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. The majority of LEDs are also IMGs (international medical graduates), for whom contract security and fair access to permanent employment can impact other concerns including immigration status.
Recent BMA gains on permanent contracts through the 2026 resident doctor deal and the SAS doctor EPF (eligibility and permanency framework) are a major opportunity. They will allow eligible LEDs to transition from fixed-term to permanent employment; providing greater job security; and for some access to nationally negotiated terms and conditions and pay progression.
While these new opportunities are a positive change, their implementation is still ongoing, and the BMA will remain vigilant to ensure LEDs can see the benefits as soon and as widely as possible.
That makes BMA membership particularly important. For LEDs looking to make use of the new options around contracts, career progression and access to permanent employment, membership is not simply about having representation available when it is needed. It gives access to tailored advice as to which option is best for their individual circumstances. It is also a way to strengthen their collective voice, ensure their concerns are heard, and help the BMA maintain the pressure needed to secure lasting improvements.
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.
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