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HCSA rejects agreement on Clinical Excellence Awards

The Hospital Consultants and Specialists Association (HCSA) has declined an invitation to sign a joint NHS Employer-BMA deal on the future of pay awards for clinical excellence, branding the plans “half-baked” and “impossible to agree” on behalf of members.

The agreement sets out a road map for an interim Local Clinical Excellence Awards scheme from April 2018, and the principles that will underpin its expected replacement from April 2021. It also commits signatories to agree to unknown changes to the higher National Clinical Excellence Awards schemes next year.

An HCSA briefing document for members is available for download (PDF).

HCSA felt unable to sign due to a number of specific concerns, including:

  • Excellence awards currently reflected in monthly salaries would become “banker-style” annual bonuses, which could have unforeseen consequences. They or their replacement should remain an integral part of the pay structure, properly rewarding excellence.
  • Signing up would involve the forfeiture of full negotiating rights over a new scheme from 2021 – it contains a clause allowing NHS Trusts to unilaterally change Local CEAs, albeit after ”consultation” with Local Negotiating Committees. It would also mean agreeing for the Secretary of State and Department of Health to do the same to National CEAs after 1st April 2019. As a professional trade union, HCSA cannot serve its members by bestowing a unilateral right on employers.
  • This is particularly the case given the ill-defined nature of the “performance” based scheme which this agreement states will replace Local CEAs from 2021. HCSA fears that this in future divert hospital doctors away from innovation, research and excellence towards narrow Trust objectives. This would be bad for patients, bad for doctors, and bad for the country’s world-class health system.
  • We believe, as stated explicitly in our evidence to this year’s DDRB pay review round, that the current LCEAs scheme should remain in place and be fully implemented until the revised Consultant Contract as a whole is agreed. We do not support a piecemeal implementation of these new terms and conditions.

HCSA President Ross Welch said: “This is a half-baked and hastily constructed scheme that will have unforeseen consequences for the profession and the drive for excellence among our most talented hospital doctors.

“It would be a neglect of our duty to members to sign up to a plan that gives carte blanche to NHS Trusts to effectively do as they like in three years’ time without reaching a national agreement on what a replacement scheme will look like.

“Doing so leaves the door wide open to a narrow focus on reward for ‘performance’ as defined by Trust objectives, rather than on innovation, professional standards, research, teaching and training. It threatens to lead inexorably to a target-related bonus scheme which does neither patients nor hospital doctors justice.

“An initial three-year boost to Local CEA pots contained in this deal will offer cold comfort after 2021 when doctors are left facing Trust-driven performance targets.

“HCSA has always held the position that Local Clinical Excellence Awards are an integral part of Consultants’ professional reward framework and should not be separated from the main negotiations.

“In its current form the scheme is seen by many hospital doctors, rightly or wrongly, as insufficiently broad and at times favouring certain individuals, yet it has at its heart the desire to reward those who go above and beyond for patient care.

“Alongside a 20 per cent decline in pay since 2010, these changes to the focus on excellence will compound the current vacancies crisis by encouraging the retirement of our most experienced doctors, while creating less incentive for the doctors of the future to go above and beyond the call of duty. 

“We maintain that until a satisfactory fair and transparent replacement LCEA scheme is devised within a wider framework of reform, the current system should remain unchanged.”