Guidance

Change of circumstances: guide for NCIA and NCEA holders

Published 9 February 2024

Applies to England and Wales

About ACCIA and the Clinical Impact Awards scheme

The Advisory Committee on Clinical Impact Awards (ACCIA) runs the national Clinical Impact Awards (NCIAs) scheme for the Department of Health and Social Care (DHSC) in England. 

ACCIA provides governance for the awards for the Welsh Government in Wales. 

The national scheme recognises consultants, dentists or academic GPs who deliver national impact above the expectations of their job role or other paid work over the previous 5 years, or since a prior national award if within the last 5 years. The scheme specifically recognises the dissemination and implementation of that work and its impact on the wider NHS and public health. You do not need to hold any local award or a previous national Clinical Excellence Award (NCEA) to be eligible for an NCIA.

Health ministers agree a limited number (up to 600) of new awards each year in England, so the selection process is very competitive. Three levels of award are available in England, from lowest to highest: National 1 (N1), National 2 (N2) and National 3 (N3). In Wales a lower level (National 0) also exists. The awards last for 5 years and have an annual, non-pensionable value of £10,000 (N0), £20,000 (N1), £30,000 (N2), £40,000 (N3).

You can apply for a new award at any time after you have completed a full year in an eligible role.

Award holders should refer to the applicants’ guide to the 2024 awards round when applying for a new NCIA.

Continued eligibility

Current award holders must continue meeting the standard eligibility criteria to receive their award for its full duration (5 years unless granted for a shorter period). You must continue to be:

• a fully registered medical or dental practitioner on the General Dental Council (GDC) specialist list or General Medical Council (GMC) specialist list, or GP register
• a permanent NHS consultant or academic GP in a permanent clinical academic role in higher education at the same level as a senior lecturer or above
• on an NHS consultant contract expressed in programmed activities (PAs), or on an academic contract expressed in an equivalent pay scale with an honorary NHS consultant contract

Consultants working in Wales must be on an NHS consultant contract expressed in sessions or on an academic contract expressed in an equivalent pay scale.

Locum or other fixed-term consultant contracts are not eligible.

The full eligibility criteria are set out in part 2 of the applicants’ guide to the 2024 awards round.

You must tell us if your circumstances change after you have gained an award.

Change of circumstances

If your circumstances change, let us know as soon as possible by completing the employment change notification form and emailing it to accia@dhsc.gov.uk.

You should do this in advance of any contract, job plan, retirement, pension or employment changes. This will allow you to implement any changes in light of our advice. Any changes already made may adversely affect your award and this cannot be retrospectively amended.

If you do not tell us when your circumstances change, it could affect whether you can keep your award, or what you and your employer are paid. Any payments made since the change in circumstances may need to be paid back. 

It is your responsibility to inform us promptly and to ensure your contact details are up to date. You can either:

• change your contact details on the ACCIA portal
• ask the ACCIA secretariat to change your contact details for you by emailing accia@dhsc.gov.uk

We will not update any contact details unless you ask us to do so.

The main changes you need to tell us about are set out below. This is not a full list, and you should tell us if anything significant changes. 

Let us know if: 

• you take any part of your pension with a resultant change in your job plan or contract
• you retire and return with or without a change to your job, job plan or employer
• you stop practising in the field in which you obtained your award
• you change your job or employer
• there is a significant change to your job plan - including a reduction in the number of programmed activities or sessions

In all cases, a minimum number of 3 clinically relevant PAs must be contractually agreed within the job plan, as well as meeting the standard eligibility criteria.

Our chair and medical director determine ‘clinically relevant’ eligibility by considering the description of your activities that describe how you directly undertake clinical care, teaching, training and research activities within the allocated PAs in job plans. Administrative, oversight or management type activities are unlikely to be considered as clinically relevant. 

If you are thinking of changing jobs (NHS or university), we would recommend an early discussion with a potential new employer and specific consideration of how any newly proposed job-planning arrangements may affect eligibility for an award in the future. Employers may not be fully aware of all requirements, so you should also contact ACCIA for advice.

