receive the full amount for the award they have been successful in obtaining.
Renewals process has been removed
The renewals process will not continue in the new scheme. Awards are held for a total of 5 years, at which point applicants need to re-apply.
Awards will no longer be pensionable or consolidated
In line with the industry standard, awards will no longer be pensionable or consolidated. This is a common approach across both public and private sectors.
The reforms introduced build on recommendations made by the DDRB and within the Mend the Gap: independent review into gender pay gaps in medicine in England, aiming to address pay gaps in NHS pay.
2022 awards round
Clinical impact examples from 2022
The NCIA scheme 2022 recognised exceptional consultants across multiple specialties and regions. As expected, there was widespread citing of work relating to COVID-19, with national contributions to the pandemic response being specifically recognised.
Other positive impacts were development of innovations that led to more efficient and effective healthcare pathways, or the conduct and dissemination of research that changed practice and national guidelines to improve patient outcomes. Similarly, the design and delivery of postgraduate education and training to increase the numbers and skills of NHS colleagues nationally was notable, with creative use of digital tools initially during the pandemic, leading to wider engagement and training impact.
These achievements across the breadth of the NHS reflect outstanding contributions to patient care, medical research and healthcare delivery, which underscore the importance of this work and its positive impact on patients and the medical community. The NCIA scheme recognises these exceptional consultants, setting the stage for their continued success and future contributions to the NHS, reinforcing their importance as role models for their colleagues.
For further examples of achievements by award holders, see the personal statements for the 2022 awards round.
Timetable
- The 2022 awards opened for applications in April 2022 and closed in June 2022. This was later than in prior years to allow time for assessor training and database testing.
- Scoring of applications took place from June 2022 to September 2022.
- Regional sub-committee meetings were held between September 2022 and November 2022.
- Main committee meeting was held in December 2022.
- Main committee recommendations were sent to ministers for approval in January 2023.
- Outcomes were communicated to applicants in February 2023.
- Appeals were processed between February 2023 and May 2023.
Withdrawn applications
Applicants may withdraw their application at any time before the awards are announced, and ACCIA will withdraw applications from assessment where the individual leaves eligible employment during the awards round. In the 2022 round, 7 individuals granted an NCIA declined the award after application outcomes had been announced, as they stated that they wished to retain their local Clinical Excellence Award (LCEA) for financial reasons.
ACCIA considers the award granted as soon as ministerial approval is given to the recommendations of the main committee. Therefore, an employer is instructed that the applicant has been successful and to withdraw the LCEA. As any award holder can relinquish their award at any time once the award is granted, this is their prerogative. In this instance, reinstatement of an LCEA is a matter for determination by employers and is not necessarily automatic or guaranteed.
ACCIA has updated the guidance on relinquishing LCEAs when granted a national award and emphasised the need for potential applicants to consider the financial implications of all possible outcomes before submitting their form. Any award not accepted at the end of the process cannot be re-allocated, meaning other potentially suitable applicants may be deprived of an award should this occur. ACCIA guidance now makes it clear that only evidence since the last successful application can be considered, irrespective of whether the award was accepted.
New award analysis
ACCIA is committed to ensuring that the awards scheme does not contribute towards, or further entrench, pay disparities. Our aim is to ensure the awards scheme is representative of the entire consultant workforce - this includes gender, age, ethnicity, disability and regional representation.
When looking at self-reported diversity data, it important to remember that applicants have the right not to disclose personal information, so the findings displayed in this report may not always represent 100% of the applicant pool.
In addition, some of the data reported below has been collated from wider NHS data platforms and, therefore, there is potential for further inconsistencies.
In 2022, there were a total of 1,267 applications for new awards: 1,186 applications in England and 81 in Wales. A total of 590 new awards were granted overall - 553 in England and 37 in Wales, resulting in an overall success rate of 46.6% in England and 45.6% in Wales.
Table 1 shows the number of applications for new awards and success rates over time. Application numbers had decreased through the years (2010 to 2019) except for the pandemic ‘catch up’ round in 2021. Although lower than in 2021, 2022 application numbers increased from recent years. With the increased number of awards, 2022 shows the highest overall success rate at 46.7%.
Table 1: number of applications for new awards and success rates over time in England and Wales
| Year | New applications for awards | Success rate |
|---|---|---|
| 2010 | 2,259 | 14.0% |
| 2011 | 2,406 | 13.2% |
| 2012 | 2,313 | 13.7% |
| 2013 | 1,817 | 17.4% |
| 2014 | 1,539 | 20.7% |
| 2015 | 1,198 | 26.4% |
| 2016 | 1,200 | 26.5% |
| 2017 | 1,078 | 29.5% |
| 2018 | 1,038 | 30.7% |
| 2019 | 1,003 | 31.5% |
| 2020 | Round suspended due to COVID-19 | Not applicable |
| 2021 | 1,804 | 29.3% |
| 2022 | 1,267 | 46.6% |
For the 2022 awards round, as the first year following scheme reform and in line with changes introduced, applicants were assessed as a single group and were rewarded based on scores given on their individual applications. Table 2 shows the number of awards granted per level.
Table 2: number and percentage of awards granted per level in England and Wales
| Level | England | Wales |
|---|---|---|
| N0 | Not applicable | 20 (3.4%) |
| N1 | 314 (56.8%) | 10 (54.9%) |
| N2 | 182 (32.9%) | 5 (31.7%) |
| N3 | 57 (10.3%) | 2 (10.0%) |
| Total | 553 | 37 |
In England, the new scheme operates on a 3-level award system doubling the number of awards from 300 to 600 each year with a target of 330 N1 awards (£20,000), 200 N2 awards (£30,000) and 70 N3 awards (£40,000) per year, with awards being granted for 5 years.
Wales has one additional tier, N0 (£10,000), and determine their own award numbers at each of these 4 levels annually. This replaces the previous bronze, silver, gold and platinum award system and increases the overall number of awards granted. Fewer than 600 awards were granted in 2022 due to the transitional pay protection costs discussed above.
Table 3: number and percentage of awards by prior and non-prior award holders in England and Wales
| Level | Prior award | No prior award |
|---|---|---|
| N0 (n=20) | 6 (30.0%) | 14 (70.0%) |
| N1 (n=324) | 88 (27.1%) | 236 (72.8%) |
| N2 (n=187) | 116 (62.0%) | 71 (38.0%) |
| N3 (n=59) | 57 (96.6%) | 2 (3.4%) |
| Total | 267 (45.3%) | 323 (54.7%) |
Table 3 shows the number of awards granted to prior award holders compared with non-prior award holders. 54.7% of new awards have been given to applicants with no previous award. N0 (only applicable in Wales) and N1 were the levels in which those with no prior awards were the most successful. A higher number of N2 and N3 award levels were granted to those with a prior award.
