Advisory Committee on Clinical Impact Awards: annual report for the 2023 awards round
Published 2 January 2025
Applies to England and Wales
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Foreword
We are pleased to present the 2023 report for the Advisory Committee on Clinical Impact Awards (ACCIA). This was the second year of the new 3-level scheme aiming to recognise and reward those that go above and beyond their job plan to deliver value and benefits to patients and the NHS at the national level.
Built on recommendations made by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the results of the public consultation, the national Clinical Impact Awards (NCIAs) relaunched with a refreshed purpose for achieving greater accessibility and inclusion, to reflect better the diversity of the NHS workforce.
We continue to deliver on our promise to give out up to 600 awards, resulting in a higher success rate than the previous iteration of the scheme. This, coupled with the removal of the renewals process, has delivered increased opportunities for those earlier in their careers, those who may have been previously unsuccessful and those who may have not considered applying before.
We are pleased to continue seeing an increased application rate from both female applicants and those who identify as being from an ethnic minority. However, there is recognition that there is still much to do to ensure the scheme reflects the full diversity of the consultant workforce.
In 2023, we responded to NHS pension changes on flexible retirement, adapting our rules to allow many award holders to continue receiving their award if they opted for flexible retirement arrangements. This proactive and positive shift in our rules will ensure we are continuing to work towards our aim of recognising and retaining clinicians within the NHS.
Having concluded yet another successful round of the new NCIA scheme, we hope that the reformed scheme will continue to make a difference by supporting innovative and transformational activities that deliver positive impact on the NHS across the country.
We would also like to extend a special thank you to all the sub-committee scorers, regional sub-committee chairs and medical vice-chairs, and all our other committee members who continue to dedicate time and commitment in supporting the scheme, enabling us to recognise highly skilled clinicians drawn from all specialties, and from all regions.
The 2023 round was the final one for Dr Stuart Dollow, ACCIA’s chair for the previous 6 years. We are grateful for his years of outstanding service and for the legacy he has left behind. We wish him all the best in his future endeavours.
Vinay Patroe, Chair
Kevin Davies, Medical Director
About 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 through 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 and 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 2023 awards round was the second since the national awards scheme was reformed following public consultation in 2021.
2023 awards round
Timetable
The 2023 awards round opened for applications on 10 March and closed on 5 May 2023. Scoring of applications took place from May to October 2023.
Regional sub-committee meetings were held between July and November 2023. The main committee meeting was held in November 2023. The main committee recommendations were sent to ministers for approval in December 2022.
Outcomes were communicated to applicants in January 2024. Appeals were processed between January and March 2024.
Clinical impact examples from 2023
NCIAs continue to recognise and reward senior clinicians delivering impact to the NHS at a national level.
Consultants granted awards in the 2023 awards round led research that contributed to national treatment protocols for COVID-19, helped establish new training and education pathways for the next generation of doctors, validated novel uses of artificial intelligence in clinical decision making, as well as thousands of other examples that make a real difference to patients and staff in the NHS.
National nominating organisation citations
Following the 2022 awards round, a review was undertaken of the extent to which citations from national nominating organisations (NNOs) reflected the likely success of an application. As part of our feedback survey we asked applicants about their perception of this element of the application process.
This review found that:
- citations had generally poor predictive value
- applications with NNO citations were roughly as likely to be unsuccessful as successful
- applicants and NNOs reported a significant additional workload in order to meet deadlines and submit citations
Some applicants also expressed a view that without a citation an application would not be likely to get an award or considered at all, indicating a misunderstanding of the importance of citations which could well dissuade some applicants without NNO support from engaging with the scheme at all.
Based on the findings of this review, it was decided that from the 2023 round onwards, only the application form with employer sign-off completed would be required to apply for an award. NNOs were informed of this decision and encouraged to direct their resources to promoting the scheme and supporting members planning to apply, either by mentoring or through the provision of guidance material.
Scoring group normalisation
Before the 2022 round, scoring groups were divided based on the level of award applied for (bronze, silver and so on) and all applications within each group were scored by every assessor, but with a single level of application this was not possible. In the 2022 round, the regions with higher application numbers split the scoring groups to manage assessors’ workload.
Following the 2022 round, a review of scoring patterns identified small differences in scoring patterns between some groups, and it was decided that there was a need for a means to manage this. A normalisation process was devised internally and reviewed by an independent statistician. This process was applied to all committees with multiple scoring groups in the 2023 awards round.
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 2023 round, 12 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. 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 because of the nature of the governance process for successful applications, 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 sex, age, ethnicity, disability and regional representation.
