The good news for geriatricians is that these awards are intended to reflect NHS related work. Whether it is clinical or academic, the contribution to patient care in the NHS is the most important criterion.

Local and national decisions
There are twelve levels of awards. The first eight are entirely determined locally, at Trust level. Level 9 can be awarded either locally or nationally. Levels 10 and above are exclusively national awards.

The British Geriatrics Society is anxious to support its members as effectively as possible in achieving these awards and I personally would be optimistic that the new criteria will result in more awards within our specialty. I think it is a matter of considerable concern that we have not achieved the numbers of higher awards that would be justified from the general level of commitment and excellence within our specialty. It is clearly the role of our Society to reveal the light that is hidden under many a bushel.

How it works
Richard Lynham outlined in the March 2003 issue of the Newsletter, the British Geriatrics Society procedures to try and help people achieve merit awards. Last year, starting in September, we have begun to introduce a new system, which we hope will be fairer and bring support to as many geriatricians as possible. We still depend very heavily on the Father Figure in each region. Our shortage of higher award holders has made this difficult in some regions as they do not have an equivalent of an A or A+ award holder. Nevertheless, we were able to get a large number of nominations from all regional branches of the BGS. CVQ’s were requested from people nominated and they were examined by a panel consisting of Prof Cameron Swift, myself, David Black (representing the English Council) and Ed Wilkins (representing the Welsh Council). Northern Ireland and Scotland have separate mechanisms and in both instances, the Society has good support systems within those nations.

Father figures
The original intention was for Father Figures to vote on the CVQ’s of all people nominated throughout England and Wales, but this was technically not possible. This year, the new system was introduced before last year’s awards were announced, and without absolutely clear criteria, when we started to consider the process. For any Society or College, there is a very short time frame to decide which of its members to support and to arrange that the proper citations are submitted by the end of January. This year we managed the process by teleconference. The only hiccup was that we failed to connect with Ed Wilkins, who was able to give independent input at a later date.

The old award system did not encourage a direct submission from the specialist society and we had previously sent a list in order of priority to the national committee and gained further recognition by supporting those nominated through the Royal College of Physicians (London) nomination system. We continue to do this. As Chairman of the Joint Geriatrics Committee of the Royal College, I sit on the President’s Panel, which considers nominations from all specialties in medicine. Although technically representation on this committee is regional, myself representing the Mersey Region, we were fortunate this year in having two geriatricians on the Panel, namely Gordon Wilcock representing the South West of England. While in the previous year the College only made four nominations from geriatric medicine, this year we gained 11 nominations. This is a significant advance and actually more accurately reflects both the contribution and numbers of geriatricians than has previously been the case.

Greater role for professional societies
This year ACCEA (the body overlooking the awards) encourages citations from professional societies. There is a specific B form that can be filled in, indicating the society’s support nominations for awards. The ACCEA indicates that specialist societies should nominate up to fifteen of their members. The first difficulty we have is that many more of our members deserve support than fifteen. Based on the CV questionnaires that our members had submitted to us, Father Figures put around fifty names forward. In my judgement, all these were justified and there were also other people who were not submitted, who deserved serious consideration.

Adding our weight where it will be most effective
Our problem as a Society is that we need to effectively support people who have the best chance of getting awards. During our tele-conference the committee therefore had to reduce the number of names submitted. At the end of the day, we have supported twenty-one candidates, one of whom dropped out because he was too modest to provide a CVQ and withdrew his name from submission. We felt justified in doing over the number fifteen number because we are such a large specialty of medicine, and we have stated this to the ACCEA.

Ever contentious
Clinical Excellence Awards, like merit awards before them, are always likely to be contentious. In deciding which people the Society supports in a given year, the committee has to make a calculation of probability of people achieving an award. The new system should be like a ladder and there are therefore critical times when people are more likely to get awards. The ACCEA have made it plain that at the national level there is likely to be a gap of five years between incremental awards, although this may be varied in exceptional circumstances. It is important when making our citations that we do not waste nominated places by putting people forward when they have no realistic chance of an award in that year. People who may feel disappointed that they have not been supported this year, should realise we feel that their application will have very much more force in the following one or two years, and it is not a reflection of the esteem in which the Committee holds the particular individual.

Self-nomination
The aim of the Society is to be as effective as possible and compete with other specialties, to make sure that geriatricians have the best opportunities to ascend the clinical excellence award ladder. We intend to evolve a system of nominations that is as fair as possible. We are still very dependent on the Father Figure in each region, but the new system does allow self-nomination and I would like to encourage a system where anybody who is a member of the Society who is putting forward an application for a clinical excellence award, allows the Society to see their CVQ application in time for it to be considered in late September or early October, the time at which we start the nomination process.

This year I have received extremely valuable support from both Alex and Amy in the BGS office, who have worked extremely hard to firstly understand the system and secondly, make sure our citations are in the correct form and have been nominated at the correct time. This year’s process has been a learning experience all round, and next year, we hope to increase our efficiency and effectiveness.

Quietly optimistic
I am optimistic that Prof Nettar Mallick and Lady Elizabeth Valance who head up the body that oversee the new schemes are mindful of the contribution that our specialty makes, and will ensure that there is a level playing field with regard to the decisions on who gets awards.

The best of luck to all those who have applied this year, even those of you who have not gained a citation from the College or the Society should still live in hope as I think regional and local nominations are still extremely important. To issue more citations than we have, we felt would have weakened the force of the support of those who had nominations this year. I think we can look forward to around fifteen or more awards this year, which will obviously free up nominations for those who have not been successful this year, to be nominated in the next round.

Jeremy Playfer
President Elect