ACCIA will continue to encourage applications from consultants who have not previously engaged with national award schemes, and it is hoped that the increased number of awards available will help to increase engagement across the consultant population with increased numbers of higher awards being granted to new applicants.
Region
Table 4 shows the number of applications and success rate of new awards per regional sub-committee. Our regional process sets the indicative numbers for each award level in each region such that applicants in any region of England have a roughly equal chance of gaining an award. It is a fundamental tenet of the scheme to recognise senior clinicians equitably across each region. The overall mean success rate was 46.6%, with some variance between 44.3% to 49.1%. The regions with the highest success rates were West Midlands (49.1%) and North East (48.1%). The region with the lowest success rate was the East of England at 43.3%, followed by the arm’s length bodies, South East and South West sub-committees at 44.4%.
In England, success rates for N1 awards varied between 22.2% to 28.8% and N2 awards varied between 12.1% to 19.6%. The biggest difference of success rates per region was seen in the N3 category, where no applicants in Cheshire and Mersey were granted an N3, after national N3 rescoring, compared to a success rate of 9.5% in the South region. Outside of these 2 outliers, the success rate of N3 awards fluctuated between 1.9% to 8.3%.
Some variations in regional success rates are due to rounding up and down the indicative numbers at each award level in each region based on the number of applications received. Moreover, the top ranked applications from each region are assessed and benchmarked nationally against candidates in all regions by the N3 sub-committee, which is made up of the most experienced scorers. The N3 committee (responsible for re-assessing candidates who meet the threshold for N3 awards) will assess the individual application based on merit regardless of the home region of the applicant. Applicants referred to the N3 committee who are unsuccessful at N3 level automatically gain an N2 award. This would explain some discrepancies between success rates per region for N3 and N2 awards. In addition, further variations are a result of national rescoring by the national reserve sub-committee (NRES) where ties occur at award-level ranking cut-offs and where governance queries are raised.
As each region scores independently, it is not possible to make direct comparisons between regions in terms of absolute scores, as it is the ranking within regions that determines success. Quality assurance governance processes are applied to all applications that are ranked within the indicative number for each region, and ACCIA continues to monitor data annually to identify any particular patterns to allow feedback, flagging any inconsistencies to the sub-committees as required.
Table 4: number of applications and success rate of each award level per regional sub-committee
| Sub-committee | Total applications in England and Wales | N1 success rate (N0 in Wales) | N2 success rate (N1 and N2 in Wales) | N3 success rate | Total successful applications |
|---|---|---|---|---|---|
| Arm’s length bodies | 36 (2.8%) | 8 (22.2%) | 5 (13.9%) | 3 (8.3%) | 16 (44.4%) |
| Cheshire and Mersey | 46 (3.6%) | 12 (26.1%) | 9 (19.6%) | 0 | 21 (45.7%) |
| East Midlands | 50 (3.9%) | 14 (28.0%) | 7 (14.0%) | 3 (6.0%) | 24 (48.0%) |
| East of England | 88 (6.9%) | 22 (25.0%) | 12 (13.6%) | 5 (5.7%) | 39 (44.3%) |
| London North East | 166 (13.1%) | 43 (25.9%) | 25 (15.1%) | 10 (6.0%) | 78 (47.0%) |
| London North West | 87 (6.9%) | 25 (28.7%) | 12 (13.8%) | 4 (4.6%) | 41 (47.1%) |
| London South | 149 (11.8%) | 41 (27.5%) | 24 (16.1%) | 6 (4.0%) | 71 (47.7%) |
| North East | 52 (4.1%) | 15 (28.8%) | 8 (15.4%) | 2 (3.8%) | 25 (48.1%) |
| North West | 90 (7.1%) | 25 (27.8%) | 14 (15.6%) | 3 (3.3%) | 42 (46.7%) |
| South East | 54 (4.3%) | 13 (24.1%) | 10 (18.5%) | 1 (1.9%) | 24 (44.4%) |
| South | 116 (9.2%) | 30 (25.9%) | 14 (12.1%) | 11 (9.5%) | 55 (47.4%) |
| South West | 109 (8.6%) | 29 (26.6%) | 17 (15.6%) | 3 (2.8%) | 49 (45.0%) |
| West Midlands | 57 (4.5%) | 16 (28.1%) | 10 (17.5%) | 2 (3.5%) | 28 (49.1%) |
| Yorkshire and the Humber | 86 (6.8%) | 21 (24.4%) | 15 (17.4%) | 4 (4.7%) | 40 (46.5%) |
| Wales | 81 (6.4%) | 20 (24.7%) | 10 (12.3%), 5 (6.2%) |
2 (2.5%) | 37 (45.7%) |
According to NHS Workforce Statistics (NHS Digital) and StatsWales data on medical and dental staff by specialty and year, in March 2022 there were 56,877 consultants in the NHS in England (does not include data on academic GPs) and 2,806 in Wales. Of these, the consultant numbers are broken down by 12 specialties. Table 5 shows the number of the consultant workforce per specialty in the NHS in March 2022 for England and Wales. It also demonstrates what percentage of each specialty makes up the consultant workforce against the total of consultants in the NHS in England (56,877) and Wales (2,806).
NHS Digital has an unaccounted specialty data for 3,259 consultants in England and StatsWales has 13 unaccounted specialty data for Wales and, therefore, numbers below do not total 100%.
