Intended for healthcare professionals


Clinical Excellence Awards—time for a fairer NHS rewards scheme

BMJ 2021; 373 doi: (Published 23 April 2021) Cite this as: BMJ 2021;373:n876
  1. Ryan Essex, research fellow1,
  2. Ishanka Talagala, consultant community physician2,
  3. Olamide Dada, medical student3,
  4. Mala Rao, director4
  1. 1The University of Greenwich, Old Royal Naval College, Greenwich, London SE10 9LS, UK
  2. 2Ministry of Health, Colombo 10, Sri Lanka
  3. 3School of Medicine, Cardiff University, Cardiff, UK
  4. 4Ethnicity and Health Unit, Department of Primary Care and Public Health, Imperial College London, UK
  1. Correspondence to: R Essex r.w.essex{at}

Ryan Essex and colleagues call for abolition of the Clinical Excellence Awards owing to their inherent divisiveness and persistent structural inequalities

Covid-19 has transformed the visibility of healthcare delivery, and public attitudes and perceptions related to the NHS have changed, potentially forever. The leadership shown by all NHS staff in managing the challenges of the pandemic leads to questions about how excellence is to be defined and how the unique contributions of individuals will and should be recognised and rewarded after covid-19.

The current NHS rewards system, known as the Clinical Excellence Awards (CEAs), which benefits consultant medical staff in England, was paused for the first time in 2020 owing to the pandemic and is currently undergoing a government consultation.1 This intermission is an opportunity to review these awards. We provide a brief overview of the scheme and discuss the lack of evidence to show that it is fairly distributed, incentivises individual or team performance, or improves patient outcomes. We call for abolition of the scheme and for input from all NHS staff to determine an equitable alternative.

A brief history

The system originally known as the Distinction Awards Scheme for hospital consultants was introduced at the inception of the NHS. Its original intention (at least in part) was to persuade the most senior members of the medical profession to end their opposition to the NHS.2 Regarded now as a performance related payment scheme,2 it has undergone several modifications over the years, but its core—a voluntary competitive process to identify and reward consultants providing the “highest quality” of service—remains unchanged. Does this apparently justifiable means to an end in 1948 deserve to be continued in the post-covid-19 era?

The Distinction Awards Scheme was criticised for many decades.3 In the 1980s, analyses found “iniquitous” allocation of awards, with women, younger …

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