Supplementary evidence on reform of clinical excellence awards

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NHS Employers' medical pay team has submitted further evidence to the Review Body on Doctors' and Dentists' Remuneration (DDRB) in response to the supplementary question on reform of the local clinical excellence award (LCEA) scheme. The evidence details a collective agreement reached by the employers’ side negotiating partners and the British Medical Association (BMA) on some interim reforms to the scheme.

Reform of the local clinical excellence award scheme

 On the 22 March, NHS Employers and the BMA announced an agreement to reform LCEA. The reforms will seek to improve links between consultants’ pay, and their contribution and performance by replacing the current ‘payments for life’ with time-limited awards that better recognise the contribution that consultants currently make. These reforms also have the potential to enable us to get the best from the consultant workforce to ensure they have the greatest possible impact on patient care and health outcomes.


Financial outlook

The financial outlook remains extremely challenging for employers, which will restrict their ability to invest in pay for the DDRB remit group without additional funds being committed by government. Investment linked to DDRB recommendations on pay that is not fully funded will create significant additional financial pressures and adversely impact on the delivery of quality care. It will also be important that any significant pay increases for consultants, recommended by DDRB above those already planned, must have a clear benefit to the taxpayer, employers and the wider system.

NHS Employers' view

Our view is that a fair and transparent performance pay mechanism can help to incentivise and engage consultants, but we expect that in 2018, only around 0.7 per cent of consultants’ average earnings will be clearly linked to evidence of recent excellence. This is partly because most spend on LCEA is used to cover liabilities associated with previous decisions which reward historic demonstrations of excellence. While the position will change over time, our preference is to increase this percentage more quickly by improving consultants’ access to the new award system.


Specifically, our view is that the DDRB should strongly consider targeting any pay recommendations for consultants into improving access to LCEA for the highest performing consultants. This would give the NHS more flexibility to secure the engagement of consultants in the delivery of organisational priorities, including increased productivity. 

This direction of travel is endorsed by the Department of Health and Social Care, and NHS Improvement. We have started to explore opportunities to work together to support employers to make the most of the changes.


Read the supplementary evidence.

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