Table 5: number and percentages of the consultant workforce per specialty in the NHS in March 2022 for England and Wales
| Specialty | Number of consultants - England | Percentage of consultant workforce - England | Number of consultants - Wales | Percentage of consultant workforce - Wales |
|---|---|---|---|---|
| Anaesthetics | 7,892 | 13.8% | 471 | 16.8% |
| Clinical oncology | 800 | 1.4% | 52 | 1.9% |
| Dental | 903 | 1.5% | 51 | 1.8% |
| Emergency medicine | 2,266 | 3.9% | 110 | 3.9% |
| General medicine | 13,221 | 23.2% | 703 | 25.1% |
| Obstetrics and gynaecology | 2,759 | 4.8% | 147 | 5.2% |
| Paediatrics | 4,005 | 7.0% | 211 | 7.5% |
| Pathology | 2,871 | 5.0% | 142 | 5.1% |
| Public health medicine | 53 | 0.09% | 41 | 1.5% |
| Psychiatry | 4,488 | 7.8% | 201 | 7.2% |
| Radiology | 3,566 | 6.2% | 160 | 5.7% |
| Surgery (including ophthalmology) | 10,343 | 18.1% | 504 | 18.0% |
Chart 1: proportion of applications relative to the proportion of the consultant workforce in England per specialty
| Specialty | Proportion of consultant workforce - England | Proportion of applications - England |
|---|---|---|
| Anaesthetics | 13.80% | 5.60% |
| Clinical oncology | 1.40% | 1.40% |
| Dental | 1.50% | 2.40% |
| Emergency medicine | 3.90% | 2.10% |
| General medicine | 23.20% | 32.70% |
| Obstetrics and gynaecology | 4.80% | 3.80% |
| Paediatrics | 7.00% | 11.90% |
| Pathology | 5.00% | 6.40% |
| Public health medicine | 0.09% | 1.70% |
| Psychiatry | 7.80% | 5.70% |
| Radiology | 6.20% | 3.80% |
| Surgery (including ophthalmology) | 18.10% | 21.40% |
Chart 2: proportion of applications relative to proportion of the consultant workforce in Wales per specialty
| Specialty | Proportion of consultant workforce - Wales | Proportion of applications - Wales |
|---|---|---|
| Anaesthetics | 16.80% | 2.50% |
| Clinical oncology | 1.90% | 3.80% |
| Dental | 1.80% | 3.80% |
| Emergency medicine | 3.90% | 1.30% |
| General medicine | 25.10% | 36.30% |
| Obstetrics and gynaecology | 5.20% | 2.50% |
| Paediatrics | 7.50% | 7.50% |
| Pathology | 5.10% | 3.80% |
| Public health medicine | 1.50% | 1.30% |
| Psychiatry | 7.20% | 8.80% |
| Radiology | 5.70% | 2.50% |
| Surgery (including ophthalmology) | 18.00% | 25.00% |
Charts 1 and 2 highlight the differences between the proportion of applications relative to the proportion of the consultant population in England and Wales per specialty.
As expected, the largest number of applications in England (32.9%) and Wales (36.3%) came from consultants in the general medicine specialty, which is a higher percentage than those practising general medicine in the wider consultant population (23.2% in England and 25.1% in Wales). It is important to note that ‘general medicine’ comprises of a number of sub-specialties.
Other specialties which have also had a higher representation in applications compared to the wider consultant population include dental, paediatrics, pathology, public health medicine and surgery (comprising a number of sub-specialties). Compared to the wider consultant pool, there is substantial under-representation of consultants specialising in anaesthetics (5.6% compared to 13.8% in England, 2.5% compared to 16.8% in Wales).
It is not clear why consultants from some specialties are more likely to apply than others. We are keen to work with membership organisations, such as royal colleges and specialist societies (particularly those representing smaller less-populated specialties), to encourage applications from their members and for them to reflect our guidance to improve the overall quality of applications and likelihood of attaining an award.
Table 6: number of applications against number of consultants and success rates by specialty in England
| Specialty | Number of applications | Proportion of applications | Number of awards granted | Success rates |
|---|---|---|---|---|
| Academic GP | 13 | 1.1% | 7 | 53.8% |
| Anaesthetics | 67 | 5.6% | 26 | 38.8% |
| Clinical oncology | 16 | 1.3% | 9 | 56.3% |
| Dental | 28 | 2.4% | 12 | 42.9% |
| Emergency medicine | 25 | 2.1% | 10 | 40.0% |
| General medicine | 390 | 32.9% | 201 | 51.5% |
| Obstetrics and gynaecology | 45 | 3.8% | 13 | 28.9% |
| Paediatrics | 139 | 11.7% | 64 | 46.0% |
| Pathology | 75 | 6.3% | 40 | 53.3%% |
| Public health medicine | 20 | 1.7% | 9 | 45.0% |
| Psychiatry | 67 | 5.6% | 25 | 37.3% |
| Radiology | 44 | 3.7% | 20 | 45.5% |
| Surgery (including ophthalmology) | 257 | 21.7% | 117 | 45.5% |
| Total | 1,186 | 100% | 553 | Not applicable |
Table 7: number of applications against number of consultants and success rates by specialty in in Wales
| Specialty | Number of applications | Proportion of applications | Number of awards granted | Success rates |
|---|---|---|---|---|
| Academic GP | 1 | 1.2% | 0 | 0% |
| Anaesthetics | 2 | 2.5% | 0 | 0% |
| Clinical oncology | 3 | 3.7% | 2 | 66.7% |
| Dental | 3 | 3.7% | 1 | 33.4% |
| Emergency medicine | 1 | 1.2% | 0 | 0% |
| General medicine | 29 | 35.8% | 16 | 55.2% |
| Obstetrics and gynaecology | 2 | 2.5% | 2 | 100.0% |
| Paediatrics | 6 | 7.4% | 3 | 50.0% |
| Pathology | 3 | 3.7% | 2 | 66.7% |
| Public health medicine | 1 | 1.2% | 0 | 0% |
| Psychiatry | 7 | 8.6% | 1 | 14.3% |
| Radiology | 2 | 2.5% | 0 | 0% |
| Surgery (including ophthalmology) | 21 | 25.9% | 10 | 47.6% |
| Total | 81 | 100% | 37 | Not applicable |
Tables 6 and 7 show the number and proportion of applications and their success rates by specialty in England and Wales in 2022. The greatest number of awards at all levels were granted to consultants whose registered specialty was general medicine and surgery.
When looking at success rates, the discrepancies between success rates for each specialty in table 7 reflect the small numbers of awards in Wales, making any proportionate analysis difficult. In England, the higher numbers of awards make analysis across the larger specialties more meaningful, but no comparisons with Wales can be made. In England, the lowest success rate is seen in obstetrics and gynaecology, with a 28.9% success rate, followed by psychiatry with a 37.3% success rate. The highest success rate in England comes from clinical oncology, who achieved a 56.3% success rate in comparison to the overall success rate of 46.7%.
