Doctors in training

Doctors in training


There are approximately 55,000 doctors in training (DiT) at any one time within the NHS. Doctors in training (DiT) are also known as junior doctors and include all Foundation Year, core, speciality, and GP training programme doctors in the UK. 
Due to the nature of training, regular movement between employing trusts is a fundamental part of their training programme. Over a 10-year training career, doctors in training move organisation an average of ten times, however for some doctors this could be as many as 16 times. This high frequency of movement reinforces the need to get the rotational process right to ensure a good experience for the trainees while enabling trusts to run an efficient and effective process.
Health Education England’s report Enhancing junior doctors’ working lives - a progress report highlighted the need for improvement in employers’ approaches to induction and mandatory training.  

Specifically, the report stated that recruitment and induction processes need to reduce duplication of pre-employment checks, mandatory training and induction when employees move from one NHS organisation to another, without any break in service.

HEE requires all trusts in England have a streamlined process in place by August 2018. 

DiT national working group 

To address this, a national core working group was established to develop an efficient rotational process that could be applied across all NHS trusts. The working group includes representatives of trust medical staffing managers, HEE recruitment team members, HEE senior business managers and the Midlands & East Streamlining Programme support team.  Where specialist, national input was required, additional stakeholders were engaged including NHS Employers, the NHS ESR Programme, UKFPO, Deans and, at a local level, occupational health professionals, learning and development leads and medical education leads.

The perfect rotational process 

The working group defined and agreed the key deliverables of a national “Perfect Rotation Process” was to:
  • enable employers to establish streamlined processes regionally for recruitment and induction by August 2018
  • ensure all trainees nationally are guaranteed access to recruitment and induction processes that limit duplication while maintaining agreed standards
  • reduce duplication of pre-employment checks and mandatory training and induction when employees move from one NHS organisation to another without any break in service
  • support the recognition of a number of pre-employment checks undertaken by the previous employing trust, allowing for a smaller number of checks to be undertaken in line with the regional policy
  • encourage recognition of training programmes undertaken in previous employing trusts, allowing for ‘refresher’ training when required periodically and induction processes remaining unique to a locality or employer
  • ensure the development of a high quality standard induction eLearning programme by HEE is recommended as best practice and incorporated into the overall induction process

Following the working groups’ in-depth review of existing processes, six principles were formulated as the key steps to achieving the “Perfect Process”. Each of the key steps has its own deliverables.

Electronic Staff Record (ESR)/TIS interface
All trusts to implement the interface and HEE regions to consistently support its rollout and use.
12 week Key Performance Indicator (KPI)
Continued and extended monitoring of the 12 week KPI to ensure timely sharing of DiT data and enabling the issue of rotas for all DiT
Pre-hire Inter Authority Transfer (IAT)
All medical resourcing teams to consistently process pre-hire IAT to support the portability of DiT data
Trust onboarding
Trusts to follow NHS Employers recruitment guidance to reduce duplication and incorporate national solutions into induction
Competencies in ESR
Trusts to record all mandatory training as competencies in ESR to enable training records to transfer electronically
Occupational Health (OH) records
Electronic transfer of OH immunisation and vaccination records

Pilot study

The below table details the selected organisations (12 pilot sites and 16 fast followers) who are currently piloting the “perfect rotation process” across England from November 2017 until April 2018. The aim of the pilot study is to ensure the six principles work effectively and that all associated supporting materials are accurate, useful and fully tested before the full release of a national toolkit in May 2018.

Once the initial pilot sites have completed a phase, the “Fast Follower” trusts will commence implementation using any newly tested processes or documentation.  This will include: support, input into the review, and development of the documents and process guides which will form the final national toolkit. There are subject matter experts for each of the six principles, who we refer to as 'internal champions'.

The internal champions will have the opportunity to shape and influence a key part of the six principles, providing the trusts with the opportunity to implement these ahead of the August 2018 deadline, and to benefit from having support and feedback directly from the pilot teams.

Trust name Region Organisation type Category
Portsmouth Hospitals NHS Trust South Central  Acute Confirmed pilot
Derby Teaching Hospitals NHS Foundation Trust East Midlands Acute Confirmed pilot
James Paget University Hospital NHS Trust East of England Acute Confirmed pilot
Imperial Healthcare London London Acute Confirmed pilot
West London Mental Health NHS Trust London Mental Health Confirmed pilot
NE Streamlining Programme - LET  North East Acute Confirmed pilot
Pennine Acute North West Acute Confirmed pilot
Surrey and Sussex Healthcare South East Coast Acute Confirmed pilot
Gloucester Hospitals South West Acute Confirmed pilot
Royal United Hospitals Bath NHS Foundation Trust South West Acute Confirmed pilot
The Royal Wolverhampton NHS Trust West Midlands Acute Confirmed pilot
Sheffield Health & Social Care NHS Foundation Trust Yorks & Humber Community and Mental Health  Confirmed pilot
West Herfordshire Hospitals NHS Foundation Trust  East of England Acute Fast followers
Central & North West London London Mental Health Fast followers
Epsom & St Helier University Hospitals NHS Trust London Acute Fast followers
Royal Brompton & Harefield NHS Foundation Trust London Acute Fast followers
St Helens & Knowsley Teaching Hospitals NHS Trust North West Acute Fast followers
Bucks Healthcare South Central Community Fast followers
Oxford University Hospitals NHS Foundation Trust South Central Acute Fast followers
Royal Bournemouth & Christchurch NHS Foundation Trust South Central Acute Fast followers
East Kent Hospitals University NHS Foundation Trust South East Coast Acute Fast followers
North Bristol NHS Trust South West Acute Fast followers
Plymouth Hospitals NHS Trust South West Acute Fast followers
Royal Devon & Exeter South West Acute Fast followers
University Hospitals Bristol NHS Foundation Trust South West Acute Fast followers
Wyne Valley NHS Trust West Midlands Acute Fast followers
Bradford Teaching Hospitals NHS Foundation Trust Yorks & Humber Acute  Fast followers
York Teaching Hospitals NHS Foundation Trust  Yorks & Humber Acute Fast followers 

