Enhancing junior doctors' working lives

We highlight the improvements being made in Health Education England's Enhancing Junior Doctors' Working Lives progress report.
Location: England
Audience: Junior doctors
Updated: Friday 3 April 2020
NHS Structure Article Illustration

In June 2019, Health Education England (HEE) published its third Enhancing Junior Doctors' Working Lives (EJDWL) progress report.

After three years of work to improve non-contractual issues from the dispute of 2016, the EJDWL report continues to drive improvements for the working lives and the educational environment for junior doctors.

Much of this is a direct result of lobbying by the BMA, who have been involved in this work from the start. After three years of reports what does the progress detailed in this latest version mean to trainees?


Emergency medicine LTFT pilot

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.

Preliminary reports suggest that the junior doctors in the pilot have felt that they were less burnt out and able to provide better care, achieve better educational outcomes, and improve their work-life balance. 

We are hopeful that this will become standard for emergency medicine. This will now be rolled out to other specialties, starting with paediatrics and obstetrics and gynaecology. 


Out of programme pause

The BMA has been calling for junior doctors to be able to access 'step on, step off' training. Junior doctors have told us that a lack of flexibility can lead to a feeling of being on a constant treadmill, and may contribute to burnout. The option to take a break from training without giving up a national training number had been absent from specialty training.

As a direct result, the out of programme pause pilot 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. 

A pilot is currently taking place for anaesthetics trainees in the East Midlands. The plan is for this to be rolled out in other regions and specialties.


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 alongside the RCP.

Read more on the Royal College of Physicians website.



When junior doctors rotate between different employers or sites, whether they are under a lead employer or not, they must:

  • complete mandatory and statutory training modules
  • have their immunisations and vaccination record updated
  • complete other laborious changes that are time consuming for junior doctors.

Following on from work that NHS Employers began, NHS Improvement is now working on streamlining, alongside HEE and NHS Employers, to ensure that it finally brings the meaningful changes for doctors that the BMA has been lobbying on for many years.

Read more from NHS Employers.


Study budgets

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

There have been concerns raised about how this has been taken forward in reality. The BMA is now part of a new working group with HEE and others to see how the study budgets policy can work.


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.

A new annual and recurring £10m fund will 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 will be used by local offices to provide a greater range of clinical support, pastoral care and refresher courses to support returning to training.


Enhanced preferencing

Previously, during the selection process, doctors who were in relationships with other doctors were often separated when they did not get offers to train in the same region. Once these offers were made doctors could not alter their choices to ensure they stayed together.

Trainees in a committed relationship are now able to reorder their preferences for regions where they have received offers. 


Special circumstances panel

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. 

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.