ACCIA appreciates that some specialties may find it easier to demonstrate national impact than others. Nevertheless, ACCIA is working to ensure that consultants across the breadth of specialties within the NHS are recognised for their exemplary work. We will continue to recommend that employers and their medical directors encourage senior clinicians to apply during annual appraisal discussions, directing applicants to our comprehensive guidance documents and informative webinars.
The scheme reformed the assessment domains to ensure that consultants from all specialties felt able to provide evidence to demonstrate various aspects of impact of their work when referenced to their clearly described job plan, and to encourage more applications. In addition, changes to the way in which NNOs engage with award processes were implemented to better balance citations by specialty proportions. We hope that membership organisations such as royal colleges and specialist societies continue to provide support and encouragement to applicants to increase the number of applications and the quality of their evidence submitted and the clarity of its presentation.
ACCIA will continue to encourage more applications from consultants from diverse backgrounds and from all NHS specialties.
Diversity reporting
In previous years, success rates by age, gender and ethnicity have been reported for England and Wales together. However, from the 2022 round the N0 award level is only available to applicants in Wales. This means that combined figures including that award level are potentially misleading to analyse.
The categories below provide summaries of success rates across age, gender, ethnicity and disability in England and Wales together, with a separate table for N0 (table 18). For N0, and some of the other award levels where numbers are small, percentage rates must be interpreted with caution. Several years’ data may be needed to assess longer-term trends.
Age
Table 8 shows the proportion of applications against proportion of consultant population. The table clearly shows we receive the largest number of applications from 45 to 54 year olds (43.6%), with number of applications decreasing either side of those age brackets. Naturally, this trend is mirrored in the proportion of awards granted.
The trends identified follow a similar pattern to that demonstrated in the wider consultant population. In March 2022, 45 to 54 year olds represented 40.9% of the consultant workforce, followed by the 35 to 44 age bracket which represented 32.5% of the consultant population. This latter figure is higher than currently represented in applications to the NCIA scheme. This reflects more recently appointed consultants who are more likely to be still building up their practice and accruing evidence that would assist in possible submission for a national award in future years.
Table 9 shows the number of applications and success rates per award level by age bracket in England and Wales. It demonstrates that success rates are higher going up the age brackets, peaking at the 55 to 64 age bracket who achieve the highest success rate of 62.9%. Although over 65s show a drop from this level, with a possible skew to the higher award levels, the numbers are much smaller so should be interpreted with caution.
There is a dynamic tension between age and accessibility for awards, as only evidence from time spent as a consultant is eligible for assessment and it inevitably takes time to generate evidence of impact. Nevertheless, in line with the reforms, we expect more consultants to consider applying earlier on in their career than previously. This will allow recognition of high-performing senior clinicians at all stages and especially the granting of higher awards in a non-age dependent manner. ACCIA will continue to engage in proactive messaging and engagement to encourage consultants from across the age brackets to feel empowered to apply and understand the ability for recognition of national impact, at all stages of their consultant career.
Table 8: proportion of applications against proportion of consultant population (NHS Workforce statistics, March 2022)
| Age | Proportion of consultant population | Proportion of applications |
|---|---|---|
| Under 25 | 0.0% | 0.0% |
| 25 to 34 | 1.6% | 0.1% |
| 35 to 44 | 32.5% | 18.6% |
| 45 to 54 | 40.9% | 43.6% |
| 55 to 64 | 21.3% | 19.8% |
| 65 and over | 3.7% | 1.6% |
| Not declared or incorrect | 0% | 16.3% |
ACCIA relies on consultants self-reporting date of birth to calculate age, and a significant minority of applicants either chose not to declare their date of birth or had made an obvious mistake such as entering the date the application was completed.
Table 9: number of applications and success rates per award level by age in England and Wales.
| Age | Number of total applications | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Overall success rate |
|---|---|---|---|---|---|---|
| Under 25 | 0 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| 25 to 34 | 1 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| 35 to 44 | 236 | 76 | 22.0% | 10.2% | 0.0% | 32.2% |
| 45 to 54 | 552 | 252 | 27.0% | 13.9% | 3.3% | 45.7% |
| 55 to 64 | 251 | 158 | 27.5% | 22.3% | 10.8% | 62.9% |
| 65 and over | 20 | 11 | 10.0% | 20.0% | 20.0% | 55.0% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022. This now means applications apply for all levels and scores depict award level.
Gender
Table 10 shows that in 2022 we received 64.6% of applications from males and 33.3% from females in England and Wales, representing a 5.9% increase in overall applications by females from the 2021 awards round. Males have the highest proportion of awards granted at 67.1%, whereas females achieved 30.7% of the awards granted. This is a slight decrease from the proportion of total applications representing females, meaning males had higher success rates of 48.4% in comparison to 42.9% for females.
The data illustrates that there is still an under-representation for females in both application and award rates when compared to the wider consultant population, where females make up 39% of the consultant workforce. Although, we have seen a positive increase in applications from females, there is still more to be done to encourage and empower this cohort to apply.
Table 10: number of applications and success rates by gender in England and Wales
| Gender | Number of total applications | Proportion of new applications | Number of successful applications | Success rates |
|---|---|---|---|---|
| Female | 422 | 33.3% | 181 | 42.9% |
| Male | 818 | 64.6% | 396 | 48.4% |
| Identify as other or prefer not to say | 27 | 2.1% | 13 | 48.1% |
Table 11 shows success rates for each gender, broken down by award levels, for the 2022 awards round. Males have the highest success rate at 48.4%, whereas females show a success rate of 42.9%. The overall success rate has significantly increased (46.7%) since previous years due to the increased number of awards available.
However, the success rate gap between males and females has widened from the 1.2% gap in the 2021 awards round to 5.5%. The higher number of awards and success rates overall may have accentuated this, and the fact that some applicants did not disclose their gender might also partly account for this. Nevertheless, the size of the gap is concerning despite some positive signs of higher N1 success rates in females than males. ACCIA remains committed to closing the success rate gap between males and females and will work with employers as described above to address this.
Additionally, the table demonstrates that males are more likely to gain an N2 and N3 award than females. ACCIA is committed to ensuring that all genders have equal opportunity and success rate in attaining an award at every level.
Table 11: success rates per gender in England and Wales
| Gender | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Overall success rate |
|---|---|---|---|---|---|
| Male | 396 | 25.2% | 16.4% | 5.1% | 48.4% |
| Female | 181 | 26.5% | 11.6% | 3.3% | 42.9% |
| Identify as other or prefer not to say | 13 | 22.2% | 14.8% | 11.1% | 48.1% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022. This now means applications apply for all levels and scores depict award level.
