Supporting locally employed doctors at Epsom & St Helier Trust

Overview

In 2021 Epsom & St Helier introduced a new medical workforce retention adviser (MWRA) role to better support its locally employed doctor (LED) workforce. The role was intended to better support training and development for these individuals, with a view to aiding better retention and progression into more senior roles within the organisation or across the NHS.

LEDs within the organisation were on local contracts mirroring the 2016 Terms & Conditions and fulfil a range of roles, most commonly working alongside doctors in training. They also come from a range of backgrounds and levels of experience, including UK and international medical graduates (IMG).

What the organisation faced

Prior to the introduction of the MWRA role, Epsom & St Helier sought to improve the experience of LEDs within the organisation. As with the wider NHS, the number of LEDs had grown rapidly at the trust to around 200 as of 2026.

LEDs were typically appointed on fixed term contracts which led to uncertainty for LEDs and instability for the trust. It also led to a greater workload for medical staffing colleagues having to manage the recruitment process of these roles.

Many LEDs working with the trust did not understand the career routes available to them. In particular, it was found that LEDs who were also IMGs did not always have a clear understanding of the different career options and support available to them and would often be reluctant to raise concerns.

Describing the experience of IMGs, Dr Samer Alahmad, medical registrar at Epsom & St Helier explained:

“Many IMGs do not have a good understanding of their entitlements and struggle to know when and how to raise concerns. We needed to break the fear in order to better support our IMG workforce.”

What the organisation did

In 2021 the organisation introduced the MWRA role to support LEDs and act as an advocate for this staff group alongside the LED tutor. The role would provide pastoral care for LEDs and in particular support the growing numbers of IMGs who are new to the trust and life in the UK.

The MWRA sits within the trust’s medical staffing team and identifies new LEDs as they are appointed.

Information about the trust is then provided to the LED prior to commencement and an initial 1:1 is arranged once the LED has commenced in post. These conversations will seek to answer any questions the LED might have as well as cover information around topics such as leave, e-portfolio, appraisal and support for career progression. With the General Medical Council (GMC), the trust provided access to LED specific training sessions.

Bespoke training sessions are also arranged for LEDs covering specific topics such as appraisal, audit and exception reporting. Many IMGs were found to have little prior experience on these topics so training in these areas was seen as particularly valuable.

The MWRA also acts as an advocate for LEDs within the organisation, ensuring they are treated fairly and that suitable support is made available. They have also been leading on work within the organisation to raise the profile of LEDs and ensure departments have a better understanding of these roles.

To support retention of LEDs, the MWRA regularly reviews those who have been with the trust for three years via a ‘staff in post’ report. Once LEDs reach this point they are contacted to better understand their career plans so that appropriate support can be provided where necessary. Intentions will vary depending on the individual such as wishing to enter specialty training, progress to specialty doctor roles or simply develop in their current role. Training and support will subsequently be tailored to suit those needs.

Overcoming obstacles

When first established the MWRA was new for the organisation and as such it took some time to properly embed into the organisation and create the bridge between LEDs and departments. It was important to build relationships with departments to ensure the role and its aims were properly recognised and the benefits for the trust understood.

Overcoming existing perceptions of LEDs as ‘gap fillers’ was initially quite challenging. The case was made that good support for training and career development would lead not only result in better doctors but better retention for the organisation as well as improving safety and patient care.

There was also a lack of understanding over the contracts of employment which could be offered, with some being unaware that LEDs could, where appropriate, be offered permanent contracts or the implications of individuals being employed in fixed term contracts for extended periods of time. Engagement and education on these topics helped managers make informed workforce decisions leading to better stability for departments and LEDs.

Takeaway tips

• Good communication skills are essential for anyone in a similar role; both to build rapport with LEDs and connections with departments.

• Ensure the purpose of the role is clearly established and communicated to all stakeholders early on.

• A robust support structure is essential – strong links to medical HR and a proactive LED tutor are essential to facilitate change.

• Cultural change around the role of LEDs is essential – promoting the benefits of retention and development of LEDs and the benefits to patient safety is key.

Further information

If you would like further information on the role, please contact Yesim Jones, yesim.jones1@nhs.net, medical workforce retention advisor at Epsom & St Helier University Hospitals NHS Trust.