The BMA's resident doctors committee (RDC) has agreed sweeping contractual changes with NHS Employers and the Department of Health and Social Care to ensure that doctors in England are paid fully for work outside of their normal hours.

This resolution follows a series of intense negotiations over many months that required RDC to go into a formal dispute, declared in March 2025 due to slow progress on the Government’s commitments.

Reform to ‘exception reporting’ (ER), the process resident doctors use to accurately record their working hours, identify unsafe staffing levels, and protect patients, was a key part of the 2024 pay deal with delivery having been expected in early 2025. Unfortunately, it has taken more than a year to agree terms.

Co-chairs of RDC, Dr Melissa Ryan and Dr Ross Nieuwoudt, said: 

“This is a good day for both doctors and patients. At the moment too many doctors are not reporting their additional hours, not pointing out where they are missing out on training, not raising the alarm over staffing shortages, because they don’t trust the system will record it. We’re putting in place a system that gives them that confidence.

“That doesn’t only mean doctors will now get paid the money they have fairly earned. It also means hospitals will be able to see the flaws in rotas, patient safety concerns, and inefficiencies that are weighing down our NHS. This is exactly the sort of reform the Government should have been champing at the bit to make: a safety-critical system that was creaking at the seams because employees could barely use it will be replaced by something responsive, smart and fair.

“What worries us is that it has taken so long for them to make these changes that are so clearly in everyone’s interest. We are currently also in talks over pay restoration. Mr Streeting has expressed willingness to address non-pay items as a substitute for pay. But if it takes this long to make even the most obvious reform to doctors’ working lives, how are those doctors meant to have faith that any of those proposed reforms will see the light of day even if they are put forward in the talks?

“We repeat that the simplest way to address doctors’ problems is to restore pay, and hope that Government will make a similar conclusion from this process.”

Notes to editors

Key aspects of the new system will include:

• Exception reports to be signed off by hospital administrators, freeing up senior doctors’ time
• Rolling fines for employers who fail to provide appropriate systems 
• All residents must receive their choice of either payment or time off in lieu (TOIL) for all time worked above contracted hours
• Doctors’ clinical judgement around working additional hours will be respected

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.