Table 12 shows the success rates over time by gender. Notably, the difference in success rates between males and females have been relatively consistent.
ACCIA remains dedicated to its commitment to increasing gender diversity among award holders. While we are pleased to see that the number of applications from female consultants and overall success rates have increased, we have seen disparities in success rates by gender increase. ACCIA will continue to work with employers and membership organisations to ensure that the applicant pool and the successful award holders are representative of the gender balances of the wider consultant population.
Table 12: success rates over time by gender in England and Wales
| Year | Male | Female | Difference |
|---|---|---|---|
| 2016 | 26.80% | 25.60% | 1.2 |
| 2017 | 30.20% | 26.70% | 3.5 |
| 2018 | 31.30% | 30.20% | 1.1 |
| 2019 | 30.50% | 31.60% | 1.1 |
| 2021 | 29.50% | 28.30% | 1.2 |
| 2022 | 48.4% | 42.9% | 5.5 |
Ethnicity
According to NHS Workforce Statistics, the consultant population was made up of 54.8% clinicians from white ethnic groups and 39.4% from black, Asian and other ethnic minorities - with 4.9% of the consultant population preferring not to disclose. ACCIA aims for and expects the applicant pool to mirror the consultant population by ethnicity as well as by gender.
Table 13 shows the over-representation of white ethnic groups, both in applications and in success rates. Of the total applications, 61.1% were from white ethnic groups, 6.3% higher than the general consultant workforce. 36.3% of applications received were from all other ethnic groups combined and 2.4% came from those who did not specify their ethnicity.
While the results are not fully indicative of the wider consultant workforce, it is encouraging to see that there has been an increase in applications (35.6% in 2022) from non-white ethnic groups since 2019 (25.6% total applications). This has improved greatly from previous years. For example, in 2012, ethnic minorities only represented 16.5% of applications.
Table 13 also shows the success rates by ethnicity in England and Wales. White ethnic groups combined represented the highest success rates of 51.7%, compared to the 37.9% achieved by all other ethnic groups combined.
Table 14 demonstrates the success rate per award level by ethnicity in England and Wales. White ethnic groups and all other ethnic groups have some proximity in success rates at N1, with white applicants still being more successful. Larger and more obvious differences start to emerge in N2 and N3 categories where white ethnic groups have much higher success rates - 17.4% and 5.9% respectively in comparison to 10.2% and 2.4% for non-white ethnic groups. A breakdown of the larger subsections of ethnic groups from this high-level data is shown in the annex.
Table 13: number of applications and success rates by ethnicity in England and Wales
| Ethnicity | Number of applications | Proportion of applications | Number of successful applications | Success rates |
|---|---|---|---|---|
| White ethnic groups combined | 774 | 61.1% | 400 | 51.7% |
| All other ethnic groups combined | 462 | 36.5% | 175 | 37.9% |
| Prefer not to say | 31 | 2.4% | 15 | 48.4% |
Table 14: success rates per award level by ethnicity in England and Wales
| Ethnicity | Success rates - N1 | Success rates - N2 | Success rates - N3 |
|---|---|---|---|
| White ethnic groups combined | 26.4% | 17.4% | 5.9% |
| All other ethnic groups combined | 24.2% | 10.2% | 2.4% |
| Prefer not to say | 25.80% | 16.10% | 6.5% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022. This now means applications apply for all levels and scores depict award level.
Looking at table 15, there is still more to do to close the disparity gap between white and non-white ethnic groups. The reformed scheme will need to operate for at least another year before we are able to understand whether this is a negative trend or is as a result of some transitional effects between the old and new schemes. Nevertheless, we are not comfortable or complacent about this data and will work with employers as described jointly to address this.
Although some of the drivers of these disparities are out of ACCIA’s control, ACCIA will continue to improve the way we provide support for applicants to ensure they stand the best chance to succeed within the scheme, particularly those for whom English is not their first language. We will also continue to evaluate and, as necessary, amend our processes to ensure that they are not contributing to any disparities.
Table 15: success rates for new awards over time by ethnic group in England and Wales
| Year | White ethnic groups combined - success rates | All other ethnic groups combined - success rates | Difference |
|---|---|---|---|
| 2016 | 26.8% | 26.1% | 0.7 |
| 2017 | 30.2% | 25.7% | 4.5 |
| 2018 | 31.8% | 23.3% | 8.5 |
| 2019 | 33.0% | 27.6% | 5.4 |
| 2021 | 32.4% | 24.4% | 8 |
| 2022 | 51.7% | 37.9% | 13.8 |
Gender by ethnicity
Table 16 demonstrates the number of applications and success rates by gender by ethnicity in England and Wales. Evidently, males from white ethnic groups have the highest overall success rate of 54.4% followed by females from white ethnic groups at 46.6%. There is a significant drop in success rates for other ethnic groups, with males from an ethnic minority background achieving 39.2% and females from an ethnic minority background achieving the lowest success rate of 35.7%. In comparison to the gender data above (table 11), this confirms an additional and independent effect of ethnicity.
The table shows females and males of white ethnic and other ethnic backgrounds have similar success rates at N1 - with females of all ethnic backgrounds having a 26.4% success rate and male white ethnic groups achieving the highest success rate of 26.5%. The lowest success rate at N1 was achieved by males of other ethnic groups at 23.5%. The data for N1 awards is more encouraging as it shows some balance at the lowest award level that we hope may reflect first time applicants. There is, however, a lot more variation between gender and ethnicity at N2 and N3 award levels, with a consistent pattern of white males achieving the highest success rate per category and females of other ethnic groups achieving the lowest success rate.
Data from those who preferred not to state their gender or ethnicity are presented for completeness, but the numbers are too small to meaningfully interpret. For these applicants and other diversity characteristics with very few applicants, any analysis will be performed over 2 or more years of the scheme to gain a more representative sample size and to avoid any inadvertent identification of individuals in such reporting annually.
ACCIA remains committed to tackling success rate discrepancies between gender by ethnicity and plans to work with employers to encourage discussions about award applications more broadly at annual appraisals. In addition, we plan to generate data on application and success rates by diversity characteristics in comparison to data from NHS England on the eligible population by each region, and where possible by individual trusts. We hope that this, together with ongoing awareness and training, will begin to help address these imbalances.
