Classification: Official
Publication reference: PRN01193

To:

• NHS trust and foundation trust:
  • ­chief people officers
  • human resource (HR) directors
  • chief medical officers
  • medical directors

cc.

• integrated care board (ICB):
  • chief executives
  • chairs
• NHS trust and foundation trust:
  • chief executives
  • chairs
• regional directors of workforce
• postgraduate deans

Dear colleague,

Improving the working lives of doctors in training

There is no NHS without the people who work in it, and those people are working incredibly hard to deliver a huge and growing amount for our patients.

Improving the working lives of NHS staff is a key strategic priority, as made clear in the NHS long term workforce plan, and again in the NHS priorities and operational planning guidance for 2024/25. It’s a priority because it’s what staff tell us they need, and also because the evidence is clear that better supported staff deliver better services for patients, better productivity, and they stay with us for longer.

While this commitment extends to improving the working lives of our entire workforce, it is evident from conversations with doctors in training that we collectively need to do better for them. The negotiations with Government about pay are not within our remit, but as the people responsible for training and employing doctors in training, there is much more we can and should do collectively to improve their working and learning experience in the NHS.

The actions outlined here are specifically aimed at addressing the concerns of doctors in training and staff who rotate. Rotations mean that doctors in training can experience low levels of choice and flexibility of when and where they work, high levels of uncertainty and competition about the next steps on the training pathway and duplicative inductions and unacceptable pay errors as they move between employers. As well as frustration and lost productivity, this can result in a reduced sense of belonging, making it harder to retain our future workforce.

In the short term, there are actions we can take now as employers to improve the working lives of doctors in training.

Increase choice and flexibility: better rota management and deployment

Doctors in training are particularly impacted by induction and shift allocation due to multiple employer changes so all employers are required to ensure they:

• provide work schedules at least 8 weeks in advance and finalised duty rosters 6 weeks in advance, as per the current contract. We will support this commitment by ensuring that information regarding incoming doctors is provided to organisations within the required 12 week time frame and with improved accuracy
• improve rota management by exploring the opportunities technology offers to move towards greater self-rostering, so doctors have greater control over their lives while meeting the needs of the service. Where rota changes are required with less than 6 weeks’ notice, the doctors in training impacted should be involved in creating the new rota. In such situations all pre-existing leave arrangements must be accommodated

NHS England will:

• reinstate monitoring of compliance with rota requirements
• continue to highlight examples of best practice and review the provision of self-rostering options across England as part of Enhancing Doctors’ Working Lives (EDWL) Reporting programme which aims to improve flexibility through increasing access to less than full time (LTFT) training, flexible portfolio training and out of programme pause along with continued supported return to training

Reduce duplicative inductions and pay errors: streamline and improve HR support

Too many doctors in training currently experience payroll errors. The trainees who learn with us while providing patient care have a right to be paid accurately first time and not suffer hardship or need to spend time trying to rectify errors. All employers should, as a minimum:

• pay specific attention to payroll accuracy for all staff, but particularly doctors in training and others who rotate because rotations and cost of training issues can make payroll errors more frequent and/or acute
• develop local service level agreements (SLAs) to include timescales for dealing with individual payroll errors so payroll queries are handled swiftly by the end of July 2024 and implement a board governance framework for monitoring and reporting payroll errors for all staff by the end of July 2024

NHS England will:

• provide intensive support to providers with the highest need, including a review and redesign of payroll processes to reduce payroll errors. NHS England will work with regions to confirm the employers in this category and will write with more details shortly
• issue best practice guidance to identify and address root causes and implications of payroll errors and set out a number of recommendations designed to support organisations in improving their payroll practices

Create a sense of value and belonging for our doctors

Doctors in training and many other staff have raised concerns about the content and frequency of statutory and mandatory (StatMand) training and having to repeat it when moving organisations. Employers are asked to ensure that they are:

• protecting training time, for both learners and educators. This improves educator and learner retention, especially our doctors in training and when students transition from higher education into permanent health and care roles. For example, no member of staff should have to do mandatory training in their own time
• addressing the unique issues caused by rotations, such as reviewing on-boarding processes, and other practical steps to help foster a sense of wellbeing and belonging such as reviewing the application processes for lockers or car parking spaces, the availability of facilities and inclusion in team photos etc.
• aligning to the latest Core skills training framework (CSTF) by the end of June 2024, confirming with NHS England when your organisation has done so. Details of how to do this have been sent to chief people officers/HR directors
• using the free eLearning for Healthcare packages and shorter e-assessments by the end of October 2024
• adopting the NHS Digital Staff Passport at the earliest opportunity
• taking action to improve the experience of trainees by ensuring the National Training and Education Survey (NETS) and GMC Survey are treated in the same way as the National Staff Survey results, with reviews by trust boards supported by clear action plans
• identifying a senior, named individual to oversee the implementation of these actions and be accountable to the trust board. Ensure that any strategies or best practice for improving working lives for staff, ie the People promise exemplars are extended to Doctors in Training
• considering BMA wellbeing guidance recently published and implementation at local level

NHS England will:

• make it easier for staff to move between organisations on a Memorandum of Understanding (MOU) for providers to accept each other’s training even if not yet fully aligned to the CSTF. This is a precursor to the Digital Staff Passport and will remove the requirement for staff to repeat the training in a new organisation
• reduce the time burden of StatMand by elongating refresher periods, where safe to do so, by the end of August 2024, and undertake a review of the staff groups and roles required to complete the training by the end of August 2024
• reform the existing approach and create a new non-professional StatMand framework by December 2024 and a new professional StatMand framework by the end of June 2025, seeking input from our staff as well as subject matter experts (SMEs), NHS Employers, the Care Quality Commission (CQC) and the Health Service Safety Investigations Body (HSSIB), NHS Resolutions and key stakeholders
• reverse the system for paying course fees so that the NHS, rather than the trainee, pays them upfront, avoiding the hardship caused by waiting for reimbursement

In addition, we will be looking at the following in the longer term:

• working with partners to consider how we can improve the experience of rotations in postgraduate training
• exploring the roll out of lead employer models (LEM) which can reduce errors through the presence of a single employer throughout the whole of the training pathway

Next steps

We expect every trust board to take responsibility for this agenda. The causes are complex and historic, but bringing NHS England and Health Education England (HEE) together is a real opportunity to use our collective levers at all levels to improve how we care for our staff, students, trainees and patients.

Yours sincerely

Amanda Pritchard, NHS Chief Executive, NHS England
Professor Sir Stephen Powis, National Medical Director, NHS England 
Dr Navina Evans CBE, Chief Workforce, Training and Education Officer, NHS England