Researchers propose revised scoring system for recognising outstanding NHS clinicians

A team of researchers has developed a new scoring system for a nationwide scheme, overseen by the Advisory Committee on Clinical Impact Awards (ACCIA), to recognise and reward senior doctors and dentists in England and Wales.

There has been a scheme in place since 1948 to reward senior clinicians who make an outstanding contribution to supporting the delivery of NHS goals. The awards have been known, through various iterations, as merit awards, clinical excellence awards, and, most recently, clinical impact awards.

Published in JRSM Open – a journal of the Royal Society of Medicine – a new study led by the University of Exeter aims to inform the development of a revised scoring system that is robust, equitable, able to distinguish between levels of excellence, and aligned with the scheme’s overall goals.

Concerns have previously been raised, and recognised by the Advisory Committee overseeing the scheme, in respect of the accessibility of the scheme to all eligible senior clinicians, most notably those who are women, from ethnic minorities or working less than full time.

A revised and rebranded scheme, called Clinical Impact Awards, was introduced in 2022. This has led to important changes, the researchers say – in particular, to a focus on clinical impact rather than clinical excellence. However, given the complexity of simultaneously introducing a substantially revised scheme, transition to a new scoring system has not yet been implemented.

Under the current arrangement, clinicians are graded using a four-point scale, whereas the proposed system offers a wider range of scores from 0-10, with each point on the scale coming with a clear description. As with the current scoring scale, the lowest point would reflect someone operating below the expectations of their job, while the highest point would signify an outstanding contribution. Applicants would be benchmarked against their peers working in similar roles. In addition, the researchers found support for the retention of pro rating of award values for consultants working less than full time, which was removed as part of the reforms for the new scheme.

A pilot study showed similar levels of reliability between the proposed scoring system and the one currently in use but suggested that the new proposed scoring system was potentially better at distinguishing between applicants demonstrating higher levels of performance.

Lead author Professor John Campbell of the University of Exeter said: “Clinical excellence awards represent substantial public spending and thus far the deployment of these funds has lacked a strong evidence base. We have supported the team responsible for the governance of the scheme by developing a new scoring system, which shows potential improvements over current assessment arrangements.”

The researchers are calling for a larger-scale prospective evaluation of the proposed scoring system, in the context of the new unstratified application process run by ACCIA, accompanied by full training in its use.