What are my responsibilities as a supervisor?
In the definitions section of the TCS, the term educational supervisor extends to cover approved clinical supervisors in GP practice placements, who will be responsible for the management of exception reports in these settings. Although the educational supervisor retains overall accountability, it may be appropriate that exception reports are also copied (or sent instead) to other appropriate persons for action - for example, the doctor’s clinical supervisor.
Ideally you will be able to find a solution with your trainee to the underlying reason for the exception report. However, this may not always be possible due to recruitment issues and rota gaps - you are not accountable for this. If you and the trainee cannot find a solution, then it is the responsibility of the employing organisation to find a solution. We suggest you raise this with the guardian urgently and repeatedly if necessary.
If no guardian is in place, the Trust is in breach of contract. In this instance please contact the BMA and notify your Local Negotiating Committee.
Some doctors, especially foundation doctors, may not have an educational supervisor based at the location where they are working. In this case, the formal responsibility for the exception reporting process may be re-assigned to the doctor’s clinical supervisor.
This should be agreed in accordance with local negotiating policy, and with consent from the junior doctors affected. Any such arrangement should be explained to junior doctors in advance, and the overall accountability in contract terms still rests with the educational supervisor.
What if I don’t have enough time to take on this additional work?
You need to speak to your employer about any changes that may need to be made in order to ensure you have sufficient time to take on these responsibilities, which are critical in the new junior doctors’ contract.
It is a contractual requirement for junior doctors to have access to an exception reporting system with timely responses, and it is the employer’s responsibility to ensure this can be delivered. Even if you do not wish to record a comprehensive job plan diary, it will be very useful for you in subsequent job plan discussions if you record how much extra time this takes each week.
If you decide that the role of Educational Supervisor is no longer for you, you are entitled to request a job plan meeting at any stage. The BMA can support you with this, but remember: you may lose the 0.25 PA per trainee that is commonly included.
How can I approve claims for additional pay if my employer tells me the trust cannot afford this?
There are clear contractual provisions in the 2016 TCS allowing junior doctors to receive additional pay for extra work they have been required to do. If it is found that a legitimate claim for additional pay has not been approved due to financial concerns, the trainee will be able to ask the independent guardian to step in and take action to address this.
All junior doctors working under the TCS have the right to access all the contractual protections and benefits it provides, and if trusts are choosing of their own accord to introduce this contract, they must ensure they have sufficient funding to resource it.
If you experience pressure or bullying from your employer when it comes to approving claims for pay or time off in lieu, you should notify the guardian of this, and if necessary contact the BMA for support.
Will I be blamed if the trainees I supervise are frequently exception reporting?
No, you should not be, and you should contact your guardian of safe working hours and the BMA if you experience this. Trainees should be encouraged to exception report as part of a wider culture of openness about problems at work in order to promote patient safety.
The point of exception reporting is not to apportion blame, but to acknowledge problems that arise, and work together to deal with them quickly. It is not ultimately your responsibility to find a solution - it is your employer’s, and it is far more important that you understand the problem that your trainee is sharing with you, and do your best to help as far as possible.
This could even mean the realisation that existing ways of working that may not seem problematic and just ‘the way things are’ actually contravene the new rules in the contract and should be changed.
If, for example, a junior doctor is required to arrive at work an hour earlier than scheduled each day in order to prepare for the start of work, this may be standard procedure, but it would merit an exception report as it goes against their work schedule. Similarly, if a trainee is told they are free to leave on time but that they ought to stay in order to benefit from a training opportunity, this too would merit an exception report.
Consultants and other senior doctors can support their junior colleagues by creating a culture of honesty and encouraging them to exception report, but only if they themselves feel supported. In the long term, this can and should mean that wider problems such as understaffing, which are out of both junior and senior doctors’ control, can be raised with trust management and resolved to everyone’s benefit.