If your management work (for example, as a medical director or chief executive) is paid by your organisation on a ‘management’ pay scale, rather than a PA-based consultant contract, you will no longer be eligible for an award.

Changes may lead to:

• a continuation of your award as normal
• the termination of your award with effect from the date of the change
• your award being prorated and/or the duration shortened

The sections below provide further information on different changes of circumstances, and leave, secondment and sabbatical arrangements.

Flexible retirement or partial drawdown of pension benefits

As of 1 April 2023, if you begin receiving pension benefits up to 100% of your allowance, but continue in eligible employment, your award will continue until its scheduled expiry date, provided you continue to meet the standard eligibility criteria. You must inform us of any changes to your contract agreed as part of any such arrangement. As with other job plan changes there may be an impact on the duration of your award.

Retirement or taking pensions before 1 April 2023

As rule changes do not apply retrospectively, if you retired or claimed any pension while in receipt of an NCEA before 1 April 2023, your award will be ceased from the date of your retirement or claiming of your pension.

If, after retirement, you return to eligible NHS work at a later date, you can apply for a new NCIA award. Assessment of any future application will only be based on evidence generated during your new contract since your return from work. Any previous NCEA holder in this circumstance, on reapplication, will no longer be eligible for transitional pay arrangements under schedule 30 of the consultant contract.

If you retired or claimed any pension while you were in receipt of a standard NCIA before 1 April 2023 your award may be able to continue, but only if you had no employment gap (beyond the statutory minimum 24 hours) between the end of your old contract and the start of your new contract.

Retirement or taking pensions on or after 1 April 2023

Full retirement

As you no longer hold an NHS consultant contract or honorary contract, you are no longer eligible for an NCEA or NCIA. Your award will be ceased from the date of your retirement.

If, after retirement, you return to eligible NHS work at a later date, you can apply for a new NCIA award. Assessment of any future application will only be based on evidence generated during your new contract since your return from work. Any previous NCEA holder in this circumstance, on reapplication, will no longer be eligible for transitional pay arrangements under schedule 30 of the consultant contract.

Retire and return

If you retire and return immediately following the statutory minimum 24-hour requirement, you may be eligible to keep your NCEA or NCIA until its scheduled expiry date, provided you continue to meet the standard eligibility criteria. However, if there are any changes to your contract, role or employer or if there is a break in employment, the duration of your award may be shortened. ACCIA will not extend the expiry date of any award unless there are extenuating circumstances relating to ill health or other reasons that prevent you from applying, and that are agreed by ACCIA.

Anything longer than the mandated minimum 24-hour requirement will constitute a break in employment. Circumstances differ if your eligible contract begins 24 hours after retirement but agreed unpaid or paid leave is taken immediately after commencing the contract. As long as you remain continuously employed under an eligible contract, paid or unpaid leave following retire and return will not constitute a break in employment. This must be clearly communicated to ACCIA to avoid incorrect application of our rules.

Locum or rolling contract holders who have retired and returned are not eligible to hold or retain an award unless the employer confirms it is their policy not to employ any returnees on permanent contracts.

NCEA holders, or NCIA holders benefiting from transitional arrangements, who reduce their contracted PAs to less than full time (10 PAs) with their employer, will have their award paid prorated.

If there are changes to your contract, job plan or employer, assessment of any future NCIA applications will only be based on evidence generated during your new contract, since the date of your retirement.

If you have retired and return to the same employment conditions (same job plan, role and employer), assessment of any future application to NCIAs will be based on evidence since your last application, except where ACCIA have advised otherwise.

Flexible retirement

Under pension rules, consultants can take partial retirement but must reduce pensionable earning by 10%. This often results in a reduction of PAs.

NCEA holders, or NCIA holders benefiting from transitional arrangements, who reduce their contracted PAs to less than full time (10 PAs) with their employer, and continue to meet the standard eligibility criteria, will have their award paid prorated.