Applicants are not obliged to provide diversity monitoring information so a ‘prefer not to say’ option is always provided. However, this does mean that the statistics reported on these areas below do not necessarily represent all applicants. 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 2023, there were a total of 1,257 applications for new awards: 1,170 applications in England and 87 in Wales
A total of 576 new awards were granted overall: 539 in England and 37 in Wales, resulting in an overall success rate of 46.1% in England and 42.5% in Wales.
Table 1 shows the number of applications for new awards and success rates over time. Application numbers decreased through the period 2010 to 2019 except for the pandemic ‘catch up’ round in 2021. Although the slight drop in application numbers for 2023 was disappointing, we are hopeful that the increased success rates in the new scheme (46.6% and 45.8% in 2022 and 2023 respectively) will encourage more consultants to apply.
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% |
| 2023 | 1,257 | 45.8% |
Table 2 shows the number of awards granted in England and Wales in 2023 and their percentage of the total number.
Table 2: number and percentage of awards granted per level in England and Wales
| Level | England | Wales |
|---|---|---|
| National 0 | Not applicable | 20 (3.5%) |
| National 1 | 300 (52.1%) | 10 (1.7%) |
| National 2 | 178 (30.9%) | 5 (0.9%) |
| National 3 | 61 (10.6%) | 2 (0.3%) |
| Total | 539 | 37 |
In England, the scheme operates on a 3-level award system doubling the number of awards from 300 to 600 each year with a target of 330 national 1 (N1) awards (£20,000), 200 national 2 (N2) awards (£30,000) and 70 national 3 (N3) awards (£40,000) per year, with awards being granted for 5 years. Wales has one additional tier, national 0 (N0) (£10,000) and determines its 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 2023 due to the transitional pay protection costs discussed above and as a result of some potentially successful applicants not receiving awards due to rescoring as part of the governance process.
Table 3: number and percentage of awards by prior and non-prior award holders in England and Wales
| Level (total applicants) | Prior award | No prior award |
|---|---|---|
| N0 (20) | 5 (25.0%) | 15 (75.0%) |
| N1 (310) | 91 (29.4%) | 219 (70.6%) |
| N2 (183) | 128 (69.9%) | 55 (30.1%) |
| N3 (63) | 59 (93.7%) | 4 (6.3%) |
| Total | 283 (49.1%) | 293 (50.9%) |
Table 3 shows the number of awards granted to prior award holders compared with non-prior award holders. 50.9% 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.
In England, a greater proportion of N3 awards were given to applicants with no prior award in 2023 (6.3%) than in 2022 (3.4%). This positive news, along with the significantly increased success rate since the scheme was reformed, should encourage consultants who have not previously engaged with the national award scheme to submit applications.
ACCIA will continue to encourage consultants from all specialties and backgrounds to apply, including conducting an independent review of our processes and guidance to ensure that any barriers that may prevent under-represented groups are identified and addressed.
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.
Overall, the mean success rate was 46.1%, but there was more significant variance between regions than in 2022 with rates from 36.4% to 48.9%. The regions with the highest success rates were Cheshire and Mersey (48.9%) and London North East (48.6%) and the region with the lowest success rate was South East at 36.4% followed by West Midlands at 44.0%. The low success rate in South East can be explained by the relatively high number of applications referred to for rescoring as part of the standard governance process.
In England, success rates for N1 awards varied between 20.0% to 28.4% and N2 awards varied between 12.0% to 19.2%. In the 2022 awards round, there were no N3 awards granted after national rescoring in Cheshire and Mersey, but in 2023, there were awards at the highest level granted in every region. Nonetheless, there was still a wide range in success rates from 1.7% to 8.3% at the N3 level. Although the overall success rate in South East region was low, at N3 the success rate for this region at 5.5% was slightly higher than the national mean of 5.2%.