Table 16: number of applications and success rates by gender by ethnicity in England and Wales
| Gender by ethnicity | Number of applications | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | success rate |
|---|---|---|---|---|---|---|
| Female - white ethnic groups | 277 | 129 | 26.4% | 14.1% | 4.0% | 46.6% |
| Male - white ethnic groups | 491 | 267 | 26.5% | 19.3% | 6.7% | 54.4% |
| Prefer not to say - white ethnic groups | 6 | 4 | 16.7% | 16.7% | 33.3% | 66.7% |
| Female - other ethnic groups | 140 | 50 | 26.4% | 7.1% | 2.1% | 35.7% |
| Male - other ethnic groups | 319 | 125 | 23.5% | 11.6% | 2.5% | 39.2% |
| Prefer not to say - other ethnic groups | 3 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| Female - prefer not to say | 5 | 2 | 40.0% | 0.0% | 0.0% | 40.00% |
| Male - prefer not to say | 8 | 4 | 12.5% | 25.0% | 12.5% | 50.00% |
| Prefer not to say | 18 | 9 | 27.8% | 16.7% | 5.6% | 50.00% |
Note: success rates per level are not comparable with previous years due to reforms introduced in 2022. This now means applications apply for all levels and scores depict award level.
Disability
Table 17 shows that only 3.1% of applications in 2022 were from those with a disability. Applicants with a disclosed disability similarly made up 3.4% of the proportions of awards granted. Although not a large percentage, it is encouraging to see that the total number of applications by this cohort is mostly mirrored in the percentage of awards granted. Disability data was not collected as part of the old scheme and therefore a comparison for previous years is not available.
In relation to the wider NHS consultant population, consultants who have self-disclosed as disabled make up 1.49% of the consultant workforce. It is positive that ACCIA receives a higher proportion of applications and proportion of awards granted than the wider consultant population. However, the numbers are small, and it is important to note that 3.1% of consultants have not disclosed or it is unknown whether they have a disability, and therefore the number of disabled consultants could be higher than reflected. Analyses over future years will be closely monitored.
Table 17 also shows the success rate by those who have self-disclosed as having a disability. Positively, those who have identified as having a disability have been shown to have a higher success rate at 51.3% compared to those who did not have a disability at 46.7%. The proportions here may seem encouraging but are too small to meaningfully interpret. Nevertheless, ACCIA will continue to uphold the highest standards to ensure our processes remain inclusive and fair.
For any protected characteristic, ACCIA will continue to monitor this data and highlight to employers and their medical directors the importance of adequate representation of their local population in the award scheme. We expect employers to encourage high-performing senior clinicians to apply during annual appraisal discussions, and to provide access to support and local advice directly, or through membership organisations based on our comprehensive guidance.
Table 17: number of applications and proportion of successful awards by disability
| Disability | Number of applications | Proportion of applications | Number of successful applications | Success rates |
|---|---|---|---|---|
| Yes | 39 | 3.1% | 20 | 51.3% |
| No | 1,189 | 93.8% | 555 | 46.7% |
| Prefer not to say or did not disclose | 39 | 3.1% | 15 | 38.5% |
Diversity reporting for N0 awards in Wales
Table 18: number of applications and success rates for N0 awards in Wales by age, gender and ethnicity
| Age, gender and ethnicity | Number of total applications | Number of successful applications | Success rate |
|---|---|---|---|
| Age - 35 to 44 | 9 | 0 | 0% |
| Age - 45 to 54 | 47 | 8 | 17.0% |
| Age - 55 to 64 | 11 | 6 | 54.5% |
| Age - 65 and over | 1 | 1 | 100% |
| Gender - female | 20 | 6 | 30% |
| Gender - male | 58 | 14 | 24.1% |
| Gender - identify as other or prefer not to say | 3 | 0 | 0% |
| Ethnicity - white ethnic groups combined | 58 | 15 | 25.9% |
| Ethnicity - all other groups combined | 21 | 5 | 23.8% |
| Ethnicity - prefer not to say | 2 | 0 | 0% |
| Gender by ethnicity - female, white ethnic groups | 17 | 6 | 35.3% |
| Gender by ethnicity - male, white ethnic groups | 40 | 9 | 22.5% |
| Gender by ethnicity - prefer not to say, white ethnic groups | 1 | 0 | 0% |
| Gender by ethnicity - female, other ethnic groups | 3 | 0 | 0% |
| Gender by ethnicity - male, other ethnic groups | 18 | 5 | 27.8% |
| Gender by ethnicity - prefer not to say | 2 | 0 | 0% |
Note: of 81 total applications, 20 N0 awards were granted. Categories where no applications were received have been intentionally omitted.
Appeals
In the 2022 awards round, ACCIA received a total of 29 appeals from applicants in England and Wales. This is a significant decrease compared to the 63 appeals received in the 2021 awards round. Every appeal is carefully assessed to determine whether there is a basis for an appeal and to ensure that due processes had been followed.
Grounds for appeal can only be made based upon demonstration of any of the following criteria:
- the committee did not consider all the supporting information or documents sent with the application
- irrelevant information was taken into account
- discrimination due to protected characteristics
- the usual evaluation processes were not followed
- the committee, or any of its members, showed bias or had a conflict of interest, such as where someone involved in a decision could be affected by the result
Disagreement with the outcome of the scoring is not in itself grounds for appeal.
All requests were reviewed by the ACCIA chair and medical director, followed by an independent panel of at least 2 senior assessors, typically consisting of a regional sub-committee chair and medical vice-chair who had not scored the application previously. After review of each request, scoring patterns and the process flow for each applicant who requested consideration, it was concluded that only one application was deemed to have sufficient grounds for appeal due to ACCIA omitting to allow the applicant to correctly account for an extenuating circumstance.
The successful appellant’s application, with the additional information of the extenuating circumstance, was then re-scored by the same panel who originally scored their applications. The application received a higher score than when initially assessed but it was still unsuccessful in achieving the threshold score for an award.
This appeal has led to a change in ACCIA processes to prevent such omissions recurring.
Governance
ACCIA is led by an independent Chair and Medical Director, who are appointed by the Secretary of State for Health and Social Care. Together, they are responsible for:
- ensuring ACCIA operates to high standards and reflects public sector values
- ensuring it is fair and robust in its assessment of applications
- ensuring it operates effectively, efficiently and transparently
- continuing to advise on the development of the NCIA scheme
At the time of the 2022 awards round, Dr Stuart Dollow was Chair and Professor Kevin Davies was the Medical Director.
