Executive statement: Why HCSA could not sign the LCEA deal

HCSA’s Executive has issued the following statement regarding the breakdown of national negotiations on a replacement LCEA scheme.

HCSA’s Executive has voted unanimously to reject proposals on a LCEA successor scheme following two years of negotiations.

HCSA engaged in these talks in good faith to try to secure the best deal possible for Consultants.

We did so despite fundamental misgivings over the replacement of nationally standardised LCEAs with locally managed “performance” schemes.

HCSA’s objective was to encourage and award excellent work, but also tackle past inequalities and allow more doctors to achieve an award. At stake is £445 million in Consultant pay.

Despite a number of welcome last-minute employer amendments, fundamental differences remained.

Given such significant flaws, the HCSA Executive felt unable to endorse the proposals as a credible scheme.

In 2018, HCSA refused to sign the deal which gave birth to the recent talks. We were concerned that it set hard deadlines which would hamper unions’ ability to negotiate a replacement. It also set out a “default” in case of failure, which HCSA felt could lead to unintended consequences.

The prospect of this “default” has been used as a lever to press unions to sign up.

Yet to do so would be to endorse a new scheme we believe would fail Consultants but could be stamped “with union approval”.

In recent months it has become clear that any attempt at a nationally standardised award framework will be fatally undermined by conditions imposed by NHS England/Improvement on funding.

These mean that individual employers with a large number of old-style LCEA-holders in their workforce will have far less left over to invest in the new scheme. The available funding for new awards per Consultant will vary between employers from a few hundred pounds to many thousands.

This postcode lottery could be lessened by earmarking a portion of the funds nationally to meet existing LCEA commitments and then distributing the remainder fairly based on Consultant population. But this was rejected by NHS England/Improvement.

Similarly it blocked multi-year awards, leading to a cumbersome and impractical requirement for Consultants to reapply every year to secure an award of lower value than in the past.

The negotiations yielded some positive improvements, which may sadly now be lost. There was, for instance, progress around the breadth of work which could be admissible for an award. There was a continued link to the concept of excellence. 

However, the proposal on the table was largely a continuation of the application-based scheme of the past but for less valuable non-consolidated, non-pensionable awards. It failed to address the concerns many Consultants have around the LCEA scheme of old. It would also have permitted employers to channel funding away from Consultant pay.

It is in this context that HCSA, which has always sought to defend the professional status of hospital doctors, could not in good faith put its name to this deal.

HCSA remains open to talks on a fair and viable LCEA replacement which truly rewards excellence by Consultants and does the best for patients and our NHS.

However, the current trajectory of LCEA reforms is in our view a disaster in the making. It represents yet another nail in the coffin of medicine as a profession.

We fear it will drive disengagement rather than engagement, provide the worst employers a further stick with which to beat hospital doctors, and do little to address the inequalities these reforms were meant to tackle.