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 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, and the variation in success rates between award rounds emphasises that direct comparisons between years are also not valid. 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 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 (N0 in Wales) | N2 (N1 and N2 in Wales) | N3 | Total successful applications |
|---|---|---|---|---|---|
| Arm’s length bodies | 45 | 11 (24.4%) | 8 (17.8%) | 1 (2.2%) | 20 (44.4%) |
| Cheshire and Mersey | 47 | 12 (25.5%) | 9 (19.1%) | 2 (4.3%) | 23 (48.9%) |
| East Midlands | 58 | 13 (22.4%) | 10 (17.2%) | 1 (1.7%) | 24 (41.3%) |
| East of England | 89 | 23 (25.8%) | 13 (14.6%) | 6 (6.7%) | 42 (47.2%) |
| London North East | 148 | 42 (28.4%) | 18 (12.2%) | 12 (8.1%) | 72 (48.6%) |
| London North West | 63 | 17 (27.0%) | 9 (14.3%) | 4 (6.3) | 30 (47.6%) |
| London South | 139 | 35 (25.2%) | 25 (18.0%) | 5 (3.6%) | 65 (46.8%) |
| North East | 73 | 17 (23.3%) | 14 (19.2%) | 2 (2.7%) | 33 (45.2%) |
| North West | 84 | 22 (26.2%) | 14 (16.7%) | 2 (2.4%) | 38 (45.2%) |
| South East | 55 | 11 (20.0%) | 6 (10.9%) | 3 (5.5%) | 20 (36.4%) |
| South | 108 | 29 (26.9%) | 13 (15.7%) | 9 (8.3%) | 51 (47.2%) |
| South West | 101 | 28 (27.7%) | 17 (16.8%) | 3 (3.0%) | 48 (47.5%) |
| West Midlands | 75 | 18 (24.0%) | 9 (12.0%) | 6 (8.0%) | 33 (44.0%) |
| Yorkshire and the Humber | 85 | 22 (23.5%) | 13 (15.3%) | 5 (5.9%) | 40 (47.1%) |
| Wales | 87 | 20 (23.0%) | 10 (11.5%) 5 (5.7%) | 2 (2.3%) | 37 (42.5%) |
Specialties
According to NHS England workforce statistics and StatsWales data on medical and dental staff by specialty and year, in March 2023 there were 58,957 consultants in the NHS in England (this does not include data on academic GPs) and 2,899 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 2023 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 (58,957) and Wales (2,899). In England, there was unaccounted specialty data for 4,141 consultants, meaning the result will not total to 100%.
Table 5: number and percentages of the consultant workforce per specialty in the NHS in March 2023 for England and Wales
| Specialty | Number of consultants - England | Percentage of consultant workforce - England | Number of consultants - Wales | Percentage of consultant workforce - Wales |
|---|---|---|---|---|
| Anaesthetics | 8,079 | 13.7% | 486 | 16.8% |
| Clinical oncology | 864 | 1.5% | 47 | 1.6% |
| Dental | 925 | 1.6% | 59 | 2.0% |
| Emergency medicine | 2,402 | 4.1% | 118 | 4.1% |
| General medicine | 13,788 | 23.4% | 762 | 26.3% |
| Obstetrics and gynaecology | 2919 | 5.0% | 154 | 5.3% |
| Paediatrics | 4,089 | 6.9% | 223 | 7.7% |
| Pathology | 2,906 | 4.9% | 154 | 5.3% |
| Public health medicine | 56 | 0.1% | 35 | 1.2% |
| Psychiatry | 4,467 | 7.6% | 195 | 6.7% |
| Radiology | 3,737 | 6.3% | 168 | 5.8% |
| Surgery (including ophthalmology) | 10,584 | 18.0% | 497 | 17.2% |
Figure 1: proportion of applications relative to the proportion of the consultant workforce in England per specialty
| Specialty | Proportion of workforce - England | Proportion of applications - England |
|---|---|---|
| Anaesthetics | 13.7% | 7.4% |
| Clinical oncology | 1.5% | 1.5% |
| Dentistry | 1.6% | 3.2% |
| Emergency medicine | 4.1% | 1.6% |
| General medicine | 23.4% | 32.6% |
| Obstetrics and gynaecology | 5.0% | 3.5% |
| Paediatrics | 6.9% | 10.2% |
| Pathology | 4.9% | 4.4% |
| Psychiatry | 7.6% | 5.9% |
| Public health medicine | 0.1% | 2.1% |
| Radiology | 6.3% | 3.9% |
| Surgery | 18.0% | 21.5% |
Figure 2: proportion of applications relative to proportion of the consultant workforce in Wales per specialty.
| Specialty | Proportion of workforce - Wales | Proportion of applications - Wales |
|---|---|---|
| Anaesthetics | 16.8% | 4.6% |
| Clinical oncology | 1.6% | 1.1% |
| Dentistry | 2.0% | 4.6% |
| Emergency medicine | 4.1% | 1.1% |
| General medicine | 26.3% | 31.0% |
| Obstetrics and gynaecology | 5.3% | 5.7% |
| Paediatrics | 7.7% | 9.2% |
| Pathology | 5.3% | 8.0% |
| Psychiatry | 6.7% | 5.7% |
| Public health medicine | 1.2% | 2.3% |
| Radiology | 5.8% | 3.4% |
| Surgery | 17.2% | 23.0% |
Figures 1 and 2 serve to highlight the differences between the proportion of applications relative to the proportion of the consultant population in England and Wales per specialty.