Dr Stuart Dollow - Chair
Stuart is a General Medical Council registered physician who trained in general medicine and general practice, having spent most of his professional career in pharmaceutical industry research and development. He has held senior leadership roles at Roche, GlaxoSmithKline, Norgine, Takeda and UCB. He is also the founder of Vermilion Life Sciences Ltd, providing medicines development consultancy services.
As Chair of ACCIA, Stuart reports to the Director General for NHS Policy and Performance at the Department of Health and Social Care (DHSC).
His responsibilities include providing leadership to ACCIA and ensuring the effective functioning of the NCIA scheme.
Professor Kevin Davies - Medical Director
Kevin was recently Foundation Chair of Medicine at Brighton and Sussex Medical School and Consultant Physician and Rheumatologist at Brighton and Sussex University Hospitals NHS Trust. He has been involved with ACCIA at a senior level for many years, as medical vice-chair for the South East region and as a member of our main committee. He previously held a gold award.
The Medical Director’s responsibilities include:
- advising on the medical and professional aspects of the scheme, ensuring it reflects and rewards current best medical practice
- the leadership of training for scorers, employers, and applicants
ACCIA secretariat
The Chair and Medical Director are supported by a secretariat of civil servants employed by DHSC. For 2022, the secretariat was staffed by 3.5 substantive full-time equivalents (4 staff). You can contact ACCIA at accia@dhsc.gov.uk.
ACCIA main committee
The main committee is ACCIA’s decision-making body. It meets to discuss and agree changes to ACCIA policy and procedures, and to agree the final recommendations to Ministers for new awards.
A list of members is available on the ACCIA governance page
Regional sub-committees
All applications for awards are scored by voluntary assessors. Our assessors are recruited regionally and can be re-assigned to another region to score applications. This helps to manage any conflict of interest, balance workload and ensure diversity of scorers.
Each sub-committee is led by a lay chair and a medical vice-chair who are responsible for the good governance of their committee. Regional sub-committee chairs and medical vice-chairs are also members of the N3 scoring committee (scored nationally) and score applications that are sent to the national reserve sub-committee (NRES) for additional scrutiny.
The remainder of each regional sub-committee consists of a mixture of:
- professional members - practising clinicians from across a range of specialties, including public health and academia
- employer members from NHS organisations, including senior managers and other leaders
- non-medical professional or lay members from a variety of backgrounds, including higher education, law, human resources, research, management and business, or retired healthcare professionals
In total, there are 14 regional sub-committees in England, with one additional sub-committee assessing applications in Wales.
The 14 regional sub-committees are:
- DHSC and arm’s length bodies
- Cheshire and Mersey
- East of England
- East Midlands
- London North East
- London North West
- London South
- North East
- North West
- South
- South East
- South West
- West Midlands
- Yorkshire and the Humber
More information on our regional sub-committees can be found in the awards application guidance.
Sub-committee recruitment and training
ACCIA regularly refreshes the membership of its regional sub-committees to balance experience with fresh perspectives. The aim is for the membership of each sub-committee to fully reflect the diverse make-up of the NHS consultant population they assess.
In 2022, we recruited a total of 55 new assessors, including 5 new chairs and 5 new medical vice-chairs. ACCIA would like to thank all new and continuing assessors for their commitment and dedication to the scheme, as well as those who have stepped down for their dedication in prior years.
All new scorers are required to attend scorer training run by the ACCIA Medical Director and Chair. The training equips all scorers with the skills to impartially assess each application in an equitable way. Assessor training is not reserved solely for new scorers. ACCIA actively encourages experienced scorers to refresh their knowledge by attending sessions as frequently as possible. In 2022, we made scorer training mandatory due to the newly reformed scheme and to require retraining at least every 3 years. The ACCIA Medical Director and Chair held 14 live training sessions online. A total of 336 assessors attended scorer training sessions, which were held over a period of 2 months.
Sub-committee diversity
ACCIA aims to reflect the wider consultant population in the make-up of sub-committees, where females made up 39% of the workforce in March 2022, with black, Asian and other ethnic minorities constituting 39.4%.
4.9% of the consultant population preferred not to disclose their ethnicity.
The regional sub-committees underwent a rebalancing exercise to ensure membership of each sub-committee reached closer representation of the gender and ethnicity of the consultant population. This saw some members moved from their home regions to other sub-committees to score.
East Midlands achieved 40% female representation, closely followed by Cheshire and Mersey and West Midlands at 38.5%. Although there is much still to do, positively all regional sub-committees achieved above 30% female representation, unlike previous years. For ethnicity, 9 out of the 14 regional sub-committees have a 39.5% or above representation of non-white ethnic groups, which is a substantial improvement from previous years.
Despite positive steps to improve the diversity of the regional sub-committees, there is still more to be done. ACCIA will continue to encourage diversity throughout the scheme, including in the composition of regional sub-committees, and welcomes applications from scorers from a wide diversity of backgrounds.
Table 19: rebalanced regional sub-committee membership by gender and ethnicity
| Sub-committee | Female | Male | All white ethnic groups | All other non-white ethnic groups |
|---|---|---|---|---|
| DHSC and arm’s length bodies | 33.3% | 66.7% | 66.7% | 33.3% |
| Cheshire and Mersey | 38.5% | 61.5% | 69.2% | 30.8% |
| East of England | 32.0% | 68.0% | 72.0% | 28.0% |
| East Midlands | 40.0% | 60.0% | 60.0% | 40.0% |
| London North East | 36.8% | 63.5% | 60.5% | 39.5% |
| London North West | 33.3% | 66.7% | 59.3% | 40.7% |
| London South | 37.0% | 63.0% | 55.6% | 44.4% |
| North East | 35.7% | 64.5% | 57.1% | 42.9% |
| North West | 33.3% | 66.7% | 70.8% | 29.2% |
| South | 37.5% | 62.5% | 58.3% | 41.7% |
| South East | 38.5% | 61.5% | 53.8% | 46.2% |
| South West | 34.5% | 65.5% | 58.6% | 41.4% |
| West Midlands | 38.5% | 61.5% | 53.8% | 46.2% |
| Yorkshire and the Humber | 33.3% | 66.7% | 66.7% | 33.3% |
Overall, on reflection, the re-balancing exercise carried out in relation to gender and ethnicity ensured that extremes of the ranges of diversity in individual sub-committees was reduced, leading to a more representative spread of scorers across all ACCIA’s sub-committees. The gender and ethnic diversity of each committee was harmonised as much as reasonably possible to be closer to, if not beyond, ACCIA’s targets of representing the proportions within the consultant population.
