Classification: Official
Publication reference: PRN02140

To:

• NHS trusts and foundation trusts:
  • chief executive officers
  • medical directors
  • chief people officers
  • directors of communications

cc.

• NHS trusts and foundation trusts chairs
• NHS England regional:
  • directors
  • medical directors
  • directors of workforce, training and education

Dear colleagues

Getting the basics right for resident doctors

Resident doctors are an integral part of the NHS. However, despite previous commitments to act on the concerns they have repeatedly raised about how they are treated as a rotating part of the workforce, many of these problems – payroll errors, poor rota management, lack of access to rest facilities and hot food, and unnecessarily repeating training – persist.

These concerns are within our collective gift to fix, and continued failure to do so risks further erosion of trust between resident doctors and their employers and undermining morale – which inevitably has an impact on patient care and the effective running of the NHS.

Resident doctors and their colleagues make a critical contribution to the NHS, and this will continue as we work together to deliver the 10 Year Health Plan. They should expect that we, as leaders, do everything within our power to make the NHS an excellent place to train and work. That is why we are today launching our 10 Point Plan to improve resident doctors’ working lives – with actions set out in the annex below.

The Government is continuing to hold constructive conversations with the BMA RDC over their dispute, but the NHS must not wait for those to make the improvements to working conditions that residents doctors have been promised by their NHS employers and repeatedly let down on. That is why we are asking NHS Trusts to make progress on these actions now.

This plan sets out clear expectations for NHS England and providers, with a 12-week delivery window for initial actions and further milestones extending into 2026. These commitments have been made before and are the basics resident doctors should expect. Importantly, we will measure and be transparent about progress.

Next steps

Professor Meghana Pandit, NHS National Medical Director, will lead a national programme over the coming 12 weeks to complete, and make rapid progress on, the actions set out in the plan. Regional medical directors, regional directors of workforce, training and education, and regional deans will support local delivery.

As a first step, we would encourage boards or executive teams to arrange to meet with their resident doctors committee to discuss the issues addressed in the plan and any other local concerns. There will be an opportunity for us to discuss any additional issues raised through these meetings at the national meeting of CEOs on 16 September.

Further, we are undertaking a baseline assessment on several of the key areas for improvement. Please complete this survey by 11:59pm Friday 12 September.

Trust boards should take clear ownership of local improvements, develop action plans informed by feedback and national survey results, and report progress publicly. We understand there will be local circumstances which will impede progress on some of these actions; where this is the case we will work with you to understand and address them.

To demonstrate progress, from Autumn 2025 NHS England will begin publishing trust-level data on the following indicators as part of the NHS Oversight Framework:

• access to basic facilities (lockers, rest areas, hot meals, on-call parking spaces)
• work schedule and rota notice compliance
• self/preferential e-rostering
• payroll errors
• board-level reporting and assurance

We will work with all trusts to deliver these actions, support regions in overseeing progress, share updates with resident doctors through educators, medical directors and deans, and – importantly – champion local improvements, working with communications teams. We will host webinars to further discuss the plan and the role of leaders – invitations will be shared separately.

This plan is a recognition that we have not done enough, and a commitment to finally get the basics right. Resident doctors will rightly be sceptical that we will deliver on our commitments after being let down before. It is our job to prove them wrong. We ask for your leadership, urgency and accountability in delivering these changes.

Yours sincerely,

Sir Jim Mackey, Chief Executive Officer, NHS England
Professor Meghana Pandit, National Medical Director, NHS England

Annex: Summary of plan deliverables

Every NHS organisation is expected to act across the following 10 priority areas:

1. Workplace wellbeing

• Within the next 12 weeks, trusts should: undertake an audit into the feasibility of improving priority areas like rest areas, parking when on call, mess facilities and 24/7 hot meals, as well as allowing resident doctors autonomy to complete portfolio and self-directed learning from an appropriate location for them.
• The audit and subsequent plans should be approved by people committees and reported nationally.

Intended impact for resident doctors: Doctors can expect better access to essential facilities like on-call parking, rest areas and hot meals, enhancing comfort and wellbeing during shifts.

2. Rota and schedule transparency

• From now, NHS England should: provide 90% of trainee information to trusts 12 weeks before rotations.
• From now, trusts should: issue work schedules at least 8 weeks in advance and detailed rotas no later than 6 weeks before rotations.
• Performance data should be submitted and monitored nationally.

Intended impact for resident doctors: Giving doctors more certainty and control over their work-life balance, reducing last-minute changes and stress.

3. Annual leave reform

• Within the next 12 weeks, NHS England will: conduct and publish a review of how annual leave allocation is managed.
• Recommendations will follow to ensure fair and consistent practices.

Intended impact for resident doctors: Doctors will benefit from fairer and more consistent annual leave policies, supporting better rest and recovery.

4. Board-level leadership

• Within the next 6 weeks, trusts should: appoint a senior named lead for resident doctors’ issues (where one is not already in place), and a resident doctor peer representative, to report to the board.
• In September 2025, NHS England will: publish a national role specification for the board lead.
• Each board should also ensure the executive team engages with resident doctors to understand and address local issues.

Intended impact for resident doctors: Stronger engagement and accountability will ensure that doctors’ working conditions are regularly reviewed and issues can be escalated.

5. Payroll accuracy

• Within the next 12 weeks, trusts should: participate in the national payroll improvement programme.
• By March 2026: rotation-related payroll errors should be reduced by at least 90%.
• Trusts should establish board-level governance and begin national reporting.

Intended impact for resident doctors: Resident doctors will experience significantly fewer payroll errors as a result of rotations, improving financial stability and trust in the system.

6. Eliminating mandatory training duplication

• Within the next 12 weeks, trusts should: comply with the May 2025 Statutory and Mandatory Staff Movement MoU to accept prior mandatory training, where this is not already the case.
• By April 2026, NHS England will: introduce a reformed national framework for statutory and mandatory training.

Intended impact for resident doctors: Doctors will no longer need to repeat mandatory training unnecessarily, saving time and allowing more focus on clinical duties.

7. Exception reporting

• NHS England will: work with the BMA, NHS Employers and DHSC to continue with preparations for the implementation of the new national framework for exception reporting, to enable and encourage resident doctors to engage with this process

Intended impact for resident doctors: The reforms to the Exception Reporting process will improve safe working practices and ensure doctors are paid fairly when they are asked to work extra hours.

8. Course-related expenses reimbursement

• Within the next 12 weeks, trusts should: review their current reimbursement processes to ensure they can reimburse resident doctors upon submission of valid receipts for all approved study leave-related expenses, including travel and subsidence – not evidence of attendance/completion – so that reimbursement can take place within 4 to 6 weeks of claims being submitted.

Intended impact for resident doctors: Doctors will be reimbursed faster for training costs and feel more able to prioritise their professional development.

9. Rotation reform

• Within the next 12 weeks: Department of Health and Social Care and NHS England will develop and launch pilot rotational schemes and continue to look at wider reform.

Intended impact for resident doctors: Pilot reforms will aim to make rotation management smoother and more predictable.

10. Lead employer model expansion

• In October 2025: NHS England will produce a roadmap for extending the Lead Employer model to cover all resident doctors and dentists.

Intended impact for resident doctors: Doctors will no longer need to change employers with each rotation, reducing paperwork and improving consistency in employment and training.