HCSA has produced this detailed FAQ explaining the background to its rejection of agreement on the shape of a new national LCEA scheme.
Why have the negotiations been taking place?
The government set their sights on the old-style pensionable, consolidated LCEAs from 2010 as part of a wholesale review of the 2003 Consultants contract. The DDRB was commissioned to review Consultant awards and reported in 2012.
A 2018 agreement between the BMA and NHS Employers created the formal contractual framework (contained in Schedule 30 of the Consultants contract) which has governed both LCEA and NCEA reform since then.
This stipulated protections for existing award-holders, detailed arrangements and funding for interim local awards (initially envisaged to last until 2020-21) and also set a deadline and fallback for the LCEAs should no agreement be reached by that point. The deadline for announcement of a new scheme was amended from April 2021 to April 2022 due to the pandemic.
HCSA rejected the 2018 agreement, warning that it left too much unknown, could lead ultimately to a pure performance-related pay scheme, and also hardwired in a deadline which would impact on our ability to negotiate.
However, we have since 2020 been engaging as part of the tripartite negotiations with the BMA and NHS Employers in order to try to win the best outcome for Consultants.
Schedule 30 lays out in limited detail the bare bones of a future scheme, and if there is no further progress then this will govern the basic requirements upon employers, including funding.
What was HCSA’s focus in negotiations?
HCSA entered negotiations in order to retain the focus on clinical excellence in any new award scheme, but also to ensure that any new scheme engaged the widest number of Consultants and worked to remove specialism-based, gender and ethnicity biases.
We recognise that while many Consultants support the old format (and in particular the fact they were pensionable and consolidated), still others felt negatively towards the awards because they saw them as elitist and unobtainable.
Many hospital doctors, in particular those without a current award, told us that they actually preferred equal distribution of the LCEA pot. However, this was flatly rejected and so talks centred on devising a broader access scheme which would reward a wider proportion of Consultants.
Why did HCSA feel unable to sign the deal?
Ultimately, for HCSA any scheme had to be fair for all Consultants and also be sufficiently rewarding of excellence. To work, any scheme must be able to gain the support and confidence of Consultants.
Some progress was made towards designing a scheme which would be widely accessible and reward excellence without an application.
However, this was rejected by employers in favour of a two-tier scheme which would allow a low payment achievable by most Consultants (provided they met criteria including around job planning and training) and then a level two application-based award of a higher value award which was strikingly similar to the old scheme, albeit non-pensionable and non-consolidated.
Domains were to be replaced with 15 new Areas of Excellence encompassing a broader range of activities, and Consultants expected to work towards three of each at both levels.
Unfortunately, a number of fundamental sticking points arose during the course of the negotiations which led to the HCSA Executive rejecting the framework agreement.
What were the sticking points?
In our view, the ultimate shape of the proposal reached by negotiation was likely to be unpopular with hospital doctors, perpetuate the systemic problems of the past scheme, and result in low engagement. It was also inequitable and would create a postcode lottery which HCSA believes would have a lasting negative impact.
Two of the central problems related to funding.
First, NHS England / Improvement rejected appeals to direct specific funding to old-style LCEA award-holders prior to distributing the rest of the LCEA pot equally to employers based on Consultant FTE.
The result of this is that where an employer has high previous commitments to old-style LCEAs, this drastically reduces the funding available for any new scheme. The variance at the top and bottom of the employer affordability scale is significant, ranging from a few hundred pounds per Consultant to several thousand. This will create a postcode lottery disadvantaging affected Consultants for some years.
Second, in order to reduce the burden on employers and individuals it was proposed by unions that higher awards could be multi-year, but this was again rejected by NHS England / Improvement which insisted that the awards could be for a single year only.
This raised the prospect of Consultants going through a cumbersome application process on an annual basis for a far lower-value award than previously. In our view this would result in less Consultant engagement.
Much of the scheme design would remain in guidance, which means that employers would have considerable latitude to alter and amend schemes locally, or simply rehash the old scheme with poorer rewards, with little recourse for Consultants.
Employers would be free to set the value of higher awards locally, and could also channel left-over funds away from Consultant pay.
In HCSA’s view caps and ceilings insisted upon by employers would make it inevitable that left-over funds would be created. In some cases this could reach a considerable amount.
One of the central objectives of HCSA was to ensure that the contribution of clinical excellence awards to the gender and ethnicity pay gaps in medicine was taken seriously and mitigations put in place to counter this.
Widening the number of Areas of Excellence (formerly domains) to encompass different types of activity and specialties was therefore a positive step.
Equally, ending the pro-rating of LCEA awards for less-than-full-time Consultants was a step recommended by the Mend the Gap review. However, we remained concerned that where a LTFT doctor was time poor, they would have less chance of achieving an award at all - something which we attempted to address in the negotiations.
We were also concerned at the lack of robust mandatory reporting at local and national level. While this concern was acknowledged and some additional reporting was included in the agreement, this remained short of the detail required to properly “stress test” the new scheme nationally for equalities concerns.
HCSA shall continue to pursue proper monitoring of awards at local and national level with any local award schemes.
What will happen to LCEAs now?
Schedule 30 currently states that clauses related to a future scheme will be effective from April 2022, that employers must “consult” JLNCs if they wish to implement changes to LCEA schemes, there must be an awards process, that awards must be non-consolidated and non-pensionable, and that the level of investment will be set contractually at national level.
However, at this stage the precise details are not clear.
I have an old-style LCEA award, what will happen to me?
If you have an old-style LCEA award, then currently this will be protected. However, under the 2018 agreement, from April 2022 old-style awards will be subject to review and can be retained, reduced or removed depending on the individual’s review score. Review scoring will take place based on the old-style LCEA scoring and domain system.