LEDs (locally employed doctors) deliver essential clinical work, support fragile rotas, maintain continuity on wards and bring experience into departments under sustained pressure.
Yet the language often used to describe them – trust grade, clinical fellow or foundation year 3 – can make this workforce appear temporary, interchangeable or somehow outside the mainstream medical career structure.
Employment insecurity remains the dominant issue. A recurring theme is that most LEDs are employed on fixed-term, temporary, bank or locum contracts, creating uncertainty around job security, career progression and long-term workforce planning. GMC workforce data shows that 76 per cent of LEDs were on fixed-term or temporary contracts, with fewer than 10 per cent believed to be on permanent contracts.
Permanent contracts are seen as a major opportunity. The BMA resident doctor deal and the specialist, associate specialist and specialty doctor EPF (eligibility and permanency framework) are being positioned as significant improvements for LEDs. Expected benefits discussed include: transition from fixed-term to permanent employment; greater job security; access to nationally negotiated terms and conditions; and pay progression.
The EPF specifically creates a route for eligible LEDs to move on to SAS contracts after 24 months with the same employer and experience in a comparable role.
Uncertainty about implementation is causing concern. While the policy direction is positive, several discussions highlight uncertainty around: how quickly trusts will implement changes; whether all LEDs will benefit; whether contracts can be made permanent before training-place expansion plans are confirmed and; how permanent contracts interact with future workforce pressures and redundancies.
That makes BMA membership particularly important. For a group facing insecurity around contracts, career progression and access to permanent employment, membership is not simply about having representation available when it is needed. It is one of the ways LEDs can strengthen their collective voice, ensure their concerns are heard, and help the BMA maintain the pressure needed to secure lasting improvements.
IMGs (international medical graduates) are central to the LED experience. Roughly two-thirds of LEDs qualified overseas. As a result, IMG concerns heavily overlap with LED concerns, career progression, contract security and fair access to permanent employment are especially important themes increasingly consider the LED and IMG audiences together.
A dedicated survey was launched to understand experiences, terms and conditions, employment arrangements and priorities for improvement. It was intended to inform future activity and ran ahead of the EPF launch and wider resident doctor deal implementation.
LEDs appear to value greater employment security, clearer career pathways and access to nationally negotiated terms and conditions. Much of the recent positive sentiment is tied to the EPF and resident doctor deal commitments around permanency.
However, there remains significant uncertainty around implementation, creating a risk that expectations may outpace delivery if trusts are unable to move quickly. Internally, LEDs are viewed as a strategically important workforce group and one of the BMA's largest membership growth opportunities.
Chris Patterson is production editor of The Doctor