COVID-19 terms and conditions: all doctors

Guidance on some of the concerns you might have as a doctor about the impact of COVID-19 on your contract terms and conditions, such as annual leave, maternity, working with a disability and childcare.

Location: UK
Audience: All doctors
Last reviewed: 13 April 2022
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Annual and study leave

Cancelling leave

Employers can lawfully cancel pre-booked days of annual leave, however they have to act reasonably. For example, if it is an important family event then it might not be lawful to cancel your holiday.

Any decision to cancel leave must be carefully considered by an employer, particularly whether this is still justified by the current circumstances. The exceptional impact of the pandemic does not mean that employers can demand that exceptional arrangements are permanent when the clinical context may no longer require it.

You have a good argument for asking for reimbursement of any reasonable losses you suffer (unless already covered by insurance).

You employer is obliged to offer at least one day notice for each day of leave. In the first instance, employers should do this on a voluntary basis rather than enforcing cancellations.

We are emphasising the importance of our members having enough rest time for their own personal wellbeing and that of patients.

Please ensure that your LNC rep/chair is aware of your concerns.

Study leave

Employers can cancel pre-booked days of study leave to meet service requirements, however the employee has a good argument for asking for reimbursement of any reasonable losses they suffer.

Read more about annual leave and study leave for junior doctors.

Carrying over leave

Temporary statutory rules introduced by the UK Government mean that employees who are unable to take their annual leave entitlement due to COVID-19, can carry over up to 20 days (pro-rated for part-time staff) of annual leave over a two year period.

In England

For contractual annual leave, NHS Employers have issued guidance for England. Where employees cannot use all their annual leave because of the pandemic, employers should consider revising their local policies to exercise maximum flexibilities in relation to carrying over of leave to the next leave year.

In Wales

In Wales, we have reached agreement with NHS Wales Employers and other trade unions that NHS staff may carry over up to 10 days of leave from their leave year commencing in 2021 into their leave year commencing in 2022. In exceptional circumstances your manager may agree that you can carry over a further 10 days, i.e. 20 in total, so long as there is an identified reason for the leave. You may also sell up to 10 days of annual leave back to your employer during February 2022. We are working with NHS Wales Employers to explore further opportunities to sell leave later in year, recognising that doctors have leave years beginning and ending throughout the year.


Acting outside of your usual role

At an earlier stage of the COVID-19 response, it was common for staff or students to be asked to act outside of their normal role. We have now reached a stage where the clinical context may no longer need such redeployment.

If you are asked to work outside your usual role, or continue with arrangements that were agreed at an earlier point in the pandemic, you should carefully consider whether this is still justified by the current circumstances.

We have recommended in our guidance on redeployment that those agreeing to such changes should only do so where they have a confirmed end or review date.

The BMA has concerns that some employers are using the pandemic as a justification for maintaining such arrangements to address workforce shortages and rota gaps.

It is not appropriate to maintain such altered working arrangements in response to regular winter pressures, or managing the backlog of care, as these are not exceptional pressures.

The GMC advises that 'In an emergency you should provide the safest care you can' and that, in exceptional circumstances, 'doctors at every level may be required to work at the limits of their comfort zone and in some cases beyond.' However, this does not extend to undertaking work outside of your specialty as a result of poor workforce planning or to solve problems with rota gaps.

Regardless of the clinical circumstances, you need to continue to work within your scope of competence and receive adequate training and supervision.

No doctor or student should feel pressured to undertake duties which they do not feel competent to perform and should feel entitled to challenge any request that they do not feel comfortable with. Contact the BMA for support if this is the case for you.

You should seek confirmation of indemnity cover for any revised roles and you may wish to contact your MDO (medical defence organisation) and employer to confirm this before starting work in a new area, if you agree that this is necessary.

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If you are pregnant

In the UK, most COVID-19 legal restrictions have now ended, including removing social distancing restrictions.

The UK government have published national guidance on COVID-19 and pregnant employees. It states that pregnant women of any gestation should not be required to continue working if this is not supported by the risk assessment. Pregnant women require special consideration as set out in government guides for different industries.

The BMA urges you to speak with your manager, HR or medical staffing, and if possible occupational health, to ensure that risk assessments happen and action is taken to keep you and your unborn child safe at work. If risks cannot be properly managed then your employer should identify suitable alternative work that does not involve direct patient contact, including home-working.

See GOV.UK advice for mothers to be, vaccinated and unvaccinated.

Starting maternity leave early

The earliest that maternity leave can begin is 11 weeks before the due date. 

The question above answers some steps you can take first. 

If you are off work sick and it is less than four weeks before your due date, your employer can require you to commence your maternity leave earlier. 

You may have the option to start maternity leave early by taking annual leave which leads into your maternity leave. You will need your employers agreement to do this. 


If you are at increased risk

Governments are advising that those who are at increased risk should be particularly stringent in following social distancing measures.

This includes those under 70 with an underlying health condition, and those aged 70 or older, regardless of whether they have any medical conditions.

While this stops short of recommending self-isolation, it does recommend measures which would be hard to reconcile with delivery of some frontline services.

NHS employers are being advised to engage with staff who are categorised as being at ‘increased risk’ and jointly consider whether adjustments to work or redeployment might be appropriate.

In the event that you are asked to self-isolate, you should do so as quickly as possible. NHS staff receive full pay whilst in self-isolation.

‘Full pay’ is paying what the staff member would have otherwise earned if they were not in isolation, inclusive of any enhancements. 

Read more about doctors isolating and those in vulnerable groups.


If you have a recognised disability

Your employer still has a duty to make reasonable adjustments under the Equality Act 2010 to enable you to work safely and avoid any substantial disadvantage linked to your disability.

What is reasonable might change, or different adjustments may be needed due to the pandemic. You should speak with your line manager, and if necessary occupational health, if you require further adjustments. You should work together to identify what adjustments are going to be practical for the employer and effective for you in the current circumstances. If you have any difficulties contact the BMA.

If you have a disability or long-term health condition which has not previously required adjustments but the current circumstances are likely to make adjustments necessary, you should inform your employer as soon as possible.

If you have an underlying condition which increases the risk of serious illness from COVID-19, NHS Employers guidance encourages adjustments to be made or redeployment to work such as virtual patient consultations to protect you.


Working outside of your specialty and indemnity

It may no longer be clinically appropriate or justified for you to be working outside of your usual area of practice, especially where this might result in you working outside of your competencies.

If you're concerned about indemnity - you should explain your concerns immediately to your manager. Ask that other arrangements are made if you are asked to perform tasks you do not feel competent to carry out.

In an emergency, where there are no alternatives available, you should provide the safest care that you are able to provide in the circumstances, with the aim of providing overall benefit for the patient.

NHS clinical negligence indemnity schemes will cover any doctor working outside their normal field of practice during the COVID-19 pandemic.

If your clinical duties have changed, you may need to inform your medical defence organisation to ensure you maintain your indemnity cover.

Specific advice on personal professional indemnity and working outside your usual field of practice is available from the MDU, the MPS and the MDDUS.

Need help? For questions about any aspect of your working life, our advisers are here to help you. Opening times: 8am - 8pm Monday to Friday (excluding UK bank holidays) and 9am - 12pm on Saturdays.