2013-Paula Hyde

Decision-making in CEA committees 2014-15

Professor Paula Hyde, University of Manchester

Professor Mark Exworthy, University of Birmingham

Pamela McDonald-Kuhne, Kingston University


Performance-related pay for senior doctors takes the form of Clinical Excellence Awards (CEAs) in the National Health Service. Despite modest reforms, CEAs have been subjected to limited assessment in terms of their effects on motivation and performance. Through empirical research we examined the current decision-making around Clinical Excellence Awards (CEAs) and what they indicate about the nature and extent of power and pay reform in the medical profession. A rapid review of extant evidence relating to medical power gave rise to four themes that provided the framework for observations (Broadly, they were; format/content, excellence/performance standards, purpose, process/decision-making). An observational study of CEA committees was undertaken in 2014 and 2015. Thirteen committee meetings were observed including national, regional and local awarding bodies. We saw how medical power operated in these meetings and how the uncertain future for these awards affected decision-making. We also discerned new tensions between medical power and challenges to it, centred on control over the decision-making processes and on notions of `medical excellence.’ Medical power may be threatened but we also see how the profession is absorbing such challenges albeit with ramifications for its own members.