NHS sets out measures to improve the working lives of doctors

In a huge push to improve the lives of tens of thousands of postgraduate doctors, NHS England is pledging to enhance choice and flexibility with rotas, while reducing payroll errors and the financial burden of course fees.

Postgraduate doctors in training, who make up more than 50,000 NHS staff, move between trusts at least twice each year during their training years after university.

This can mean finding out new work schedules at short notice and duplication of inductions when starting work at a new hospital.

As part of the NHS's Long Term Workforce Plan ambition to support and retain staff, the NHS will outline its commitment to make doctors lives easier by working with partners to consider how it can improve the experience of rotations in postgraduate training.

In a letter from NHS leaders today, the health service is also announcing it will carry out a review of the minimum legal requirements for statutory and mandatory training so that staff can spend less time on admin and inductions and more time caring for patients.

This review could see the time burden for such training halved, with plans to lengthen the refresher period between retaking these training modules.  

Doctors are currently legally required to complete 11 statutory and mandatory training courses every year, but the NHS England review which is due to be completed by August 2024, will determine which staff groups and roles are required to complete each mandatory training module.

Cutting the amount of training that NHS staff need to complete could free up to one day a year for each doctor.

To reduce the administrative burden on doctors the NHS will also ask trusts to adopt a national training framework and an eLearning online training portal which will ensure mandatory training is completed and reported consistently. This new system will mean doctors will no longer need to repeat mandatory training when moving between hospitals.

The system for paying course fees will also be reversed so that the NHS, rather than the trainee, pays them upfront; avoiding the hardship caused by waiting for reimbursement.

NHS England will also be ensuring trusts are meeting requirements to provide choice and flexibility with rotas, and exploring the opportunities technology offers to enable greater self-rostering so doctors have more control over their lives while meeting the needs of the service.  

While employers will be asked to pay specific attention to payroll accuracy for their staff, particularly for doctors in training because rotations and cost of training can make payroll errors more frequent.

New payroll governance will be put in place at each trust by the end of July and for employers with the most errors reported by staff, intensive support will be provided including a review and resign of payroll processes where needed.

To help reduce errors like this happening during the rotation process, the NHS will also be exploring rolling out Lead Employer Models, so each doctor has a single lead employer throughout the whole of their training.

NHS England will be ensuring the National Training and Education Survey and GMC Survey which details the unique experiences of trainees is treated in the same way as the National Staff Survey results, with oversight by Trust Boards supported by clear action plans.

Trusts must identify a senior, named individual to oversee the implementation of these actions and be accountable at Board level.

Amanda Pritchard, NHS chief executive, said: 

“Our doctors are there for our patients who need their expert, specialist care everyday - so we must do everything we can to make sure we are there for them too.

“We have listened to and continue to listen to staff frustrations, so from cutting red tape in training, to improving flexible working options, to sorting out payroll errors, we really hope that these practical actions will help make a tangible difference to their working lives.

“Some of these are immediate actions which trusts should make sure are happening right away, while other are longer term measures which we are making a priority – we want our skilled doctors to stay working in the NHS and have rewarding careers – and I am committed to making these important changes.”

Professor Sir Stephen Powis, NHS national medical director said:

“Our doctors work across a wide range of services day in day out to provide expert, compassionate care to patients and so it is absolutely right that in NHS England, we do everything within our power to boost their working lives.

“We are listening to the concerns of the medical workforce – so whether that's cutting down on unnecessary training requirements or eliminating payroll errors, we will work with local leaders to make sure these improvements happen and without delay.

“And as part of the NHS Long Term Workforce Plan, we are taking further action to retain our hardworking, committed workforce, so we can continue to meet the growing demand for care across all of our services.”

Dr Navina Evans, Chief Workforce, Training and Education Officer said:

“It is really important that all NHS staff feel they can manage the demands of work alongside their lives outside of work, and we know this can be difficult for postgraduate doctors who are required to move between hospitals a lot during their training.

“We're asking all NHS trusts to ensure there is greater choice and flexibility with rotas, and self-rostering will be explored so doctors have more control over their lives whilst meeting the needs of the service.

“It is also not acceptable that any of our hard-working staff get to the end of a month and then find they've not been paid the right amount – or in some cases not been paid at all – so where needed payroll processes will be redesigned and monitored.”

Health and Social Care Secretary Victoria Atkins said:

“I want to find ways to improve the working conditions for all our NHS staff.

“The measures announced today will help improve working lives for thousands of postgraduate doctors, by boosting training choices and giving them flexibility on rotas, and by helping cut down the time spent on admin so they can spend more time focussing on patients.

“This review, alongside the NHS Long Term Workforce Plan, is good news for doctors and good news for patients.”

Retaining staff is a key part of the NHS' Long Term Workforce Plan – and these measures will not only reduce the administrative burden on staff, but it will free them up to spend more time caring for and treating patients. 

In addition, the LTWP also laid out better opportunities for career development, improved flexible working options, alongside government reforms to the pension scheme could mean up to 130,000 staff stay working in NHS settings longer.

Dr Waqas Akhtar, Chair of the Academy of Medical Royal Colleges' Trainee Doctors' Committee said: “We welcome these proposals and are grateful to NHS England for engaging positively and at the highest level to explore our ideas. They won't solve all the challenges trainees face in their working lives or their learning experience, but it's a good start and we applaud the scale of the ambition. We now look to NHS employers to show the necessary commitment to make the recommendations a reality.”

Dr Melanie Nana, Obstetric Medicine Registrar and RCP Trainees Committee Co-Chair and Dr Megan Rutter, Rheumatology Specialist Registrar and RCP Trainees Committee Co-Chair, said: “We welcome this positive announcement from NHS England, detailing some tangible improvements in the working conditions for doctors in training and other rotating staff members. These align with ongoing discussions we are having with Sir Steve Powis,  Professor Sheona Macleod, and Sir Chris Whitty. The reduction in the burden of mandatory training through avoiding duplication will reduce the pressure on individuals around the time of rotations, as will the clear directive that it should not fall to doctors in training to undertake this in their own personal time. Initiatives such as reversing the system for paying course fees, so that doctors in training don't face financial hardship whilst awaiting reimbursement, and developing set timescales to rectify pay errors, will also have an immediate positive impact. While there is certainly more to do, this is a good start. We look forward to the swift introduction of these measures and will continue our collaborative discussions with NHSE and the DHSC about further strategies to improve the working conditions and training experience of doctors within the NHS.”

Danny Mortimer, chief executive of NHS Employers (part of the NHS Confederation), said:“These are important steps to improve the working and educational lives of doctors in training.  NHS Employers has worked with NHS England to identify those areas where individual employers can offer a more consistent and positive experience of HR processes to doctors in training. We have also been part of making the case for longer term reform of the system of rotations between large numbers of organisations for often very small periods of time which is clearly no longer fit for purpose.  We look forward to working with medical representatives, regulators and our members to ensure the effective implementation of these plans.”

Dr Katie Petty-Saphon, CEO of the Medical Schools Council said: “Medical schools welcome these developments to improve the working lives and conditions of doctors-in-training. As we look to grow our medical workforce, these measures will help to facilitate the transition from student to employee and importantly, progress towards improving retention in the NHS. Medical schools remain committed to working with NHS England and employers to create rewarding and caring work environments for our current and future doctors.”

The deputy chief executive of NHS Providers, Saffron Cordery, said: “Doctors in training are vital for the future of the NHS and trust leaders know much more needs to be done to improve the working lives of this highly valued group of staff. Measures such as ensuring work schedules and duty rosters are provided in advance, getting pay right when they change jobs and protecting training time are important and will help support and retain these doctors.”