If you agree a mixture of pensionable and non-pensionable contracted PAs with your employer, ACCIA will use the total contracted PAs for the calculation of your award. You should ensure this does not cause you to breach the 10% reduction requirement, as doing so could cause abatement of your pension to apply.

NCIA holders who are not in receipt of transitional arrangements, who are still deemed eligible, will not have their award prorated as per reforms to the NCIA schemes in 2022.

However, for all NCEA and NCIA holders, if there are any changes to your contract, role or employer, the duration of your award may be shortened. ACCIA will not extend the expiry date of any award unless there are extenuating circumstances relating to ill health or other reasons that prevent you from applying, and that are agreed by ACCIA.

Locum or rolling contract holders who have retired and returned are not eligible to hold or retain an award unless the employer confirms it is their policy not to employ any returnees on permanent contracts.

Assessment of any future applications to NCIAs will only be based on evidence generated during your new contract, since the date of your retirement.

Leave or secondments

Unpaid leave

We do not pay any awards during unpaid leave. If you take unpaid leave for more than a year, our medical director will decide whether your award can be reinstated.

Maternity leave, parental leave and adoption leave 

If you have an award and go on maternity, parental or adoption leave, you will receive your award payments during any period of paid leave from your employer. 

Sickness absence

If you are off sick for any reason, we will continue to pay your award while you remain in role on your employer’s payroll. Please keep us informed of absences, returns and phased returns to work and any changes to your work pattern so that we can assess if your award needs to be altered in any way. Each case will be reviewed and assessed based on the individual circumstances.

Secondments and sabbaticals

If you are on full-time secondment to a post with an employer that does not qualify under the NCIA scheme, we will suspend your award.  

If you are planning a sabbatical, you must speak to your employer and contact us to agree what happens with your award. To retain the award, you must prove your sabbatical will be of benefit to the NHS, and we must agree that this is the case and its duration. This would not normally be for more than one year. Otherwise, we will consider suspending your award until you return, or it expires. 

Let us know the timing of any secondment or sabbatical and speak to your employer before any new arrangement starts to understand the effect on your award. This will include time for us to assess if you are eligible to retain your award, and whether you can start collecting it again after your secondment or sabbatical has finished.  

If you are seconded part time or have a part-time sabbatical and continue some work from your original contract part time, you may be eligible for a prorata payment if you hold an NCEA. If you hold an NCIA, you may be eligible to continue your award payments. In either case, tell us your plans before you start your secondment or sabbatical, so we can agree the arrangements and ensure the balance of your part-time job plan still contains the minimum of 3 clinically relevant PAs. 

If you are on secondment or sabbatical for up to a year, you will resume receipt of your award once this has ended. The end date of your award will not be extended  

If the secondment or sabbatical is longer than a year, your award will not be reinstated automatically. We will consider whether to reinstate your award depending on the individual circumstances and duration of your secondment or sabbatical and subsequent expectations on your return. In all cases we will only do this once you and your employer let us know you have returned to the NHS and we have assessed your job plan to confirm if your role remains eligible. In no cases will the end date of your original award be extended.

If you are seconded to the Independent Sector Treatment programme, or similar, while you still have your NHS consultant contract, you may be able to retain your award based on our assessment of your role. Should you remain eligible you will be able to apply for a new award during this time if your award is expiring.  

Prolonged absence from the NHS 

If, for any reason, you have been on a prolonged absence and not practised your specialty in the NHS for more than a year, we will review whether your award can be reinstated. 

Tell us if you start being investigated

You must tell us - as soon as you know - of any investigations, disciplinary procedures or legal action against you. If there are delays in notifying us, we may be concerned about your commitment to full transparency and may choose to terminate your award as a result.

Investigations into your work and disciplinary or legal action against you can affect your award or application. This includes interim, temporary or final court orders, or penalties relating to your professional or personal conduct that may reflect badly on your judgement, or the expected standards of the profession.

We will look at each case individually, but we may remove your award if:

• there are adverse outcomes following investigations or any disciplinary measures that result from a finding of a lack of maintaining high professional standards
• if we believe you have failed to notify us appropriately or in a timely manner

If this happens, you will need to pay back any overpayments.

