Junior doctors - flexible training
May 2006
(This briefing paper applies to England)
The NHS needs doctors to implement NHS Plan commitments, deliver improved services and meet the European Working Time Directive (EWTD). Flexible training makes an important contribution to this by retaining doctors in training who might otherwise quit the NHS because of their other commitments. It is also an essential element in facilitating the return of doctors to the NHS.
Flexible training is essential to current medical training and will undoubtedly influence the future shape of both the medical workforce and working practice.
Background
The NHS currently employs around 1700 flexible trainees – doctors in training who work less than full-time but more than half-time. The majority are women with young children who would find it difficult to stay in the NHS if they did not have the opportunity to work flexibly.
It is predicted that the number of female trainees will continue to increase, and research has shown that half the UK's 39,000 junior doctors (including four in ten men) would like to work part-time in future.
The increasing numbers of women doctors and medical students, and changing aspirations of doctors, along with a greater acceptance that part-time working is a reasonable option for a whole variety of personal reasons, will mean greater numbers of part-time posts will be needed if doctors are not to be lost to the health service.
Recommendations on flexible training
A working party of representatives from the BMA, the Royal Colleges, the Department of Health, and the Postgraduate medical deaneries was established in 2000 to investigate ways of increasing access to flexible training and improving conditions for flexible trainees.
Its report in August 2003 concluded that that there is a need for more flexibility and work-life balance for all doctors, both full-time and part-time, and called for an end to the distinction between full-time and flexible training. It also calls for increased central funding for all doctors' training.
The report also recommends:
- flexible training to be available for all who want it
- all flexible trainees, including those with ill health or disabilities, to have the same rights and opportunities as full-time trainees
- better childcare provision
- the publication of detailed guidance on access to the flexible training scheme
- more guidance on the rights of flexible trainees
- easy access to help and advice
- more sophisticated assessments of trusts' training capacity.
A BMA report "Why do doctors leave the profession?" (April 2004) called for better access to part-time and flexible working for doctors in the early stages of training, and said that the availability of flexible training in the pre-registration house officer and senior house officer years needed to be increased.
It recommended that all doctors should be involved in the design of their working patterns to improve the work-life balance.
Funding for flexible trainees
A new pay banding system was implemented on 1 December 2000 for all junior doctors to reflect the anti-social nature and the intensity of the hours worked, and also the number of hours worked each week. The new system was designed to improve out-of-hours pay for junior doctors and to move them away from the culture of long and arduous hours by financially penalising those trusts that exploited the workforce. The new junior doctors’ contract should also have resulted in a pay rise for most flexible trainees ensuring that the majority are paid fairly for the work they do.
New arrangements were made by the Department of Health in negotitation with the BMA in 2005 to mainstream flexible working doctors and give less of a discentive to employers to employ flexible trainees. Targets to ensure an increase in accessibility for the NHS to meet were included in this agreement, and it is vital that these access targets are met to ensure that flexible training becomes an important part of workforce planning and rpvosion without delay.
Trusts/Deaneries
Funding for flexible training currently comes partly from the trust where the doctor works, and partly from the budget of the postgraduate medical deaneries.
One result of the new pay system is that hospital trusts are having to fund three or more times the amount of salary per flexible trainee than under the old arrangements without there having been an equivalent increase in the central funding available to the trusts.
There are also huge problems with the Deanery funding. Deaneries have had their budgets cut. An additional £7 million has been given to deaneries to fund flexible training, but there is no evidence of this money being allocated to ease the longsstanding problems of flexible trainees. The BMA has called on the Deaneries to use this money to make flexible training easier to access and to resolve problems of individuals.
For further information, please contact the parliamentary unit:
E-mail: parliamentaryunit@bma.org.uk