Editor’s blog Friday 20 August 2010: Review of NHS consultants' bonuses

Clearly there are not enough reviews under way: the DH has announced another, and significant one, on the Clinical Excellence and Distinction Awards for consultants.

This is a subject covered here by Alan Maynard, some months ago.

The press release points out that "The awards were first introduced in 1948, and some 60 years later the schemes have remained largely unchanged. The review will bring the awards scheme up to date and in line with other public sector pay schemes. As well as ensuring that the rewards are effective and contribute to improving health outcomes for patients, the review will make sure that the scheme is affordable.

"The review, commissioned by the four UK Health Departments, will be led by the independent Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The DDRB will work closely with a range of external stakeholders, including NHS organisations, the British Medical Association and the independent committees which make awards in the devolved administrations".

The notes of the release show that Clinical Excellence Awards are held until retirement subject to reviews every 5 years. If reviews are unsatisfactory a one year review is required. Any unsatisfactory one year review can lead to an award being taken away but pay protection applies if an award is removed. Awards are consolidated in pay and contribute to pension entitlements.  Consultants on retirement receive a pension and retirement lump sum which is based on the best of the last three years’ pensionable pay (since 2008 some consultants have moved to a new pension scheme where pensionable pay is based on the average of the best three consecutive years in the last ten).

There are 12 levels of award in England. Levels 1-8 are awarded locally (employer based awards) and Levels 9-12 (Bronze, Silver, Gold and Platinum) are awarded nationally in England by The Advisory Committee on Clinical Excellence Awards (ACCEA).

Helpfully, at the foot of the release is a link to a downloadable file detailing the payments and their cash value for 2009-10.

The principles to drive the review are as follows:
Compensation levels, incentives and the Clinical Excellence and Distinction award schemes for NHS consultants - Terms of Reference for a UK-wide review

The review is to look at compensation levels and incentive systems and the various Clinical Excellence and Distinction Award Schemes for NHS consultants at both national and local level in England, Wales, Scotland and Northern Ireland. The review will take place in the context of key Government documents and the remit is -

To consider the need for compensation levels above the basic pay scales for NHS consultant doctors and dentists including clinical academics with honorary NHS contracts, in order to recruit, retain and motivate the necessary supply of consultants in the context of the international medical job market and maintain a comprehensive and universal provision of consultants across the NHS. The review will consider total compensation levels for consultants and may make observations (rather than recommendations) on basic pay scales

To consider the need for incentives to encourage and reward excellent quality of care, innovation, leadership, health research, productivity and contributions to the wider NHS - including those beyond the immediate workplace, and over and above contractual expectations. The review should specifically reassess the structure of and purpose for the Clinical Excellence and Distinction Awards Schemes and provide assurance that any system for the future includes a process which is fair, equitable and provides value for money

The review will be fully linked into other activity on public sector pay, including:
The benchmarking work on senior public sector pay being carried out by the Senior Salaries Review Body;
The Fair Pay Review in the public sector led by Will Hutton; and
The review of public service pensions by the Independent Public  Service Pensions Committee chaired by John Hutton

The review should consider issues of comparability with other public sector and NHS incentive schemes. The recommendations of the review must take full account of affordability and value for money. The recommendations must also respect the accrued rights of individuals.

The review is to be led by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The DDRB as an independent body will work closely with a range of external stakeholders, including NHS employers, the British Medical Association and the independent Committees which make awards in the four countries.

The review has been commissioned by Ministers of the four countries in the UK. The DDRB has been asked to submit recommendations to UK Ministers by July 2011.