A career pathway seeking to end the ‘wild west’ of exploitative contracts for LEDs (locally employed doctors) has been unveiled by the BMA and NHS Employers.
Known as the EPF (Eligibility Permanency Framework), it will enable LEDs who meet the relevant criteria to move to nationally recognised specialist, associate specialist and specialty doctor contracts.
The introduction of a framework comes as a result of an agreement reached in the 2024 SAS pay deal, which called for the creation of a mechanism to allow all LEDs who have been employed in a role with duties and responsibilities comparable to that of an SAS doctor for 24 months or more, to be able to access permanent contracts with nationally recognised terms and conditions.
With more than 30,000 staff in England and Wales, LEDs represent one of the fastest growing parts of the NHS workforce. The majority of those of those employed on local contracts also hail from IMG (international medical graduate) backgrounds.
Despite the critical role they play in the health service, LEDs have historically faced significant disadvantages in the workplace and from the standpoint of career progression.
Lack of supervision
With many of these doctors employed on insecure, short-term contracts, which lack the safeguards and clear career progression pathways afforded by national terms and conditions, LEDs work long hours in service-provision roles, often find their opportunities to access training limited and can lack proper supervision and support.
BMA specialist, associate specialist and specialty doctor committee chair Ujjwala Mohite said she hoped the framework would be a significant step towards bringing an end to the long-standing injustices faced by many LEDs forced to work on short-term contracts while being denied proper protections and support.
She said: ‘For too long doctors have been exploited in the "wild west" of locally employed contracts, where they are used to plug gaps and keep services afloat, and left facing a huge amount of career and financial uncertainty.
‘Many of these doctors originally trained overseas and in many cases are not aware at the poor hand they are being dealt by their employers until it is too late.
‘If they are doing the work of an SAS doctor, they deserve to be recognised for this with job security and opportunities, which is why this is a significant step forward for LEDs in England.’
Working lives
Dr Mohite added: ‘This move came as a direct result of SAS doctors standing up to be counted during the 2024 dispute and negotiations, and demonstrates why SAS doctors, currently being balloted over pay and further improvements to working conditions must once again come together to fight to improve our working lives and the care we are able to continue offering to patients.’
A clear demand among these staff for the type of pathway provided by the EPF was evidenced in a recent survey of LEDs conducted by the BMA.
The survey, which received more than 1,400 responses from LEDs, found that 65 per cent said that they would be interested in taking a national SAS contract if they had the opportunity, with over half of respondents meeting the experience requirements necessary to become a SAS doctor.
In a joint statement released by the association and NHS Employers, both parties said the development of the EPF had been ‘informed by the experience of SAS doctors, LEDs, employers and system partners’, adding it would set out a clear process for any staff looking to move to a SAS grade.
UJJWALA: LEDs face many injustices
It said: ‘This framework reflects a shared intention to provide greater clarity, consistency and fairness for LEDs who are undertaking work comparable to SAS roles and to support employers and doctors to navigate this process transparently and collaboratively at local level.
‘It is grounded in the principle that doctors who are contributing at SAS level should be able to access appropriate recognition, job security and career progression where eligibility criteria are met.
‘This work demonstrates a shared commitment to improving the working lives of SAS doctors and LEDs, strengthening workforce sustainability and supporting high quality patient care. NHS Employers and the BMA will continue to work together to review how the framework operates in practice and to respond constructively to feedback from the service.’
Applications to transition to SAS contracts under the framework will open in September, with qualifying LEDs then able to apply on a rolling basis.