Wednesday, 25 August 2010


There have been a number of articles in the media lately about the threat to Clinical Excellence Awards, which are being reviewed by the Doctors and Dentists Review Body at the request of the Health Secretary. (1) (2) (3) (4)

The articles reveal differing viewpoints about CEAs but all seem to agree that those Hospital Consultants in receipt of an award are going to lose out. There is certainly likely to be a cut in their value and some advocate total abolition. The pensionable nature of the extra pay is also likely to be lost. 

There is unlikely to be much opposition to the loss of CEAs as far as the general public is concerned. First of all we (hospital consultants) are widely perceived as being very well paid. With the top increment (£100,400pa) being over three times the national average wage it would be hard to argue with that perception. With the current attitude towards bonuses (which is what CEAs are) the government could abolish CEAs altogether with the strong support of most of the population.

Also bearing in mind what has happened to the pension schemes of millions of workers in the private sector, doctors who whinge about their pensions and the effect of the loss of  CEAs on their pensions are going to get precious little sympathy.

Nor can I see a socialist opposition in Parliament being able to stomach supporting us on this issue.

In his article in “Hospital Doctor” Mike Broad makes the naive assumption that the Consultant Body as a whole is in favour of retaining the present system. Well he should hear the carping and whining in my hospital when the awards are announced. The truth is there is much opposition to CEAs within the consultants themselves. There is widespread perception of iniquity, racism, sexism, cronyism and even corruption, in the awarding of CEAs. I know of a number of good hard working consultants who refuse to apply on principal. As one of them put it, “I would rather my colleagues express surprise that I don’t get one, than outrage that I do.” Dr Broad opines that the only consultants who would support the government are those who don’t get a CEA. Oh well that is only 65% of them then.

Dr Broad’s ultimate naivety is in expecting the BMA to rise to this “enormous challenge”. Unfortunately for the BMA to do this they would require two things they don’t have. 1. A backbone, and 2. the strong support of the majority of NHS consultants, many of whom don’t get an award and never will. Face it the rank and file are not going to go to war to protect the bonuses of the privileged  minority.

Dr Broad urges consultants to communicate their opposition to the loss of CEAs to the Health Secretary. I would advocate that the many consultants who have no such opposition should also communicate their views.


  1. Not because some think it is an unfair system that it should be abolished! The BMA should fight to: 1- Keep it, since all those who achieve anywhere else do get bonuses (Not forgeting the bankers outrageous bonuses either!}, 2- Insist that the system is reformed to make it fairer, one that rewards real commitment and outstanding performance to encourage a culture of effeciency and excellence.

    Otherwise, how do you propose to reward achievement? And why should anyone excel or innovate if there is no incentive for them?!

    It would be a big mistake to abolish such reward system because it will only lead to more stagnation, which leads to carelessness, thus more waste, leading to much more increased cost than it saves!

  2. "Otherwise, how do you propose to reward achievement? And why should anyone excel or innovate if there is no incentive for them?!"

    Firstly however you define achievement the system is still going to be arbitrary at best and still with the potential for corruption.
    Secondly, are you suggesting that those that contribute the most do so only for financial gain? If so you confirm Aneurin Bevan's view of the medical profession as being totally mercenary and scheming.
    Thirdly, are you suggesting that the majority of the profession who will never get an award have contributed nothing, because that view is not only wrong in my opinion, it is a fucking insult.

  3. To your first point I say, reward and bonus systems are all over the place in the private sector. They are fair, reward 'exceptional endeavour' and are successful. Why can't the same be done at the NHS?

    Hence, you two other points are invalid because you are assuming that those who have 'above average abilities' should satisfy themselves with an 'average' reward or be considered 'totally mercenery and scheming'! And no, I am not saying 'those who don't get it are contributing nothing! In a fair system, they'd be the ones with average performance and those don't work for 'nothing' because they do get their salaries as per contract after all. Bonuses are meant to be for 'outstanding performance'.

  4. The private sector do not command the job security and pensions enjoyed by the public sector and the bonuses are balanced by risk. Also it is clear in the private sector that bonuses are paid even when the company is failing due to poor management.

    In the NHS CEAs are all to often given for simply occupying the right positions and doing what is presented as additional work when in fact it is done instead of, rather than in addition to clinical duties. The recipient gets the reward while his colleagues cover the extra work.

    I do not agree with your view, and if it comes to confrontation with government on the issue you will not have my support.

  5. CEA's, in my somewhat limited view, seem both divisive and unrepresentative of effort. To cite the private sector is also wide of the mark. With the possible exception of the grasping financial sector, incentive rewards are fairly thin on the ground and come no where near the CEA maximum of £76K.
    My own Consultant whom I believe to be the worst I have met in twenty years of treatment for a chronic condition, gets the full amount every year without fail. He is the only one in his speciality to do so. Yet he is c**p.
    In his private practise, he takes the punters gold for cursory treatment. Unlike his predecessor who was both a gentleman and one who invested heavily in his own consulting rooms with the latest diagnostic equipment. This guy uses hired rooms with none, at a BMI hospital and goes through the motions at £120 a pop. If he was so good and worthy of his CEA he shouldn't really have time for me. I don't for him, so I've canned him. He is rarely seen in the trenches except of course if there is kudos involved when he will turn up for the opening of a envelope.
    CEA's foster elitism; lets consign them to history.

  6. Blackdog is spot on describing CEAs as divisive. They are so divisive one wonders if they were devised with that very objective in mind. To divide and rule.