Employing registrars on the 2016 junior doctor contract

What practices employing GP registrars under the 2016 contract must be aware of: work scheduling, exception reporting, guardians of safe working and transitional pay protection.
Location: England
Audience: GPs Practice managers
Updated: Friday 3 November 2023
GP practice article illustration

GP practices are not obliged to offer the 2016 terms and conditions. If they choose to, there are many non-negotiable contractual requirements that must be in place.

They apply to GP registrars employed by practices directly, and to those under a lead employer arrangement.

 

Work scheduling

GP registrars employed under the 2016 contract are issued with a generic work schedule prior to starting their placement. This sets out the working hours and training opportunities in their placement. The generic schedule is then personalised, jointly by the trainee and their clinical supervisor, according to their learning needs and opportunities available in the post.

The supervisor should arrange an educational meeting to agree a personalised work schedule either before or at the start of the trainee’s placement, and they are responsible for reviewing the work schedule to ensure it remains fit for purpose.

 

Exception reporting

Exception reporting for junior doctors in England

Find out when to flag up work that varies from your agreed work schedule, who should receive your reports, how to submit an exception report, and at what stage.

 Read more about exception reporting

Exception reporting allows junior doctors to immediately report instances where their actual work and training vary from their work schedule. The employer must provide an electronic system for registrars to submit exception reports. The two most commonly used are Allocate and DRS.

Reports are sent to educational supervisors. In GP practice placements, these will be approved clinical supervisors. They are also copied to guardians of safe working (for work issues) or the director of medical education (for training issues).

Clinical supervisors will review and discuss exception reports with the GP trainee to agree any actions. This could mean revising their work schedule, and approving claims for additional pay or time off in lieu. If a solution cannot be agreed, this needs to be raised with the guardian of safe working. Clinical supervisors should read the exception reporting guide for senior doctors.

This extension of the clinical supervisor’s role will have implications for their workload. This is additional to the trainer’s grant and may need to be varied locally. The non-educational element of the changes will be a new skill for many.

 

Work schedule review

Work scheduling guidance

We answer your frequently asked questions about work scheduling - what it includes, how one is agreed, when to submit one, and how to change it and incorporate your rota.

 Read more about work scheduling

If sessions overrun frequently, it may be necessary to undertake a work schedule review.

This is a conversation between the trainer and trainee about whether the work schedule is fit for purpose, which may prompt one or more of these outcomes:

  • No change to the work schedule, but compensation in the form of pay or time off in lieu is required for one or more individual breaches of the work schedule.
  • Prospective changes to the work schedule so that going forward, the trainee’s hours and/or training commitments are changed.
  • Organisational changes, such as a review of the clinics and administrative tasks. It may take some time to make organisational changes, so temporary alternative arrangements should be made where necessary.

If a trainee is unhappy with the outcome of the work schedule review, they can escalate this by requesting a level 2 work schedule review within 14 days of being notified of the outcome of the first review.

If the trainee is still unhappy, they can request a final stage work review. This will involve a formal hearing with a panel including a BMA or other trade union representative.

 

Educational sessions

If an educational session is cancelled, the session should still be used for educational purposes. For example, if a structured session is cancelled, an independent educational session should be taken in that time.

Registrars should exception report any changes to planned training sessions. A work schedule review may be required to agree the soonest possible date that the missed session can be arranged.

 

Guardian of safe working

All registrars employed under the 2016 contract must have access to a guardian of safe working. If there is a lead employer, it is their responsibility to appoint a guardian. If the practice employs registrars directly, it is the practice’s responsibility.

Practices that directly employ registrars and who have fewer than 10 GP registrars should jointly appoint a guardian. The guardian must be responsible for at least 10 registrars, OR enter a contract with a neighbouring trust to provide the guardian function for the practice.

The guardian:

  • oversees compliance with the safeguards in the 2016 terms and conditions
  • identifies and either resolves or escalates problems
  • acts as a champion of safe working hours for junior doctors
  • provides assurance to the employer or host organisation that issues of compliance with safe working hours will be addressed as they arise.

 

Scheduling out-of-hours shifts

  • When designing a rota, you must ensure a minimum of 11 hours’ rest between shifts.

    This means that instead of having a trainee carry out a day shift and then arranging a separate evening shift for OOH work, a single shift must be rostered to encompass OOH without any gaps.
  • Individual shifts must not exceed 13 hours.
  • OOH (out-of-hours) work must be deducted from a clinical shift in the same week, or a later week (if agreed), to ensure the working hours on average per week do not exceed 40 hours.
  • Work schedules – including rotas – should be planned in advance, and personalised together with the trainee.
  • For LTFT (less than full-time) registrars, OOH will be pro rata. This means that if a trainee works 50%, their OOH requirement will be 36 hours over the course of the year.

BMA members can check whether their rota is compliant using the rota checking tool.

 

Pay

Basic salary

GP registrars are paid a salary linked to their grade, calculated on an average of 40 hours’ work per week.

Flexible pay premia

 

Unsocial hours

 

Additional hours

Registrars can be rostered and paid for an additional 8 hours per week on average above their 40 hours.

Additional hours will normally be considered as service provision and therefore not be eligible for reimbursement by HEE.

LTFT trainees

 

Breaches of hourly limits

A penalty fine, equal to four times the hourly rate, is levied by the guardian of safe working if a trainee:

  • works over 48 hours on average per week
  • works over 72 hours in seven consecutive days
  • misses more than 25% of breaks across a four-week reference period
  • if the minimum rest period of 11 hours between shifts is reduced to less than 8 hours.
Total value of the penalty Hourly penalty rate paid to the doctor
Additional hours worked attract a basic rate x4 the basic hourly rate x1.5 of the basic hourly locum rate
Additional hours worked attract an enhanced (night) rate x4 the enhanced hourly rate x1.5 of the enhanced hourly locum rate
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