Contract Junior doctor England

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Exception reporting - FAQs

Read FAQs on exception reporting, including:

  • contractual obligations
  • reporting under the 2002 contract
  • and other common scenarios

Does the GMC support exception reporting?

The GMC strongly encourages doctors in training to make use of exception reports, to ensure that issues are addressed in a timely way.

On 9 March 2017, the GMC issued a statement detailing their views on exception reporting.

Read the statement

 

How does exception reporting work for non-resident on-call?

If you are required to work non-resident on-call as part of your working pattern, your work schedule should include both the length of the period during which you will be on-call, plus a prospective estimate of the average hours of work you will actually do during the on-call period. You are paid a flat rate of 8% of basic pay as an availability allowance for the duration of the duty period, plus additional pay at the prevailing rate for the actual hours of work done.

If you are required to work additional hours above the estimate for your availability period, you should submit an exception report. If, across the rota cycle, you work a greater number of hours than the prospective average estimate, you should be paid in line with the process set out in outcomes of exception reports – pay). This is worked out across the rota cycle in the same way as the total average weekly working hours (see calculating missed breaks and average weekly hours).

There are separate provisions in the contract to ensure your safety if you don’t meet the expected rest requirements while working non-resident on-call (schedule 3 paragraphs 30-33), which allow for you to immediately report to your employer when you haven’t had enough rest. However in these circumstances you should still submit an exception report in the usual way, to keep a record of this in the event that the breach becomes a pattern.

 

How will monitoring and banding work for doctors remaining on the 2002 contract? Will they exception report instead?

Exception reporting and other provisions under the 2016 terms and conditions of service will not apply to junior doctors employed under the 2002 contract. Monitoring and banding will continue to apply for these trainees, including where they are working on the same rota as those on the 2016 contract.

In such circumstances, only doctors employed under the 2002 contract should be included in the monitoring. This means that doctors on the 2016 contract will not be included in the 75% of returns required (even if they are paid under the 2002 system and receive banding) – this threshold will only apply to those employed on the 2002 contract. You may wish to check whether the return rate has been calculated correctly to ensure that your employer doesn’t count staff who are on leave or on the 2016 contract as non-returns.

It may also be necessary for the monitoring period to be extended beyond the standard two weeks in order to collate sufficient data to build a proportionate representation of the working pattern.

For more on monitoring and banding, see the guidance on the BMA website.

 

How does exception reporting work for those employed on the 2016 contract whose pay protection means they are paid under the 2002 system?

Monitoring and re-banding will no longer apply if you are employed under the 2016 contract, even if you are pay protected under ‘Section 2’ arrangements. You will still continue to receive banding, but this will be calculated differently and you should file an exception report if your actual work varies from the work schedule, same as any other trainee on the 2016 contract.

A work schedule review will then be carried out to determine if your banding supplement is correct for your working pattern. The questionnaire in Annex B of the 2016 TCS should be used to work out a different banding where necessary.

It is important to note that although you may be paid under the 2002 system, all other provisions under the 2016 TCS apply to you. You should therefore utilise the provisions relating to work schedule reviews and guardian of safe working where necessary, including where you have concerns regarding your hours, pay, or educational opportunities.

 

How does exception reporting work under lead employer arrangements?

If you are employed on the 2016 contract under a lead employer arrangement and undertake a placement at another trust, you should file your exception report to the educational supervisor where the variation took place. If this is at the host trust, you may also wish to copy your lead employer in the report for monitoring purposes.

For those working under lead employer arrangements, a guardian will be established in the host employer (the exception is for GP trainees where the responsibility for appointing a guardian remains with the lead employer). Your host guardian is responsible for ensuring that the lead employer guardian sees the guardian reports concerning all doctors under their employment.

In lead employer arrangements for GP trainees, your supervisor (ordinarily this will be the clinical supervisor) may be based at a different trust to the guardian. You should still copy in both your supervisor and the guardian if the variation is related to safe working hours, as the guardian maintains responsibility for overseeing safe working hours.

If you are in doubt about lines of responsibility, you may wish to copy in both trusts so that both employers are able to monitor your actual working pattern.

Example

Tim is a GPST3 employed under a lead employer arrangement. During a four month placement at a general practice, he finds himself working late in order to issue urgent referrals.

Tim files an exception report and sends this to the clinical supervisor at the practice where the variance occurred, and copies the guardian of safe working who is based at his lead employer trust. The clinical supervisor meets with Tim and discusses the nature of the variance. The two of them agree that this was a one-off scenario and on payment as the method of compensation.