The re-balancing exercise worked well, particularly as the regional sub-committee meetings were held virtually, ensuring that re-located scorers were not required to travel. ACCIA also received positive feedback on the impact ‘imported’ scorers had on their allocated regions, including bringing fresh perspectives and balance to the committees.
As the Welsh committee and the Welsh scheme operates separately, no re-balancing was implemented between Wales and England.
We will continue to monitor and refresh our membership and report on progress in 2023. We will also continue to re-allocate assessors between regions to optimise the gender and ethnicity distribution and minimise sub-committee variability. We are grateful for the flexibility shown by our scorers in this regard.
Operations
Finances
The ACCIA Chair and Medical Director are remunerated at a rate of £52,240 per year.
The ACCIA Chair and Medical Director may claim expenses for travel and other associated costs. As most meetings - except N3, Wales committee and some London based meetings - were held virtually, a total of £61.90 of expenses were claimed by the Chair and Medical Director in 2022 to 2023.
Lay regional sub-committee members and chairs can also claim expenses for travel, meeting attendance and other costs such as scoring and appeal reviews. In 2022 to 2023 claims for such costs totalled £69,553.65.
Additional costs arise from the ACCIA secretariat, who manage the running and operations of the scheme. The secretariat consists of 4 civil servants employed by DHSC. The team includes one grade 7, one senior executive officer and 2 higher executive officers.
Funding flows
DHSC holds the budget for the small number of awards paid to those working within the department and for NHS Blood and Transplant, as well as awards paid to consultants working within any of DHSC’s arm’s length bodies.
Most awards in England are funded through NHS England. NHS trusts and foundation trusts receive their budgets from NHS England, which include the relevant provision for new NCIAs. Where an award holder is employed by a university or other academic institution, their academic employer recovers the costs for awards from NHS England.
In Wales, most awards are funded by the Welsh Government. Health boards in Wales receive their budgets from the Welsh Government and these incorporate costs associated with new Clinical Impact Awards.
Total value of awards in payment
In the 2022 to 2023 financial year, there were a total of 2,023 awards in payment, accruing a total value of £117,399,426.77, comprising:
- £109,767,631.77 in legacy awards
- £7,631,795 in new awards
The balance of these latter figures does not include any former NCEA holder who successfully applied for an NCIA in the 2022 awards round, as their NCIA commenced on 1 April 2023. The award amount for any former NCEA holders who successfully achieved a new NCIA in the 2022 round (plus any transition payments for eligible consultants) will be included in the subsequent financial year and reported in the 2023 annual report.
This total cost includes on-cost calculations and is the total value spread across 5 instalments.
Ongoing costs include National Insurance and legacy pension contributions. In 2022, these costs were calculated at 20.68% for award holders on the NHS Pension Scheme and 21.6% for award holders on the University Superannuation Scheme.
More information on the numbers of awards in payment by award level and specialism can be found using our 2022 nominal roll.
IT
ACCIA replaced its IT system for the 2022 awards round. In September 2022, SmartSimple Software was awarded a contract following a procurement exercise that was run through the government G-Cloud framework. SmartSimple Software allocated the ACCIA contract to Re-Solved, a Canadian firm who act as delivery partner for SmartSimple.
The 2022 awards round represented the first live round of the new IT system produced by SmartSimple. Due to business need, the IT system was initially created to meet a base standard to allow the 2022 awards round to go ahead without delays. ACCIA is continuously working with SmartSimple Software and Re-Solved to update and improve the functionality of the IT system to improve the delivery of the NCIAs.
Forward look
Reflecting on the 2022 awards round, the first for the reformed scheme, there have been many highs and learning points.
The new, reformed scheme has enabled positive strides towards improving the diversity and equality of the NCIA scheme and has highlighted points which still require further work to improve. The biggest realised benefit of the new scheme has been the expansion of the number of awards granted and the increased number of awards going to an increasingly diverse population of consultants. Notwithstanding this, the diversity success rates are a cause for further attention and action to address. Additionally, the scheme benefits from being more streamlined and thus agile and adaptable, with the new IT system allowing for more analyses.
We will not be able to make a full assessment of the impacts of the reforms until the scheme has been running for several years. Some changes will take time to embed due to the 5-year transition period for those holding legacy NCEAs. These are affected by the financial impacts of schedule 30 provisions made by NHS England in the consultant contract during this period. However, in future reports, ACCIA will continue to monitor and report on progress, particularly on diversity data, identifying actions with stakeholders to ensure equality. Our plan is to report on a wider variety of diversity data reflecting smaller groups with protected characteristics, pooled over 2 or more years to analyse trends and minimise inadvertent identification of applicants.
For more information on schedule 30 provisions see the see the annex to the awards application guidance: transition and reversion arrangements for NCEA holders.
Additionally, ACCIA plans to present diversity characteristics by region from NHS England data, in comparison to application and success rates. This will allow greater awareness and exploration of any discrepancies in application representation or success by region. If possible, similar diversity data will be presented to individual employers to highlight any discrepancies, together with pooled anonymised data by employer to show how close these local application proportions are to employers’ baseline NHS England data.
For the 2023 awards round, ACCIA continues to strive towards a fair and equitable scheme, improving our processes to ensure they contribute to our aims while improving our outreach to encourage applications from under-represented groups.
Annex: ethnicity
Table 20: success rates per award level by high-level ethnic descriptors in England and Wales
| Ethnicity | Number of applications | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Overall success rate |
|---|---|---|---|---|---|---|
| All Asian ethnic groups | 379 | 150 | 24.8% | 11.1% | 2.6% | 39.6% |
| All black ethnic groups | 20 | 3 | 10.0% | 0.0% | 0.0% | 15.0% |
| Mixed or any other background | 63 | 22 | 25.4% | 7.9% | 1.6% | 34.9% |
| White - British or Irish | 610 | 325 | 25.9% | 18.4% | 6.7% | 53.3% |
| White - any other background | 164 | 75 | 28.0% | 14.0% | 3.0% | 45.7% |
| Prefer not to say | 31 | 15 | 25.8% | 16.1% | 6.5% | 48.4% |
Note: figures for N0 awards in Wales have not been included due to the low numbers in some categories which could have allowed the identification of individuals from the data.