As has been the case in previous years, the largest number of applications in England (32.6%) and Wales (31.0%) came from consultants in the general medicine specialty, which itself covers multiple sub-specialties. The proportion of applications is higher than the proportion of the workforce working in general medicine (23.4% in England and 26.3% in Wales).
Other specialties which have also had a higher representation in applications compared to the wider consultant population include dental, paediatrics, public health medicine and surgery (comprising several sub-specialties). Compared to the wider consultant pool, there is substantial under-representation of consultants specialising in anaesthetics (7.4% compared to 13.7% in England, 4.6% compared to 16.8% in Wales), a pattern similar to previous years and influenced by various factors.
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 | 25 | 2.1% | 11 | 44.0% |
| Anaesthetics | 87 | 7.4% | 37 | 42.5% |
| Clinical oncology | 17 | 1.5% | 8 | 47.1% |
| Dental | 37 | 3.2% | 17 | 45.9% |
| Emergency medicine | 19 | 1.6% | 4 | 21.1% |
| General medicine | 382 | 32.6% | 188 | 49.2% |
| Obstetrics and gynaecology | 41 | 3.5% | 12 | 29.3% |
| Paediatrics | 119 | 10.2% | 50 | 42.0% |
| Pathology | 52 | 4.4% | 39 | 75.0% |
| Public health medicine | 24 | 2.1% | 11 | 45.8% |
| Psychiatry | 69 | 5.9% | 21 | 30.4% |
| Radiology | 46 | 3.9% | 22 | 47.8% |
| Surgery (including ophthalmology) | 252 | 21.5% | 119 | 47.2% |
| Total | 1,170 | 100% | 539 | Not applicable |
Table 7: number of applications against number of consultants and success rates by specialty in Wales
| Specialty | Number of applications | Proportion of applications | Number of awards granted | Success rates |
|---|---|---|---|---|
| Academic GP | 0 | 0% | 0 | 0% |
| Anaesthetics | 4 | 4.6% | 1 | 25% |
| Clinical oncology | 1 | 1.1% | 1 | 100% |
| Dental | 4 | 4.6% | 3 | 75.0% |
| Emergency medicine | 1 | 1.1% | 0 | 0% |
| General medicine | 27 | 31.0% | 10 | 37.0% |
| Obstetrics and gynaecology | 5 | 5.7% | 1 | 20.0% |
| Paediatrics | 8 | 9.2% | 0 | 0% |
| Pathology | 7 | 8.0% | 3 | 42.9% |
| Public health medicine | 2 | 2.3% | 2 | 100% |
| Psychiatry | 5 | 5.7% | 2 | 40.0% |
| Radiology | 3 | 3.4% | 3 | 100% |
| Surgery (including ophthalmology) | 20 | 23.0% | 11 | 55.0% |
| Total | 87 | 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 2023. The greatest number of awards at all levels were granted to consultants whose registered specialty was general medicine and surgery.
The discrepancies between success rates for each specialty in table 7 reflects the small numbers of awards in Wales making any proportionate analysis difficult, while in England, the higher numbers of awards make analysis across the larger specialties more meaningful. Therefore it would not be appropriate to make comparisons between England and Wales.
In England, the lowest success rate is seen in emergency medicine, with a 21.1% success rate, followed by obstetrics and gynaecology with a 29.3% success rate. The highest success rate in England comes from pathology by a significant margin: a 75.0% success rate in comparison to the overall success rate of 45.8%.
ACCIA is aware of the difference between specialties in terms of demonstrating national impact, but remains committed to working with employers, membership organisations, and NHS England to ensure that consultants from all specialties can be recognised for exemplary work. Senior clinicians could be encouraged to develop their evidence portfolios and apply at annual appraisals and revalidation discussions, and we will continue to encourage employers to embed this into their processes.
ACCIA will continue to encourage more applications from consultants from diverse backgrounds and from all NHS specialties, and we will be conducting a review of our support materials and processes to identify any areas which may present barriers to certain groups or where a different approach may be more universally accessible.
Diversity reporting
Up to the 2021 awards round, success rates by protected characteristics 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 3 protected characteristics in England and Wales together, with a separate N0 table that follows. 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-terms trends, but we will continue to monitor both application and success data to identify those that do arise.
