Early adoption of exception reporting reforms at NHS Humber Health Partnership
Overview
NHS Humber Health Partnership (HHP) has been one of the first employers taking steps towards a rollout of the upcoming exception reporting reforms ahead of the 4 February 2026, implementation date and has already rolled out access to exception reporting to its locally employed doctors on mirrored terms to the 2016 TCS.
Key benefits and outcomes
- When reviewing the exception reporting reform process, the trust recognised it could improve the experience for resident doctors.
- The trust saw the improvements and early adoption as an opportunity to attract, recruit and retain staff.
- Northern Lincolnshire and Goole Foundation Trust (NLAG) and Hull University Teaching Hospital, which work in partnership, ran a successful internal campaign encouraging its resident doctors to exception report to ensure that they take regular breaks to avoid burn out and overworking.
- The trust sends welcome packs out to new starters, which includes exception reporting log in details and guides as well as dates for all up and coming RDF meetings.
What the organisation faced
When HHP’s two guardian of safe working hours (GoSWH) reviewed the reform details they realised they already met several requirements and saw this an opportunity to further improve the experience for resident doctors. Feedback from those doctors aligned with the reforms’ ambition and the team was keen to keep the process simple and efficient.
Each trust within the group has a GoSWH and they worked in partnership to review the reforms in conjunction with a core team including the GoSWH admin, medical staffing and human resources.
Even before the reforms, resident doctors were supported with a dedicated admin function that shares the GoSWH’s vision and passion.
The reforms came at an opportune time for the organisation, as it had just finished a campaign to encourage exception reporting and reminding resident doctors of the importance of taking breaks.
What the organisation did
The team started by identifying the key stakeholders to engage with in preparation for the change in approach to exception reporting. The core team then created a detailed action list, updating it as new information emerged to stay active and overcome barriers. The stakeholders agreed to meet biweekly review progress, update the action list and addresses any questions.
When the new version of the 2016 terms and conditions was available the team updated the actions and used the record of amendments document as a check list.
The trust worked to find solutions for some of the questions that arose around the process. For instance, if the doctor does not express a preference of pay or time off in lieu (TOIL) for reports due to an outcome, the organisation defaults to TOIL.
For TOIL allowances, the organisation will use secured PDF records which the doctor will share with their rota coordinator when booking time off. Doctors email their rota coordinator copying in the GoSWH and/or admin support. The employer notified all resident doctors the day before the changes, outlining this new process.
So that individuals in small departments are not identifiable the team is changing the board report template so that reporting happens at a directorate level. The team already has existing steering groups within various departments to resolve issues raised by resident doctors that includes exception reporting and recommendations from the GoSWH.
To drive cultural change and improve processes and work schedules in advance, the group has introduced ‘mock fines’ to show departments where fines would apply when they are implemented in February 2026. The group will issue fines when the TCS go live and plans to agree at the resident doctors forum (RDF) how fine money will be spent at the start of rotations, avoiding delays in reaching agreement in retrospect.
Local policies will be updated and will focus on the process for more than two additional hour reports.
One of the trust’s within the group runs an anonymous rotational feedback survey for resident doctors after each placement and plans to expand it to include the detriment survey required in the updated 2016 TCS. The trust also holds quarterly meetings with the post graduate medical education team and the freedom to speak up guardian to share and discuss emerging themes, filter issues and improve communication.
Results and benefits
In the last year, there has been an increase in exception reports, rising further after the reform was announced and again when supervisors were removed from the exception reporting process in October 2025.
The increase in submissions of exception reports has given trust greater insight into resident doctors’ actual working hours, enabling departments to make constructive rota changes.
With dedicated admin support already in place, GoSWH has been able to manage the efficiently and close reports within the recommended timeframes.
Overcoming obstacles
Resistance to change was anticipated as a key issue and the team addressed it by stressing the importance of clear communication. Not only to the resident doctor workforce but also with their shift leads and supervisors.
One unresolved challenge for the employer is finding a solution for geo-location and evidencing requirements to meet financial standards and audit requirements. To address this the trust has joined the NHS Employers early adoption group for peer support and to help generate ideas and shape national guidance. In addition, regular meetings have been set up with the finance and fraud teams to find a solution that all stakeholders are confident will protect both the doctors and the trust. HHP is continuing to work with its core team and the finance and fraud teams to overcome this, in addition to escalating concerns via the early adoption group.
To prepare for the final implementation date of 4 February 2026, the team has challenged resident doctors stress test the system to identify issues early, allowing fixes before the fines are introduced.
Take away tips
- The largest task was removing supervisors from the exception reporting system. The organisation would suggest to other employers that where viable, they start doing this as soon as possible and ensure they have conversations in advance of the implementation date in February 2026.
- Increase visibility of the upcoming changes and look at ways you can promote the changes. HHP plans to advertise the changes on PC screensavers.
- Do not fear the changes, be visible and approachable, and do not be afraid to get things wrong.
- HHP currently hosts around 1,400 doctors in training and locally employed doctors, meaning only six team members across the organisation need access exception reporting.
Further information
For more information about the work in this case study please contact:
Dr Liz Evans, Guardian of Safe Working Hours.
Helen Fitzpatrick, Northern Lincolnshire and Goole NHS Trust.
