NHS Employers has amended guidance around guardian fines, after intervention from the BMA.
Concerns had been raised that previous guidance suggested junior doctors who exception reported owing to being overworked could have ‘failed’, implying the system would judge junior doctors’ work.
Exception reporting is actually designed to flag up wider problems or weaknesses in the system and ensure safe working limits – crucially allowing trusts to respond to rota issues in real time.
BMA junior doctors committee co-chairs Jeeves Wijesuriya (pictured) and Pete Campbell (pictured, top) welcomed that NHS Employers had responded to our requests to clarify the original wording of their guidance, they said.
'This makes it clear that it is employers who are responsible for overseeing a system in which juniors are never required to work unsafely, and that junior doctors can and should exception report all breaches of their work schedule with total confidence and no implication of their individual failure.
'Staffing shortages, rota gaps and unpredictable service pressures are outside the control of any individual doctor, whether that is a junior, their supervisor or their guardian of safe working.
'The exception reporting system has the potential to be an effective tool for doctors to be open about the pressures the system is under and seek immediate solutions to ensure their safety, with no concept of individual failure or blame on anyone’s part.'
The exception reporting system stipulates that, while junior doctors should be paid if they are required to work beyond their rostered hours, if such extra work leads to them working beyond the upper limits a fine is levied, with a higher ‘penalty’ rate paid to the doctor and the rest collected by the guardian. The aim of this is to provide a strong financial disincentive to employers against overworking their trainees.
The purpose of fines is to eliminate the practice of juniors working unsafely. As such, fines should ideally never have to be used, as a junior doctor should never be expected to breach the working-hour limits that are in place to protect their safety legally.
However, in an NHS under growing pressure, with major recruitment and retention problems in many specialties and rota gaps increasingly common, junior doctors are often relied upon to cover service gaps to the extent that they risk breaching the safety limits.
Concerns had also been raised that some employers had plans to pay fines – and continue to allow junior doctors to be overworked and breach set limits.
NHS Employers guidance makes it clear that this is not acceptable, however, and in these circumstances action should be taken to protect junior doctors.
Find out more about exception reporting
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