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Enhancing junior doctors' working lives - annual progress report 2019

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 originating from the dispute of 2016, the EJDWL report continues to drive improvements for the working lives and the educational environment for junior doctors.

This year, the EJDWL report details a great deal of work that is of crucial importance to junior doctors. Much of this is a direct result of lobbying by the BMA, who have been involved in this work from the start. So, after three years of reports what does the progress detailed in this latest version mean to trainees?

Background

During the contract dispute of 2016, the BMA identified a substantial number of issues that sat outside the contract itself and could not be resolved through discussions with NHS Employers alone. These issues ranged from a lack of flexibility in training, to late notification of rotas, to problems with study budgets. These issues were taken forwards through a tripartite working group, chaired by HEE with the BMA and NHS Employers; this committee became the Enhancing Junior Doctors’ Working Lives group, and includes input from the Royal College and GMC.

An initial report was published in 2017, followed by a progress report that was published in May 2018. This year discusses new initiatives, progress on long-term aspirations and looks to the future of what is next for improving the postgraduate training environment.

"While many problems still face those working in our health service, these improvements from the Enhancing Junior Doctors Working Lives report are significant and important steps."

The latest Enhancing Junior Doctor’s Working Lives report has been welcomed by the chair of JDC, Jeeves Wijesuriya, and the deputy chair of JDC (education and training), Sarah Hallett, as being: "instrumental in driving forwards many significant programmes to improve the lives of junior doctors in England since its inception during the contract dispute of 2016.

"This report’s focus on increased flexibility is particularly welcome. The new form of out of programme pause and RCP flexible portfolio pilot recognise the training needs of a modern workforce. This is alongside iterative improvements to the study budget system that enable widening participation, and a move towards ensuring equity for all trainees across all specialties in England. It is also encouraging to see the LTFT pilot extended to paediatrics and obstetrics and gynaecology, and we hope that other specialties will consider extending the same initiative to aid recruitment and retention."

Dr Wijesuriya and Dr Hallett added that: "While many problems still face those working in our health service, these improvements from the Enhancing Junior Doctors Working Lives report are significant and important steps."

This is part of a larger piece of work from HEE to reform postgraduate medical training in England. You can read an overview of how Enhancing Junior Doctors’ Working Lives fits into the medical education reform programme in a blog from the chair of EJDWL. Many initiatives that have been taken forward over previous months have come from this group, the highlights of which are covered below: 

 

Progress report 2019 details

  • 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. Evaluation of this pilot is ongoing, and it has been confirmed that the pilot will continue into 2019/20.

    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. This has been demonstrated consistently through case studies from the pilot.

    The third report confirmed that the pilot is being expanded to a larger group of emergency medicine trainees, and the BMA is hopeful to see a continuation of themes that will allow such a proposal to become standard for emergency medicine.The BMA is also delighted that the less than full time pilot will now be rolled out to other specialties, starting with paediatrics and obstetrics and gynaecology. While these will remain as pilots in the interim, it is extremely positive to see that learning from the emergency medicine LTFT pilot is now being shared with other specialties, to improve retention and recruitment of junior doctors.

    What does this mean for me?

    Watch this space – the EM LTFT pilots were shared widely with all EM doctors in England. It is unclear what the process will be for paediatrics and obstetrics and gynaecology, but it is hoped that details will be made available soon.

    It is not yet clear when this will be formalised into a standard option for trainees, but given the positive feedback to date, the BMA will push to see this available for all trainees.

  • 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 has thus far been absent from specialty training.

    As a direct result, the out of programme pause pilot has been developed by HEE as a step towards step on, step off training. It allows flexibility to step out of training temporarily to work in a patient facing role in a UK based organisation. Any skills acquired out of training during the pause may still be able to be counted towards training upon return to the programme, subject to a gap analysis; the details of this are currently being developed with the Academy of Medical Royal Colleges (AoMRC).

    What does this mean for me?

    This programme has been developed with the BMA junior doctors committee over the course of the last year, but is not yet available for all junior doctors. A pilot is currently taking place for anaesthetics trainees in the East Midlands, however, and the BMA is closely monitoring its progress. 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 physicianly training to have one day of protected time within their working week to pursue professional development in four discrete areas. These offers have been targeted at those working in the most acute specialties, as well as specific geographies identified alongside the RCP.

    The pilot will focus on the following areas, with each HEE local office having an offer for one of these areas:

    • Clinical informatics (Northern, North West)
    • Medical education (East Midlands, West Midlands)
    • Quality improvement (East of England, South West)
    • Research (Yorkshire and Humber)

    The pilot is in the early stages and currently has 60-65 spaces for physician trainees across a variety of sub-specialties. However, HEE is keen to expand this to further specialties depending on the success of the pilot – watch this space for further updates.

