Exception reporting guidance for directors of medical education
What is exception reporting and who it applies to
Exception reporting applies to all doctors and dentists in training (referred to collectively hereafter as ‘the doctor’) who are substantively employed under the Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016 (2016 TCS) and to those whom the provision has been extended locally. It is recognised that the 2016 TCS are widely mirrored in other employment contexts, and we encourage employers in England to make every effort to extend exception reporting where appropriate*.
The purpose of exception reporting is to ensure prompt resolution and / or remedial action to ensure safe working hours are maintained, secure patient safety, and safeguard the delivery of agreed educational opportunities. Exception reporting is also the mechanism used by doctors to ensure compensation for all work performed and uphold agreed educational opportunities.
This exception reporting guidance is intended to provide direction and advice on how to interpret and implement the changes to exception reporting being enacted via version 13 of the 2016 TCS. This guidance seeks to provide recommendations and best practice approaches to implementing and adhering to these changes.
The overriding principle of these changes is to trust doctors to conduct themselves professionally, and to remove previously existing barriers to exception reporting.
*For example: Academic trainees who hold a national training number/deanery number and are substantively employed by universities. For these doctors, it is encouraged that their exception reporting provision should be extended by clinical employers through a standardised contract. Armed forces trainees who hold a national training number/deanery number. Public health trainees. Locally employed doctors whose terms of employment substantively mirror the 2016 TCS. Locally employed doctors whose terms of employment do not substantively mirror the 2016 TCS, but to whom ER has already been extended at a local level by their employers.
The roles and responsibilities of the DME in exception reporting
All exception reports detailing missed educational opportunities as outlined in Schedule 5, paragraph 2 of version 13 of the 2016 TCS, are to be sent directly to the DME or a suitable DME deputy. They may be reviewed by the GoSWH.
Additionally, if during the review of an exception report for additional hours worked, HR or the GoSWH identifies an educational component, they must obtain the doctor’s consent before sharing these details with the DME.
The DME may then take appropriate action to replace or reinstate any missed educational opportunities and identify whether further improvements to the doctor’s training experience are required.
The DME will also provide an annual update to the Trust board on all work schedule reviews relating to education or training.
What has changed?
For an overview of the changes in process following the exception reporting reforms, please refer to our exception reporting guidance for guardians of safe working hours.
What can be reported for an educational exception report?
Exception reporting can be used to allow doctors to inform their employer when their day-to-day work varies from their agreed work schedule.
Therefore, educational exception reports should relate to education opportunities as described in the doctor’s work schedule, or for the reasons outlined in Schedule 5 paragraph 2.
Educational opportunities not meeting the above criteria would not be within the scope of the exception reporting process. If it is felt that appropriate educational opportunities are not included within the schedule, doctors should speak to their educational supervisor, and a work schedule review may be required.
Academic trainees in training roles must also have recourse to educational exception reporting in the event that clinical activity impinges upon their academic time.
Preparing for exception reporting reforms
Specific steps for the DME to take in preparation for the reforms include:
- Understand changes to role and updated DME guidance.
- Review and update DME job plan if required.
- Confirm deputising arrangements where appropriate to ensure provisions to resolve reports are maintained. Wherever possible, an identified DME/deputy should not also be an educational/clinical supervisor.
- Communicate changes in role to the medical workforce; including escalation/remediation pathways.
- Consult with HR/medical workforce HR on changes and new ways of working.
- Establish a trust approach to common exception reports (such as missing protected training), proactively identifying themes from early reports and act on them.
- The DME should have access to (or have the ability to access where required) the doctor’s personalised work schedules in order to review and reinstate relevant opportunities.
- Plan for annual report to the trust's board on all work schedule reviews relating to education and training.
Reinstating educational opportunities
Educational opportunities are working time and should, where possible, be reinstated back into working time. This should be done by mutual agreement between the DME and the doctor and should not result in the loss of additional educational or training opportunities.
Whilst every effort must be made to ensure delivery of remediation during their scheduled hours, it may be necessary, with the agreement of the doctor, that the educational activity is reinstated in non-working time.
In such cases, it will be appropriate for an additional hours exception report to also be submitted to capture the additional hours worked and reference the original educational exception report. A doctor cannot claim or receive payment for the same hours twice across all exception reports. It should be made clear within the report when additional hours were worked as part of the reinstating of educational activity, and consideration must be given to ensure safe working hours are maintained.
Note that payment in lieu of educational activity is not permitted, except and unless additional hours were worked, in which case an additional hours’ exception report is needed.
There is a range of educational activities that will be captured within a doctor’s exception reports. Whilst in some cases reinstating this activity might be straightforward, for others it will be less so, and employers should determine local approaches to this.
Detriment and information control
Identifiable data for all educational exception reporting must only be shared with the DME and their deputies. Academic trainees under the 2016 TCS can include a nominated academic supervisor at their discretion. A doctor can consent to share their data with other individuals where they wish to do so, for example, to allow a specialised clinic reinstatement. The GoSWH will retain oversight over all submitted reports, including educational ones.
Educational exception report information may be shared beyond these individuals only when required for remediation of exceptions related to educational activity, and only following written or electronic receipt of the reporting doctor’s express consent. Identifiable data may only be shared for clearly defined reasons as per Annex D, paragraphs 27 to32 of the 2016 TCS.
If consent is not obtained despite reasonable attempts, it may not be possible to reinstate the activity. In which case, the DME can take no action, and the report will be noted for information and reporting purposes only.
If there are repeated instances of this occurring, the DME may wish to escalate concerns to the GoSWH to investigate further. The reporting doctor should be notified when this is the case.