Age
Table 8 shows the proportion of applications against proportion of consultant population. We continue to receive the largest number of applications from consultants in the 45 to 54 year old bracket (38.9%), however this is lower than the previous year. Applications from the 55 to 64 year old bracket increased from 19.8% in 2022 to 22.4% in 2023.
The wider consultant population data also shows a slight increase in the proportions in higher age categories, but the reduction in applications from 35 to 44 year old consultants from 18.6% to 17.4% is a potential concern as this group were already under-represented compared to the overall population. While many consultants in this group will be developing evidence that can be used in applications at a later stage, the 2022 reforms allowed consultants at any point in their career to access all levels of awards and we will continue to highlight this to encourage recently appointed consultants to apply.
Table 9 shows the number of applications and success rates per award level by age bracket in England and Wales. The highest success rate continues to be in the 55 to 64 year old age bracket (58.2%), but the difference between this and the success rate in the 45 to 64 year old age bracket (47.2%) has decreased from a difference of 17.2% in 2022 to a difference of 11% in 2023.
Only evidence from time spent as a consultant is eligible for assessment and it inevitably takes time to generate evidence of impact, resulting in predictably lower success rates from applications submitted early in a consultant’s career. 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 Digital Data, 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 | 32.1% | 17.4% |
| 45 to 54 | 40.7% | 38.9% |
| 55 to 64 | 21.7% | 22.4% |
| 65 and over | 3.9% | 1.8% |
| Not declared or incorrect | 0% | 19.4% |
ACCIA relies on consultants self-reporting their 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 | 219 | 59 | 19.2% | 5.5% | 1.4% | 26.9% |
| 45 to 54 | 489 | 231 | 26.4% | 15.1% | 3.3% | 47.2% |
| 55 to 64 | 282 | 164 | 26.6% | 22.3% | 8.2% | 58.2% |
| 65 and over | 22 | 12 | 9.1% | 22.7% | 22.7% | 54.5% |
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.
Sex
Table 10 shows that in 2023 we received 33.5% of applications from females and 64.1% from males in England and Wales, showing only a very modest increase of 0.2% in the proportion of applications from female consultants. The proportion of awards granted at 67.2% to males is almost identical to the figure of 67.1% in 2022, whereas the figure of 30.0% of awards granted to females has decreased by 0.7%. Coinciding with the 5.2% increase in applicants identifying as other or preferring not to say makes it difficult to determine if this is a change in applicant proportions or an artefact of the data. Despite the small increase in the proportion of total applications from females, the gap in success rates widened with a rate of 48.0% for males and 41.1% for females. The difference in success rates between males and females was 5.5% in 2022 and 6.9% in 2023.
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. Although over recent years 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 and ensure that our materials and processes support all applicants appropriately.
Table 10: number of applications and success rates by sex in England and Wales
| Sex | Number of total applications | Proportion of new applications | Number of successful applications | Success rates |
|---|---|---|---|---|
| Female | 421 | 33.5% | 173 | 41.1% |
| Male | 806 | 64.1% | 387 | 48.0% |
| Identify as other or prefer not to say | 30 | 2.4% | 16 | 53.3% |
Table 11 shows success rates for each sex, broken down by award levels, for the 2023 awards round. The success rate for males (48.0%) continues to be higher than the success rate for females (41.1%). The overall success rate (45.8%) has decreased from the 2022 figure (46.7%), in part due to the number of applications that were unsuccessful following the governance review and rescoring processes. As mentioned above, the gap between overall male and female success rates has increased again and this is concerning, despite the continued 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 to jointly 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 sexes have equal opportunity and success rate in attaining an award at every level.
Table 11: success rates per sex in England and Wales
| Sex | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Overall success rate |
|---|---|---|---|---|---|
| Male | 387 | 23.8% | 16.7% | 5.8% | 48.0% |
| Female | 173 | 25.7% | 10.2% | 3.6% | 41.1% |
| Identify as other or prefer not to say | 16 | 33.3% | 16.7% | 3.3% | 53.3% |
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 show the success rates over time by sex. The consistency of differences in success rates between female and male applicants suggests a systemic issue and ACCIA will continue to work with a range of stakeholders engage on this issue.