    What does this mean for me?

    This pilot is only available for physicianly trainees at the point of recruitment to ST3. When applying for your higher training, make sure to select the correct option from the list of specialties, since, if you are interested and apply for regular higher training, you will miss out on the pilot.

    Make sure to check the Royal College of Physicians’ (London) website for more information.

  • Streamlining

    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, and 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. These changes are based on improvements of six processes:

    1. Electronic staff record: As HEE’s new trainee information system (TIS) is rolled out, all trusts will implement a system that allows the electronic staff record (ESR) to share selected information with TIS so information can follow the trainee.
    2. 12-week key performance indicator (KPI): Trusts and HEE local offices will have their compliance with the 12-week target in the code of practice monitored closely. Employers and HEE local offices will be held to account for performance.

    3. Pre-hire inter authority transfer (IAT): All medical resourcing teams in trusts will now consistently process pre-hire IAT to ensure data of doctors in training is retained.

    4. Trust onboarding: NHS Employers have developed guidance for trusts that will standardise much of the induction process, therefore allowing particular requirements to be carried over.

    5. Competencies in the electronic staff record (ESR): Completion of statutory and mandatory training will be recorded in the ESR, forming the basis of easier sharing of information between organisations.

    6. Occupational health records: Immunisation and vaccination records will now follow trainees, preventing the need for repeated extensive assessments and vaccinations.

    The BMA is actively involved with the programme and sits on the programme board with NHS Improvement, NHS Employers and HEE, monitoring and challenging progress for this project to ensure that it delivers for junior doctors.

    What does this mean for me?

    The programme is scheduled to bring benefits for all junior doctors in England from August 2020, but as local areas bring in the guidance at different points, there may be improvements that are made available in your area earlier.

    Keep up to date on progress via your regional and national JDC, in addition to information that will be shared by your employer and your HEE local office.

  • Study budgets

    Having come into effect on 1 April 2018, the intent of this new system was to ensure that all courses relevant to a junior doctor's training programme curriculum were covered by their study budget, as well as increasing transparency and equity of access throughout the country, including for LTFT trainees who may have previously paid proportionately 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. While this is on the proviso of trainees proceeding in line with what is expected from them for their core curriculum, it is nonetheless vital funding for trainees to be able to access, alongside no single limit on spend for core curriculum content.

    Since the policy was enacted, there have been concerns raised from across England 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 change to bring more choice, equitability and consistency for junior doctors across England and by specialty.

    What does this mean for me?

    This is a change that affects all specialty trainees in hospital placements in England, but how it works for you can vary by local area and specialty. It does not affect GP trainees in GP placements, public health trainees, or anyone else not currently covered by the education and training tariff. If the policy is updated to reflect an improvement in practices, the BMA will ensure that members are informed. Please get in contact with us if there are any issues for you at a local level.

  • 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 of the clinical environment, only to be expected to pick up where they left off, with no induction or clinical skills refreshment.

    Now, as decided during the ACAS agreement, a new annual and recurring £10m fund will be used to provide bespoke return to work packages, and innovative courses, to support junior doctors across England back into the clinical environment after an extended period of time out, for whatever reason.

    Funding will be used by local offices to provide a greater range of clinical support, pastoral care, refresher courses, and other support that trainees need to resume their training.

    What does this mean for me?

    If you are a trainee returning to practice after time out of the clinical environment for any reason (such as maternity, time out for research, career break, health or any other reason), HEE local offices will now have a bespoke set of courses and enhanced support for trainees that need it. Further detail will be available via your HEE local office for your region.

  • 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. Such was the inflexibility of the system, once these offers were made, trainees were locked into these regions, and 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, to ensure they are both able to train in a region where they have both met the required score. Much more detail can be found in this blog from the JDC chair for education and training, Sarah Hallett.

    What does this mean for me?

    Should your preferences for where you wish to train change during the course of your specialty application – whether due to a partner getting a job in a particular location, or for any other reason or change in circumstances – the new system means that this can be reflected during the offer process, to make the possibility of swapping to a different region much more straightforward, and therefore giving you extra flexibility.

  • Special circumstances panels

    From 2017, as a result of lobbying by JDC, applicants with a disability, or caring responsibilities for someone with a disability, 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. The process also includes an appeals panel.

    What does this mean for me?

    If you are a trainee that meets the criteria for pre-allocation owing to special circumstances (either disability or caring responsibilities for someone with a disability), then make sure you complete the relevant paperwork to notify the recruitment teams that you wish to be considered for pre-allocation.

    It is worth noting that evidence is required for this, therefore it is worth gathering this evidence in a timely fashion, to give your application the best chance of being approved on the first round.