This agreed outcome is set out in an email sent by the clinical supervisor to Tim, with the guardian copied in.

 

Will exception reporting data be used to my detriment in my Annual Review of Competence Progression (ARCP)?

Exception reporting is a neutral process – in itself it is neither a positive nor negative reflection on a trainee or an educational environment, and is simply a tool to ensure potential issues are picked up, considered and addressed if appropriate. It was therefore not designed to input directly into the ARCP process, and is not appropriate for a panel to draw directly upon exception report data – data is meaningless without competent interpretation. If a panel did act inappropriately, there is scope to appeal its outcome, and BMA support is of course available through this process.

Data may be relevant as one source of data to an educational supervisor, in informing their own judgement and report, however a core purpose of exception reporting is to avoid adverse ARCP outcomes in the first place – by ensuring that intervention can be made by the educational supervisor in real time where a trainee is not able to benefit educationally as intended from a post.

In the event that appropriate intervention does not occur, and a trainee is let down by their educational environment in a way that jeopardises their progression, they may choose themselves to refer to exception reporting data to their ARCP – for example if this evidences that they had raised recurring problems throughout their post. However this would be for the trainee to decide to do.

 

Does exception reporting constitute whistleblowing?

‘Whistleblowing’ is the term used to describe raising concerns in the workplace. If you are a worker and you report a type of wrongdoing to your employer or another prescribed person - usually something you've seen at work, but not always - and the disclosure of this wrongdoing is in the public interest, you are protected by law. You must not be treated unfairly or lose your job because you 'blow the whistle' on wrongdoing that could affect the general public.

If you are an employee and you report that you believe that someone's health and safety is in danger, you are protected from any unfair treatment by your employer as a result of raising a concern in accordance with the law. The current legislation is contained in the Public Interest Disclosure Act 1998 and the Employment Rights Act 1996. Patient safety is of paramount importance in the NHS, and workers must feel able to raise concerns about wrongdoing in their workplace that could harm patient safety.

Generally an exception report would not constitute a protected disclosure. Most often exception reports will be purely because an individual’s work has varied from their work schedule, which isn’t illegal. If you exception reported a variation which caused you to breach the upper hours limits or rest requirements of the Working Time Regulations, this could be considered a qualifying disclosure as while these limits are intended to protect the personal safety of workers, for doctors they in turn protect the safety of the patients, i.e. members of the public.

If an individual were to receive detrimental treatment by their employer as a result of making a protected disclosure via an exception report, they would be covered by the statutory protections outlined above. A recent legal agreement has been secured by the BMA to extend these protection to the trainee-HEE relationship as well, as HEE are not an employer but can have a significant influence on a trainee’s career – however this would almost certainly never be required in this scenario as exception reports are a feature of the contract between junior doctors and their employer only.

 

What if I don’t feel comfortable exception reporting?

Exception reporting is both a contractual right and part of your responsibility to highlight unsafe working hours, unsuitable work schedules, and any training concerns you may have. It is imperative for safeguarding training and doctor and patient safety, and junior doctors should be encouraged by senior colleagues and employers to exception report as part of a wider culture of transparency and joint problem solving.

Exception reporting covers issues such as safe working hours, compensation for additional hours worked, and lack of educational opportunities or support available. Previously monitoring and banding was the primary mechanism for addressing concerns about your hours and working pattern, and many doctors will be familiar with the process of completing diary monitoring cards. Exception reporting operates on a similar system – although filing an exception report may sometimes feel like an individual act, collective participation is vital for it to work. As with monitoring, it is only effective if a majority of junior doctors take part and you should not face any pressure to resist completing an exception report or to falsify your hours.

It’s important to recognise that exception reporting is not about apportioning blame nor a reflection of your performance – it is a reflection of the realities of the service and an integral part of the 2016 contract. This contract has introduced new working patterns and rest requirements, and exception reporting is how you and your employer ensure that your actual working pattern is both compliant with these new rules and appropriate to both training and service needs.

If you are worried about filing an exception report or concerned that you will be reprimanded for doing so, you should contact the BMA for support. You should also always copy the guardian of safe working in exception reports relating to safe hours or the director of medical education in reports relating to training issues, as these may be indicative of wider structural issues that need to be addressed. If you are unsure of who to copy in or if the issue raised relates to both training and safe working hours, you should copy in both.

Watch our exception reporting video

 

Read the latest guidance on the junior doctor contract 2016