How NHS trusts can progress 

For those organisations that have not opted to form part of the pilot study, it is recommended that the following pre-requisite tasks are undertaken in readiness for August 2018:
  1. Align all statutory & mandatory training to the Core Skills Training Framework (CSTF).
  2. Record CSTF competencies in ESR Oracle Learning Management System (OLM).
  3. Enable the ESR/TIS Interface.
  4. Determine local process for running the Pre-hire Inter Authority Transfer (IAT) for doctors on rotation.
  5. Medical staffing to run the Pre-Hire IAT.
  6. Accept CSTF competencies via the Pre-Hire IAT and remove all unnecessary duplicate training.

Project team

Setting up a project team that includes the right people will be essential to successfully implementing the new process. Key roles within the organisation will provide subject-specific expertise, while ensuring that staff are engaged with the changes and the benefits of the new process are understood.

it is recommended that the local project team comprise of the following roles:
Role  Responsibilities
Executive Sponsor 
(For example, HR director or medical director) 
Overall responsibility for the project and its successful implementation. Steer the project, influence and support to overcome issues and ensure maximum benefits
Project Lead 
(For example, Deputy HR Director) 
Overall responsibility for ensuring tasks are completed, kept on track, address issues, raise issues to executive sponsor and/or streamlining team where necessary. Be the point of contact for Exec sponsor & streamlining programme team.
Medical Staffing Lead Providing expert medical staffing knowledge, ensuring all medical staffing process changes are implemented across the medical staffing team.
Learning & Development Lead Providing expert L&D knowledge, ensuring all process changes are implemented across the L&D team. Leading on the alignment & declaration to CSTF. Leading on the Competencies in ESR principle
IT Lead Ensure all IT requirements are met to ensure the successful implementation of all six principles. Key is the MM0-100 ESR Organisation Site IT Printer and Network Infrastructure Readiness document. Support where necessary of any automation of reports, forms and processes.
ESR Reporting Lead Provide expert ESR reporting knowledge, providing reports required as part of the project implementation and continued support of reporting required as business as usual. In particular, reporting that will enable pre-population of forms/documentation.
ESR Work Structures Lead Provide ESR work structures support where needed as part of the project. This will mainly be part of the ESR TIS Interface principle and the set up/amendments as necessary to positions in a timely manner to enable to successful implementation of the interface.
ESR System Admin Lead Provide ESR system admin support where needed as part of the project, to allocate URP's and notification roles in a timely manner to enable the success of the project.
Payroll Lead Provide expert payroll knowledge and support to any changes of current processes particularly around the pre-hire IAT principle.
Medical Education Lead  Providing expert education knowledge, ensuring that any process changes maintain the DIT required standards and training requirements.

Frequently Asked Questions (FAQs)

1. What are the timeframes for trusts to have implemented the ‘Perfect Rotational Process’?

There is a national expectation that all trusts will begin the transition to this new approach during the coming months, with all trusts expected to have made significant progress to full implementation by August 2018.

2. Can my organisation be involved if it isn’t a pilot site?

It is possible the National Working Group may require consultation from a wider audience. If you would like to be contacted, Please email to register your interest.

3. Our organisation does not use ESR OLM for recording training records, is the expectation to have this data in ESR?

It is an expectation that all training data is electronically transferred via the ESR Pre-Hire Inter Authority Transfer (IAT) process.  All organisations therefore need to ensure that following declaration to alignment to the Core Skills Training Framework (CSTF) that CSTF competencies are in ESR.  There is new functionality available in ESR known as the ESR competency bulk upload process which will assist organisations who do not use OLM with adding CSTF competencies on a regular basis. To find out more contact your Regional NHS ESR Account Manager.  To find out who this is, visit the ESR website

Support and useful contacts 

• If your region has already engaged in a Streamlining Programme ensure your local workstream leads are attending the regional workstream meetings.

• If you have a question relating directly to Streamlining, contact your regional Streamlining Programme Office, if you have one.  If you do not know details of your regional PMO or do not have one, contact:

• If you have any questions relating to streamlining and ESR, please contact your regional NHS ESR Account Manager, if you are unsure who this rel="noopener noreferrer" visit the 
ESR website


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