National Clinical Excellence Award Scheme – Changes introduced in 2022

There have been important changes to the National Clinical Excellence Award scheme which is now known as the National Clinical Impact Award scheme. These changes were unilaterally introduced by the Advisory Committee on Clinical Impact Awards (ACCIA) following a consultation last year.

The BMA highlighted a number of concerns both during the consultation process and following the publication of the consultation response in 2021. Read the BMA submission to the consultation process and the subsequent letter sent to the Department of Health and Social Care.

Despite these concerns, ACCIA and DHSC have proceeded with these changes. Consultants, consultant clinical academics and academic GPs in England and Wales need to consider very carefully the impact of these changes before applying for or receiving an award. 

How has the scheme changed?

The main changes are summarised below. You can find more detail about the changes to the awards on the ACCIA website. 

• The awards are no longer pensionable.
• The value of awards has been significantly reduced. Instead of Bronze (£36,192, Silver (47,582), Gold (£59,477) and Platinum (£77,320) awards there are 3 levels of award in England: N1 (£20,000), N2 (£30,000) and N3 (£40,000). [There is an additional N0 (£10,000) in Wales.]
• There has been an increase in the total number of awards from 300 to a maximum of 600 (note this is a maximum rather than a target).
• There is a change to the domain structure with the previous Domains 1 and 2 merged into "Developing and Delivering your Service", the Previous Domain 5 expanded to 'Education, Training and People Development' and a new Domain for other high-quality work.
• It had been initially proposed that applicants could hold a local clinical excellence award and an NCIA at the same time, however in England it was been decided that national and local awards cannot be held concurrently. [NB in Wales, commitment awards and NCIAs can be held concurrently]
• If you are a consultant in England who has old pensionable LCEAs, a successful application for non-pensionable NCIA will require you to surrender any pensionable LCEAs.
• There is no formal renewal process for NCIAs with awards time limited and award holders wishing to maintain their award will need to submit a new application.
• There will be changes to the nomination and citation process, with no 3rd party certifications allowed and a maximum of one citation from a national nominating organisation (NNO). Applicants can apply for support from 2 but choose only 1 in their final submission. In addition, the number of NNOs and Speciality Organisations have been reduced and the maximum number of candidates they can support has also been reduced. The BMA remains a NNO and applications are now open.
• Awards made to those working less than full time are no longer be paid pro-rata.

BMA concerns about the changes

Although some of the changes – such as paying awards in full to those who work LTFT and widening the domain structure – are positive, there are significant problems with many of the changes. 

Furthermore, while it appears to be a positive step to increase the number of awards, this is being paid for by drastically reducing the value of the awards and removing their pensionability.
Therefore, this does not represent an increase in funding despite the number of awards having been reduced from 600 awards to the current 300 in 2010 as part of the then Government’s austerity programme.

Indeed, the major problems with these changes result both from the loss of pensionability and that fact that in England, you cannot hold local and national awards concurrently. Therefore, before applying, people must consider their individual circumstances very carefully.

Due to the complexity, we cannot advise on every possible scenario, but we have highlighted the 3 main situations that people may encounter here.

Common scenarios

• I hold an existing pensionable LCEA (Level 1 to level 9)

These awards are pensionable and consolidated and range in value from £3,092 to £36,192. Active scheme members will accrue 2015 pension on these amounts each year from 2022 onwards. However, these awards will only translate into pensionable benefit in the 1995 scheme if they are held until retirement (or no later than 2 years of active scheme membership after losing an award).

Under the new NCIA scheme, if successful at gaining a NCIA, you will need to surrender your local pensionable LCEA. Given a N1 starts at £20k and an N3 is £40k, non-pensionable and time limited to 5 years, potential applicants would need to consider whether it is in their interests to surrender a pensionable LCEA, particularly if they had paid annual allowance tax charges when receiving one as by giving up an award you may not receive the 1995 pension benefit from it at the point of retirement. You might also have been paying tax on a benefit which you would not benefit from by switching.

It is important to note that NCIA holders will also not be able to receive new local CEAs either via a competitive process or by equal distribution, whereas existing local CEA holders will. The BMA could not agree a new local CEA scheme with NHS employers but under their proposals, most consultants could expect to receive a Level 1 payment of £2,500 and 25-30% of consultants could expect to receive a Level 2 payment of up to £20,000.

• I have an existing pensionable NCEA

If you hold an existing NCEA you will be invited to renew your existing NCEA at the relevant renewal date. The arrangements that apply are outlined in Schedule 30 of the TCS.

In summary however, if you are successful at the same or higher level (e.g. you are a current Silver award holder (£47k) and you are awarded an N1 (£20k), you will be awarded an N1 but receive an additional payment (in this case £27k) up to the value of the previous NCEA. In addition, the total value will remain pensionable.

However, if you are unsuccessful, the reversion arrangements whereby you may revert to the equivalent of a local 7 or local 8 pensionable CEA still apply. Unfortunately, at present Academic GPs do not have access to this reversion mechanism, something we have been seeking to address and different arrangements apply in Wales, whereby you revert to the relevant commitment award that applies.

These arrangements are clear for the first renewal but the BMA are clarifying the position that would apply regarding these protection payments at subsequent renewals.
It is important to apply to protect the level of pensionable pay (i.e. the value on which your 1995/2008 pension is based on), rather than the level of pay you actually receive if your pensionable pay falls as a result of losing a pensionable NCEA.

• I don’t hold a pensionable LCEA

In these circumstances, it is unlikely there would be any immediate detriment if you receive an NCIA.

National Clinical Impact Awards (NCIAs) Application Process

Further information on applying for a CIA is available on the ACCIA website, including the word version of the application form which can be started now in advance of the award round opening. We advise that applicants read all supporting documents, including guidance for employers, and assessors to understand how best to present their application. 

Candidates are responsible for submitting their online CIA application as per the instructions on the ACCIA website.

What to demonstrate

National CIAs are awarded to consultants who work in England or Wales, and who:

• demonstrate sustained commitment to patient care and wellbeing, or improving public health
• maintain high standards of technical and clinical aspects of service while providing patient-focused care
• in their day-to-day practice, demonstrate a commitment to NHS values and goals by participating actively in job planning, observing the private practice code of conduct and achieving agreed service objectives
• through active participation in clinical governance, contribute to continuous improvement in service organisation and delivery
• embrace the principles of evidence-based practice
• contribute to our knowledge base through research and participate actively in research governance
• are recognised as excellent teachers, trainers or managers
• contribute to policy-making and planning in health and healthcare; or
• make an outstanding contribution to professional leadership.