As newly-qualifed doctors across England start their first hospital job today, 200 doctors will begin pilot programmes across different stages of training. It’s hoped that these pilots will help reform the “absurd” current “rotation” system that moves them between hospitals several times a year.  

While rotations can ensure early-career doctors gain diverse experience, the waste and disruption caused by the current system has become an exhausting burden on resident doctors and the wider NHS. Medical teams are broken apart every four, six and twelve months, which undermines continuity, productivity, and morale, while departments must continually induct and integrate new staff.   

Resident doctors often receive very little notice of where they will be working next and the distance between hospitals can be vast. They are then forced either to uproot their lives and move home or commute hundreds of miles to work. The constant churn as medical teams split up and re-form can also leave doctors unable to build the work relationships that lead to better patient care.   

Reform to the rotation system was part of the deal that ended resident doctor industrial action in 2024. The BMA agreed with NHS England and the Department for Health and Social Care to start with pilots that would:  

• Reduce geographical size of the rotation area to cut long commutes or costly relocations  

• Keep doctors in the same hospital trust where possible during a rotation  

• Make rotations longer and less frequent  

Resident doctors have long stated their unhappiness with the current system, with 72% of general surgery trainees responding in a BMA survey that they were unhappy with the distance between their rotations.  

Dr Alex Boulton, a resident doctor who has been through the current system, said:  

“After I graduated as a doctor, I was initially not allocated a specific job and instead told I was going to be placed in West Yorkshire, Leeds and the surrounding areas, where both my friends and my partner lived. As we approached our start date, I started renting a flat in the centre of Leeds as I was going to be working locally and it made the most sense.   

“With mere weeks to go before my first day of work as a doctor I was unceremoniously told I was instead being placed in an entirely different area of Northern Lincolnshire, approximately 90 miles away from where I was living at the time.  

"There I was, facing down the barrel of a two hour commute each way daily and I had no choice but to do it - I had already signed my tenancy agreement. Shifts longer than twelve hours, night shifts, weekends, and each day driving more than four hours on top of this. It made it physically impossible for me to get a full eight hours of sleep on many days, and the impact of this was tangible.   

"I was exhausted, as anyone would be in my position, and this exhaustion was persistent and unrelenting because there was nothing I could do about this. Even after discussing with my employer, it took months for them to even recognise this and compensate my travel.”  

Dr Shivam Sharma, BMA resident doctors committee deputy chair and training lead, said:  

“This absurd system has been overdue for reform for years. Doctors with their whole careers ahead of them are being sent from hospital to hospital, sometimes as often as several times a year. They are expected to uproot their lives, find new accommodation, rebuild their support networks, and adjust to an entirely new workplace — only to do it all again months later.  

“How are doctors meant to concentrate on caring for their patients when they are driving hours across the country to get to a new job every few months? How are they meant to start a family or even hold down a relationship when they are also trying to find a new flat in a new town over and again?  

"This constant change can also make life difficult for hospitals. In some departments, colleagues barely have time to learn a doctor’s name before they move on. Resident doctors lose the opportunity to develop lasting relationships with consultants who understand their strengths, can invest in their development, and gradually give them greater clinical responsibility to become the experienced specialists we need.  

“These reforms should not have needed industrial action to secure. But if these pilots demonstrate that doctors can receive high-quality training through longer rotations, in more stable teams and with shorter travelling distances, they should be extended rapidly across the country. It will show what we can achieve when doctors stand together and fight for working conditions that are better for staff and patients alike.  

“My best wishes go to the more than 200 doctors beginning these pilots and to every doctor starting their career today.”

Notes to editors