Table 12: success rates over time by sex 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 |
| 2023 | 48.0% | 41.1% | 6.9 |
Ethnicity
According to NHS England workforce statistics, the consultant population in March 2023 was made up of 53.9% clinicians from white ethnic groups and 40.2% from black, Asian and other ethnic minorities - with 4.8% of the consultant population preferring not to disclose. There has been a long-term trend of the consultant population becoming more diverse and this continues. ACCIA aims for and expects the applicant pool to mirror the consultant population by ethnicity as well as by sex.
Table 13 shows the proportion of applicants and success rates for different ethnic groups, demonstrating that white ethnic groups are over-represented in terms of both applicants (58.6%) and success rates (53.1%), compared to applicants from other ethnic groups who represent 38.2% of applicants and with a success rate of 35.0% in 2023. The proportion of applications received is now very close to the balance of the consultant workforce, and it is positive that a lower proportion of applicants prefer not to disclose this information than in the population statistics. Nonetheless, the disparity in success rates continues to be of concern and ACCIA will be working with employers, membership organisations and other stakeholder groups to enable applicants from all backgrounds to access the award scheme in a way that gives them the best possibility of success.
The success rate per award level by ethnicity in England and Wales is shown in table 14. There are significant differences in success rates in all award categories, with white ethnic groups having higher success rates, however the biggest disparities are at N2 and N3 levels. It is worth noting that the gap between success rates at N1 (6.4%) is significantly greater this year than in 2022 (2.2%). A breakdown of the larger subsections of ethnic groups from this high-level data is shown in the annex, and reduction at N1 success rates for applicants from ethnic groups other than white appears to be a general reduction.
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 | 736 | 58.6% | 391 | 53.1% |
| All other ethnic groups combined | 480 | 38.2% | 168 | 35.0% |
| Prefer not to say | 41 | 3.3% | 17 | 41.5% |
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 | 27.2% | 17.8% | 6.0% |
| All other ethnic groups combined | 20.8% | 9.8% | 3.5% |
| Prefer not to say | 24.4% | 12.2% | 4.9% |
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 15 shows the widening of the gap in success rates between 2022 and 2023, which taken in context with the trend since 2021 is cause for concern. While not all the factors behind the disparities in success rates are under ACCIA’s control or influence, we 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 particularly work on what we are able to do to increase the quality of applications submitted, including through training materials and promotion of case studies and guidance that can help prospective applicants demonstrate the impact they have done in the most suitable way.
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 |
| 2023 | 53.1% | 35.0% | 18.1 |
Sex by ethnicity
Table 16 shows the number of applications and success rates by sex by ethnicity in England and Wales.
As in 2022, males from white ethnic groups have the highest overall success rate of 57.2%, followed by females from white ethnic groups at 46.7%. The success rate of 100% for applicants from ethnic groups other than white who preferred not to disclose their sex is anomalous due to the very small number involved (3 applicants). Otherwise, there remains a significant drop in success rates for other ethnic groups, with males from an ethnic minority background achieving 36.6% and females from an ethnic minority background achieving the lowest success rate of 30.6%. As well as there being a disparity between female and male applicants overall, there is an added influence when considering the impact of ethnic background at the same time, with the most notable drop being in success rate being for females from other than white ethnic groups, which was 35.7% in the 2022 round.
As in the 2022 round, males from ethnic groups other than white achieved the lowest success rate at N1 with 20.1%, and there were reductions in success rates at N1 and N2 level for both male and female applicants from ethnic groups other than white. However, at N3 level female applicants from other ethnic groups maintained the same success rate as in 2022 (2.1%), whereas male applicants from other ethnic groups increased the success rate from 2.5% in 2022 to 4.2% in 2023. While it is encouraging that these rates have remained steady or increased, it should be noted that most awards at this level are granted to holders of existing awards, therefore familiarity with the scheme and application process are significant factors.
Data from those who preferred not to state their sex or ethnicity is presented for completeness, but the numbers are too small to meaningfully interpret, although the proportion of applicants in this category has increased slightly in 2023. For these applicants and other protected 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 sex by ethnicity and plans to work with employers to encourage discussions about award applications more broadly at annual appraisals.
