In June 2020, HEE (Health Education England) published its fourth Enhancing Junior Doctors' Working Lives (EJDWL) progress report.

This comes amidst the biggest health challenge the NHS has ever faced. The system acknowledges the significant role that junior doctors have played in the ability of the NHS to prepare and respond to the pandemic.

In spite of the significant impact of COVID-19, many improvements and flexibilities in postgraduate training are beginning, and others are becoming business as usual.

The BMA has been involved since the start of this work, and will continue to engage in order to improve the non-contractual conditions for junior doctors. After four years of reports, what does the progress detailed in this latest version mean to trainees?

COVID-19

HEE fully recognises that the additional work and compassion of junior doctors in the midst of COVID-19 has been exceptional. It has been very open about its thanks for the extra work you have done in the face of difficulties in and outside of your work and postgraduate training.

Options are being developed to allow the existing suite of flexibility offers, including some below. The BMA has lobbied for all junior doctors to be able to access these progressive policies in order to recognise the work and the sacrifices that junior doctors have made.

These discussions are ongoing, and the BMA will continue to be involved with these proposals as they develop.

Expanding access to LTFT

In 2017, for the first time, all higher EM (emergency medicine) trainees were able to apply for LTFT (less than full time) training, without the requirement to give a reason.

Several reports suggesting that the junior doctors in the pilot had felt that they were:

• less burnt out
• able to provide better care
• able to achieve better educational outcomes
• able to improve their work-life balance.

And so, the decision was made to expand this to further specialties. This began with paediatrics and obstetrics and gynaecology in November 2019.

HEE has now committed to expanding category 3 LTFT for all trainees in England regardless of their specialty or stage of training, and is looking into how this can be introduced in the coming years.

Out of programme pause

Junior doctors regularly tell us that a lack of flexibility can lead to a feeling of being on a constant treadmill, and may contribute to burnout. As such, the BMA has been calling on GMC, HEE and other organisations to allow a ‘step on, step off’ training programme.

As a direct result, the out of programme pause pilot (OOP(P)) has been developed by HEE. It allows flexibility to step out of training temporarily to work in a patient facing role in a UK based organisation.

When considered alongside the development of a ‘gap analysis’ tool with the Academy of Medical Royal Colleges that will allow recognition of competencies outside of formal training, OOP(P) is a stepping stone to allowing easier movement in and out of training programmes.

An evaluation of the pilot is ongoing as the first cohort of trainees return from their time on OOP(P). The BMA is in ongoing discussions with HEE about an expansion to a larger group of trainees. We are keen to see the early successes of this pilot expanded to wider groups of trainees across England and across different specialties.

Supported return to training

Trainees who returned to training from time out have told the BMA that they would often return to work after months or even years out, only to be expected to pick up where they left off, with no induction or clinical skills refreshment.

As a result in 2017, annual and recurring £10m funding was established to be used to provide return to work packages to support junior doctors back into work after a period of time out, for whatever reason.

Funding is used by local offices to provide a greater range of clinical support, pastoral care and refresher courses to support returning to training.

Following a successful evaluation, the Supported Return to Training programme is now considered business as usual.

Special circumstances panels

As a result of lobbying by JDC (BMA junior doctors committee), applicants with a disability, or caring responsibilities, which means that they need to train in a particular part of the country, can be pre-allocated to that region during the recruitment process.

The panels are organised on a UK-wide basis and meet shortly after applications are submitted.

The BMA has been in discussions elsewhere about making special circumstances applications less difficult, and relaxing some of the more complex wording requirements, among other changes. These changes will be worked into the new process for the next recruitment rounds.

If you are a trainee that meets the criteria for pre-allocation owing to special circumstances, then make sure you complete paperwork to notify the recruitment teams that you wish to be considered.

Royal College of Physicians' flexible portfolio pilot

This is designed for junior doctors in higher physician training to have one day of protected time within their working week for professional development in four areas.

These offers have been targeted at those working in the most acute specialties, as well as specific geographies identified with the RCP.

The pilot will now continue for a second year. Read more from the Royal College of Physicians.

Study budgets

This system was to ensure that all courses relevant to a junior doctor's training programme curriculum were covered by your study budget.

It should increase transparency and equity of access throughout the country, including for LTFT trainees who may have previously paid more from their own pockets.

The BMA pushed hard for this to include funding for clinical interests and a trainee's future career ambitions that may lie outside the main curriculum.

The financial pressures on the NHS are leading to moves to reverse the reforms that were introduced in April 2018. The BMA remains to be linked into this work and will challenge any changes that negatively impact junior doctors.