You must keep us up to date about any developments and the outcomes of any investigations. We will decide if they affect your award. However, we always use an ‘innocent unless proven otherwise’ approach. 

Appeals related to changes in circumstances affecting existing awards

All appeals are handled by ACCIA. You can request an appeal if you disagree with our decision on the effects on your award following a review of your change in circumstances form and job plan and believe we have made the wrong decision according to our rules.  

To appeal, you need to tell us why you believe our assessment of your new circumstances and their effect on your existing award was unfair, and provide evidence of this. 

You must submit your intention to appeal within 2 weeks of being notified of our decision, by emailing accia@dhsc.gov.uk.

You must provide all additional information within a further 2 weeks.

Reasons you can request an appeal

You can request an appeal if we have either:

• informed you that any change to your contract makes you ineligible to retain your award
• shortened the duration of your award

You cannot appeal if you disagree with our decision and do not state why it is inconsistent with our rules.

You cannot appeal decisions on prorating the value of a legacy NCEA or an NCIA in transitional pay protection. These are based entirely on the factual details of the number of PAs in your contract.

You can appeal if:

• our guidelines on changes of circumstances and the resultant eligibility criteria were not followed
• you can show that our chair and medical director did not consider all the supporting information or documents you provided
• you can show that irrelevant information was taken into account
• you were discriminated against due to characteristics such as your gender, ethnicity or age
• there is a relevant or undeclared conflict of interest with our chair or medical director

How we handle appeals

Once the decision on your eligibility or duration for your existing award has been sent to you by email, you have 2 weeks to register your request to appeal. No additional information is required at that stage.

Within 2 weeks of your notification of your request to appeal you must send us the detailed reasons for your appeal. These must include:

• full details of your old and new job plans and a description of the weekly activities for each of these, specifying the activities you actively and personally undertake as part of this job plan and which you have a leadership, management or oversight responsibility for
• a detailed timeline of when the change occurred or is planned to occur and the dates that ACCIA was notified. Any delays in notifying changes that have been implemented prior to ACCIA being informed must be explained
• confirmation from your employer that this is a true reflection of your role

Our chair and medical director will review these submissions and decide at this stage whether to uphold your appeal. This will be within 2 weeks of receiving your full appeal documents. If your appeal is upheld at this stage your award will continue and any gaps in payment from it being ceased will be reimbursed.

If our chair and medical director do not agree to uphold your appeal at this stage, it will progress to be reviewed by a separate panel of people who are independent of your region and have not assessed your applications in the past. The panel will include:  

• a medical or dental professional
• an employer
• a non-professional member as chairperson

They will look at:  

• your appeal submission
• the documents that set out our agreed criteria and process
• the correspondence between the secretariat, chair and medical director related to your change of circumstances and their initial decision

You can see all the documents the panel considers. The panel does not usually hear oral evidence. However, you can apply in writing to have an oral hearing. The panel chair will decide whether you can have one.

The appeals process and timeline

Here is an outline of the process with indicative timelines:

1. When we get your request to appeal, we will contact you within 5 working days to acknowledge its receipt.
2. Our chair and medical director will review your submitted documents and decide whether your appeal provides sufficient additional information to uphold your appeal.
3. Within 2 weeks of your submission, our chair and medical director will let you know of their opinion to accept your appeal or to refer it to the appeals panel.
4. If the appeal progresses to the next stage, we will set up a panel and agree a timeline for them to review your submission, usually within 20 working days.
5. When our chair and medical director hear what the panel has decided, they will let you know the final decision, usually within 20 working days.

In all cases, the panel’s decision is final.

If your appeal is successful

If your appeal is successful, our chair and medical director will consider the best way to put things right. This may be to grant you eligibility to retain your award when your new job plan had previously been ruled as ineligible and/or to amend the duration of your existing award. Their decision will be consistent with other similar cases and appeals.  

Even if your appeal against the process is successful, you may not get your award reinstated for the full duration. If this happens, we will write to you to tell you why.