Retain clinical excellence awards, but cap sum and number of recipients, says DDRB

BMJ 2012; 345 doi: (Published 18 December 2012) Cite this as: BMJ 2012;345:e8585
  1. Helen Jaques, news reporter
  1. 1BMJ Careers
  1. hjaques{at}

Clinical excellence and distinction awards for consultants in the NHS in the United Kingdom should be retained, but the maximum sums on offer and the number of awards available should be capped, the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) has said.

The independent body’s report says that national awards should be available to a maximum of 10% of consultants and be capped at £40 000 (€49 000; $65 000) a year, £35 000 less than at present. Local awards should be available to 25% of doctors and be capped at £35 000 a year, it says.1

In 2010, 9.7% of UK consultants and clinical academics held national clinical excellence or distinction awards, worth on average £43 107 a year. In addition, about 40% held local clinical excellence awards, worth on average £12 143 a year. The current maximum limits are £35 484 a year for local awards and £75 796 a year for national awards.

At present, awards are given on top of a doctor’s regular salary, are pensionable, and are paid until a doctor retires. The DDRB has recommended that clinical excellence and distinction awards should be one-off annual lump sum payments and should not be pensionable. But the government has rejected this recommendation, arguing that recent pension reforms meant that pensionable rewards were affordable as part of an overall agreement.

The government has accepted all the report’s other main recommendations and will hold discussions with the BMA and NHS Employers in early 2013 to ensure that agreement on the changes is reached by spring.

In 2010 the government asked the DDRB to review the various clinical excellence and distinction award schemes in place across the UK. The review sought to establish whether such awards were necessary to incentivise NHS consultants to provide care and innovation over and above their contractual expectations.

The DDRB has concluded that the awards support recruitment and retention and provide an incentive to work beyond job roles in patient care and in contributing to the development of the NHS.

But it said that national and local awards were not sufficiently linked to performance, rewarding length of service rather than contribution to the NHS, and were treated “as an extension to the basic pay scale.” Both types of awards should be linked more strongly with measures of performance, such as quality of care and patient feedback, and should be “re-earned” on an annual basis in most instances, it argued.

Local awards should be linked to appraisals, determined by employing organisations rather than awarded by application, and awarded for one year, with the maximum length of award three years in exceptional cases, the DDRB said.

National awards should comprise four levels of award: of £10 000, £20 000, £30 000, and £40 000 a year, to be awarded to 4%, 3%, 2%, and 1% of consultants, respectively, it said.

The BMA has welcomed the decision to continue with the award schemes and the government’s decision that the awards remain pensionable. “Consultant award schemes help drive improvements to NHS care, as well as benefiting the UK research base and economy,” said Paul Flynn, chairman of the BMA’s Consultants Committee.

“We will be looking at the proposals carefully,” he added. “It is vital that they do not water down incentives for excellence, particularly in the context of the ongoing pay freeze for doctors and major changes to NHS pensions.”


Cite this as: BMJ 2012;345:e8585