Exception reporting reform background information

On 31 March 2025, the British Medical Association UK Resident Doctors Committee (BMA RDC) announced it has accepted the framework agreement for exception reporting. The acceptance of the framework agreement has formally ended the BMA RDC’s dispute with the government and the document was ratified by DHSC ministers. 

The framework agreement is a document outlining the planned exception reporting reform for the 2016 Terms and Conditions of Service (TCS) in England.

NHS Employers hosted a webinar on 8 April 2025 to outline the upcoming exception reporting reforms for resident doctors on the 2016 TCS in England. 

This event was targeted to employers in medical HR, medical workforce lead and guardian of safe working hours roles and can be watched below.

Details of additional webinars will be promoted in due course.

The exception reporting reform was introduced as part of the broader pay offer for doctors in training, initially announced on the 29 July 2024. Twelve guiding principles were established to underpin the reform of the exception reporting process. This pay offer was subsequently accepted by BMA members on 16 September 2024. Following this, an implementation group was formed to discuss and finalise the reform based on these principles.

Doctors must be paid/receive time off in lieu (TOIL) for all time worked above contracted hours subject to making an exception report.

1. Doctors should be enabled and encouraged to exception report.
2. They should not suffer any detriment as a result of reporting.
3. None of these changes should undermine the Guardian of Safe Working Hours' ability to undertake their roles and identify unsafe working practices.
4. As with all claims for overtime/additional working, there needs to be a sign-off process, but challenges to claims should be by exception rather than the norm.
5. The system for reporting should be clear and straightforward.
6. In reference to exception reports asserting a doctor worked additional hours of two hours or less in one occurrence, the only determination the employer will seek to reach when deciding whether to pay the doctor is whether or not the additional hours were indeed worked; the perceived retrospective merits of the doctors’ decision to work the additional hours should not be considered when determining whether to make payment for the additional hours.
7. Exception reports arising from a doctor having worked more than two hours in one occurrence, should be investigated to ensure safe staffing is maintained and could be subject to a locally determined process, which must be agreed upon with the BMA Local Negotiating Committee.
8. Claims should be based upon clear agreed criteria for what constitutes additional working, for example theatre overruns.
9. All educational exception reports to go to DME for approval.
10. All other exception reports to go to HR or Medical Workforce HR for approval.
11. Review the contractual deadlines to ensure that they are sufficient for exception reporting submission to remove the undue burden from doctors and replace with timeframes that empower doctors to manage exception reporting when convenient to them as professionals.
12. The underlying ethos to this change should be to empower and trust doctors to conduct themselves professionally, and to remove wherever possible, and minimise wherever it is not, the time-consuming aspects of the process.