Table 16: number of applications and success rates by sex by ethnicity in England and Wales
| Sex by ethnicity | Number of applications | Number of successful applications | Success rate - N1 | Success rate - N2 | Success rate - N3 | Success rate |
|---|---|---|---|---|---|---|
| Female - white ethnic groups | 276 | 129 | 27.9% | 12.0% | 4.3% | 46.7% |
| Male - white ethnic groups | 458 | 262 | 26.9% | 21.4% | 7.0% | 57.2% |
| Prefer not to say - white ethnic groups | 2 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| Female - other ethnic groups | 144 | 44 | 21.5% | 6.9% | 2.1% | 30.6% |
| Male - other ethnic groups | 333 | 121 | 20.1% | 10.8% | 4.2% | 36.6% |
| Prefer not to say - other ethnic groups | 3 | 3 | 66.7% | 33.3% | 0.0% | 100% |
| Female - prefer not to say | 1 | 0 | 0.0% | 0.0% | 0.0% | 0.0% |
| Male - prefer not to say | 15 | 4 | 13.3% | 6.7% | 6.7% | 26.7% |
| Prefer not to say - prefer not to say | 25 | 13 | 32.0% | 16.0% | 4.0% | 52.0% |
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.
Disability
Table 17 shows the number and success rates by applicants’ declared disability. As in 2022, it is encouraging that the total number of applications by this cohort is mirrored by the percentage of the awards granted. The proportion of NCIA applicants declaring a disability is still higher than the wider consultant workforce, but the proportion of applicants not declaring has also increased.
As with all protected characteristics where the annual numbers are relatively small and so difficult to analyse individually, 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 | 45 | 3.6% | 22 | 48.9% |
| No | 1160 | 92.3% | 532 | 45.9% |
| Prefer not to say or did not disclose | 52 | 4.1% | 22 | 42.3% |
Diversity reporting for N0 awards in Wales
Table 18: number of applications and success rates for N0 awards in Wales by age, sex, and ethnicity
| Age, sex and ethnicity | Number of total applications | Number of successful applications | Success rate (%) |
|---|---|---|---|
| Age - not declared or incorrect | 7 | 3 | 42.9% |
| Age - 35 to 44 | 19 | 2 | 10.5% |
| Age - 45 to 54 | 36 | 12 | 33.3% |
| Age - 55 to 64 | 25 | 3 | 12.0% |
| Sex - female | 33 | 7 | 21.2% |
| Sex - male | 53 | 13 | 24.5% |
| Sex - identify as other or prefer not to say | 1 | 0 | 0% |
| Ethnicity - white ethnic groups combined | 52 | 16 | 30.8% |
| Ethnicity - all other groups combined | 34 | 4 | 11.8% |
| Ethnicity - prefer not to say | 1 | 0 | 0% |
| Sex by ethnicity - female, white ethnic groups | 24 | 7 | 29.2% |
| Sex by ethnicity - male, white ethnic groups | 28 | 9 | 32.1% |
| Sex by ethnicity - female, other ethnic groups | 9 | 0 | 0% |
| Sex by ethnicity - male, other ethnic groups | 20 | 4 | 16.0% |
| Sex by ethnicity - prefer not to say, prefer not to say | 1 | 0 | 0% |
Note: of 87 total applications, 20 N0 awards were granted. Categories where no applications were received have been intentionally omitted.
Appeals
In the 2023 awards round, ACCIA received a total of 20 appeals from applicants in England and Wales. 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 such as sex, ethnicity or age
- 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 none of the cases was deemed to have sufficient grounds for appeal to ACCIA.
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 that ACCIA:
- operates to high standards and reflects public sector values
- is fair and robust in its assessment of applications
- operates effectively, efficiently and transparently
- advising on the development of the NCIA scheme
At the time of the 2023 awards round, Dr Stuart Dollow was Chair and Professor Kevin Davies was the Medical Director.
Where existing award holders inform ACCIA of changes in circumstances, such as changes of employer and changes to job plans, the Chair and Medical Director review each case and determine any impact on the award. For legacy national Clinical Excellence Awards (NCEAs), this can include pro-rating of the award payment, and for both NCEAs and NCIAs changes can affect the duration of an award.
During the November 2023 main committee meeting there was a discussion about the introduction of an appeal process where an award holder disagrees with the original decision. It was agreed that a process would be put into guidance ahead of the 2024 awards round.
Chair of ACCIA to 31 May 2024 - Dr Stuart Dollow
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 currently also founder of Vermilion Life Sciences Ltd, providing medicines development consultancy services.
As Chair of ACCIA, Stuart reported to the Director of Workforce at DHSC.
His responsibilities included providing leadership to ACCIA and ensuring the effective functioning of the NCIA scheme.
ACCIA Medical Director - Professor Kevin Davies
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 NCEA.
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, and 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 2023, the secretariat was staffed by 3.5 substantive full-time equivalents (4 staff).
You can contact ACCIA by emailing 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, to balance workload and to 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 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, 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 application guidance for the 2023 awards round.
