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Supporting doctors in training

We recognise that in the current climate, many junior doctors feel undervalued and morale can be low. We are keen to help recognise and respond to this challenge and are involved in a wide range of initiatives to improve the experience of doctors in training and improve their working lives.  It is, however, important that this work is inclusive and provides the whole system with advice about changing the culture of how we work together in the NHS.


Enhancing junior doctors working lives

Working with partners we established a working group to look at how we can enhance junior doctors working lives, addressing some of the challenges that were highlighted to us by doctors in training.

Our progress report outlines the work we have taken with partners to address these issues and our proposed next steps including:

  • increasing the focus on valuing healthcare staff including junior doctors
  • committing to reducing inequity in study leave ensuring that essential costs of training are not borne by junior doctors;
  • creating more flexibility to doctors with regard to deployment which will benefit doctors with special circumstances who need to train in a certain area, and those who want to train in the same areas as their partner and those who want to move region; pilots planned to look at different ways to increase flexibility in training, optional reductions in hours, and allowing doctors to pursue less pressured training opportunities in parallel to standard training programmes.

Cross cover by doctors in training

We have updated our policy on cross cover by doctors in training. While it is the professional duty of all doctors to help patients in need, any diversion of junior doctors from their usual professional responsibilities should be regarded as exceptional and should not risk adversely affecting their training progress.

Extending whistleblowing protection for junior doctors

We have extended whistleblowing protection for junior doctors, providing a new legal route directly against ourselves, if required, for trainees who raise concerns and believe that we have caused detriment to them as a consequence.  We have now placed this into our contracts with local employers a provision that protects junior doctors making patient safety disclosures.

Accelerating doctors returning to training

We will work with partners across the system to look at innovative approaches to support doctors that have taken time out as they return to training, for example, due to caring responsibilities or maternity. These will include an enhanced induction programme including, for example, continued access to mentoring and educational supervision, boot camps, and greater use of simulation training. This approach would include targeted initiatives to ensure the person who has taken time out is confident and ready to resume their training.

Extended notice to placements and rotas

In partnership with BMA and NHS Employers, we have agreed a revised Code of Practice for postgraduate medical training which sets out the information that recruiting organisations and employers should provide to doctors and dentists at each stage of the recruitment process and subsequent rotations.

This agreement means that all postgraduate medical and dental trainees will benefit from an extra four weeks’ notice on placement and rotas – meaning that trainee placement information should be provided a minimum of 12 weeks in advance and to make sure rotas are shared a minimum of 8 weeks before the trainee start date. This will better enable trainees to make necessary preparation and remove the need for them to take annual leave during fixed periods in each rotation.

Supporting doctors with illness, disability or caring responsibilities

We’ve agreed with the BMA that, for the first time, doctors with a medical condition, disability or caring responsibilities are guaranteed special consideration in the allocation of offers. Under this agreement, applicants with a medical condition or disability for which they need to work in a particular location, and those who are carers for someone who is disabled, will be pre-allocated to their required region if they score highly enough to achieve an offer.

Remaining close to a partner or family

We have introduced a formalised swapping process across all specialties, except for academic programmes, open to applicants once they have accepted offers. Agreed with the BMA, this process gives a further opportunity for juniors to train in their preferred region by applying to swap with a fellow applicant or into a vacant place, where there is a position available.

Supporting doctors to fulfil their career goals

We are taking forward a review of the annual review of competence progression process (ARCP) to make it simpler, less stressful and more supportive of the aspirations of individual doctors. This review will aim to improve opportunities to support career progression on the basis of competency, add value to the experience gained outside formal training programmes and introduce more flexibility. It will also consider how the NHS can support the career aspirations of doctors not in formal training programmes.

Piloting improvements to surgical training

We are working with the Royal College of Surgeons to pilot a new competence-based, run-through training programme in general surgery. The Improving Surgical Training pilot will trial improvements in the quality of training, a better training-service balance for trainees, professionalise the role of the trainer, and look at developing other members of the team from other professional backgrounds to work alongside trainees to improve patient care. Further details on the project are available on the College’s website.

The pilot represents an opportunity for trusts to develop an alternative workforce model, maximising productive training time and making use of the focused specialisms of members of the extended surgical team. It also provides the ideal opportunity to develop the concept of the modern firm, announced by Rt Hon Jeremy Hunt MP, involving the multi-disciplinary team within which junior doctors work, and who are best placed to provide the support they require in a positive and collaborative environment. We will be looking to recruit to the pilots next year.

We are also:

  • looking at rotations so that, where possible in terms of delivering the curriculum and while ensuring that doctors are fairly distributed for patient care, trainees do not have to rotate more than necessary so that they can establish a relationship with a single organisation
  • with partners, looking at how we can improve the experience of junior doctors, specifically:
  1. identifying and removing barriers to flexible working
  2. making more equitable use of the study budget and
  3. addressing rising costs for individual trainees.
  • driving up quality of support for junior doctors, through introducing our Commissioning for Quality Framework. This will include in the culture and educational leadership, and in supporting and empowering both trainees and educators to ensure consistent and high quality learning environments.

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