Sub-committee recruitment and training
ACCIA regularly refreshes the membership of our regional sub-committees to balance experience with fresh perspectives. Our aim is for the membership of each sub-committee to fully reflect the diverse make-up of the NHS consultant population they assess.
For the 2023 awards round, 44 new assessors were recruited, and as ever ACCIA owes a debt of gratitude to all those assessors who have and who continue to give their time to help make the scheme work.
As in previous years, all new assessors were required to undertake training run by the ACCIA medical director and chair, with training sessions also open to any existing assessors who feel they would benefit. After each awards round, scoring patterns are analysed to ensure consistency of approach by assessors, with the option to request that assessors re-attend training before they score in another round.
Sub-committee diversity
ACCIA aims to reflect the wider consultant population in the make-up of sub-committees, where females made up 39.8% of the workforce in March 2023, with black, Asian and other ethnic minorities constituting 40.2%.
4.8% 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 sex and ethnicity of the consultant population. This saw some members moved from their home regions to other sub-committees to score.
Although all regional sub-committees continued to have more than 30% female and other than white ethnic group representation, there is still more to be done. The model of re-allocating assessors between regions, both to manage conflicts of interest and to rebalance committees will continue to be used, bearing in mind the need to maintain a regional ‘identity’ for each sub-committee due to their different characteristics. We will continue to work with our regional chairs and medical vice-chairs to recruit new members and will be actively engaging with external stakeholders to promote the benefits of assessing for prospective applicants and employers alike.
Table 19: rebalanced regional sub-committee membership by sex and ethnicity
| Sub-committee | Female | Male | All white ethnic groups | All other non-white ethnic groups |
|---|---|---|---|---|
| DHSC and arm’s length bodies | 35.0% | 65.0% | 60.0% | 40.0% |
| Cheshire and Mersey | 33.3% | 66.7% | 66.7% | 33.3% |
| East of England | 35.3% | 64.7% | 72.0% | 38.0% |
| East Midlands | 31.3% | 68.7% | 62.5% | 37.5% |
| London North East | 33.3% | 66.7% | 63.9% | 36.1% |
| London North West | 37.5% | 62.5% | 62.5% | 37.5% |
| London South | 33.3% | 66.7% | 63.6% | 36.4% |
| North East | 37.5% | 662.5% | 62.5% | 37.5% |
| North West | 35.3% | 64.7% | 61.8% | 38.2% |
| South | 33.3% | 66.7% | 60.0% | 40.0% |
| South East | 35.3% | 64.7% | 58.8% | 41.2% |
| South West | 35.3% | 64.7% | 58.8% | 41.2% |
| West Midlands | 37.5% | 62.5% | 62.5% | 37.5% |
| Yorkshire and the Humber | 33.3% | 66.7% | 56.7% | 43.3% |
As the Welsh committee and the Welsh scheme operates separately, no rebalancing was implemented between Wales and England.
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 via NHS England. NHS trusts and foundation trusts receive their budgets from NHS England, which include the relevant provision for any renewed and 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 and renewed Clinical Impact Awards.
Total value of awards in payment
The total cost of awards in payment in England for the 2023 to 2024 financial year was £110,794,460, including £6,850,760 of new awards granted in the 2023 round and backdated to 1 April 2023. Costs for new awards granted in the 2023 awards round to previous NCEA holders will fall in the 2024 to 2025 financial year when their new awards commence.
This total cost includes on-cost calculations and is the total value spread across 2 instalments.
Ongoing costs include National Insurance and pension contributions for NCEAs and NCIAs granted in the 2022 awards round that are now in transition arrangements. In 2023, these on-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.
The 2023 nominal roll and personal statements will be published shortly, providing information on awards in payment by award level and specialism, as well as details of new award holders’ activities.
IT
ACCIA continues to work with SmartSimple and Re-Solved, and the contract for the online application and assessment platform provided by SmartSimple was reissued for one year from September 2023.
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 | 392 | 142 | 20.9% | 10.5% | 3.8% | 36.2% |
| All black ethnic groups | 21 | 3 | 14.3% | 0.0% | 0.0% | 14.3% |
| Mixed or any other background | 67 | 23 | 22.4% | 9.0% | 3.0% | 34.3% |
| White - British or Irish | 609 | 337 | 28.4% | 18.2% | 6.4% | 55.3% |
| White - any other background | 127 | 54 | 21.3% | 15.7% | 3.9% | 42.5% |
| Prefer not to say | 41 | 17 | 24.4% | 12.2% | 4.9% | 41.5% |
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.