Medical and dental workforce issues

We are working with key stakeholders including Department of Health and Social Care (DHSC), Health Education England (HEE) and the British Medical Association (BMA) to clarify a number of issues that have been raised by employers in relation to the medical and dental workforce. We will update these FAQs regularly as issues are resolved.

Consultants and SAS doctors
August rotation
Less than full time training
Related published updates


Consultants and SAS doctors

NHS Employers has agreed a joint statement with the British Medical Association to acknowledge the contribution of consultant, consultant clinical academic and SAS doctors during the COVID-19 pandemic, and the flexibilities which they have offered to support the response.


Frequently asked questions (to be updated regularly)


1. How far should doctors and dentists be expected to cover for colleagues under the contractual provisions?

While the contracts provide for (and expect) a certain amount of flexibility to cover absence, doctors should not be required or expected to undertake additional work under this arrangement for prolonged periods, or on a regular basis. Where there is expected to be an ongoing requirement for additional or altered work commitments, this would be a change to the existing job plan/work schedule.

2. Is it possible to convert consultant/speciality and associate specialist (SAS) supporting professional activities (SPA) into clinical time?

We expect SPA time to come under pressure as greater emphasis is put on the delivery of clinical activity. This is a matter for local management and employers should work together with their doctors to agree where time may be able to be made available for clinical or non-clinical work supporting the COVID-19 effort.

3. What acting down and acting up arrangements will apply?

At present employers should follow existing guidance on acting up and acting down and ensure doctors are not asked to undertake duties beyond their level of competence. 

4. How should employers be managing cases under Maintaining High Professional Standards (MHPS)?

Practitioner Performance Advice (formerly the National Clinical Assessment Service) has produced guidance on how to manage concerns about doctors and dentists in accordance with MHPS during the COVID-19 outbreak. NHS organisations should continue to have oversight of professional concerns, but as the situation evolves the priority will be those concerns assessed as high risk. The guidance covers urgent concerns, investigations, exclusion from work as well as the support currently available to practitioners and employers. 

Access further information on medical students and doctors and training.

5. Do employers need to issue individual new work schedules reflecting any changes to planned working patterns?

For the purposes of correct hours and pay calculation, all new and amended rota patterns will require a work schedule, or equivalent mechanism where employers are unable to reissue work schedules, to ensure that there is appropriate remuneration for all work done.  

6. What are the provisions for junior doctors acting up to work on COVID-19 rotas and how should they be paid?

There are no nationally agreed contractual provisions on acting up within the 2016 terms and conditions for doctors in training. However, the 2002 terms and conditions of service (paragraph 122) refers to doctors acting up and provides employers with a useful framework should they wish to introduce this arrangement. This section provided for an acting-up allowance to bring the doctor’s total pay up to the rate the trainee would have received on promotion to that grade.

An allowance to be paid on top of the total existing pay as per the 2002 provisions would be a reasonable way to approach acting up in the current situation. 

Less than full time training (LTFT) 

7. Do LTFTs who temporarily go full time for the purpose of helping with the pandemic continue to receive the LTFT allowance?

Yes. The intention of the allowance was to support LTFTs with the cost of training and where LTFT trainees provide additional hours during the pandemic, the LTFT allowance will not be withdrawn. Trainees providing temporary full-time service to support the pandemic response are not effectively returning to full-time training.


Pay Protection

8. Will NHS Employers be issuing any guidance on pay protection related matters?

Due to delays in reaching agreement nationally on various other guidance, NHS Employers will not be in a position to issue any joint guidance with the BMA on this matter. Pay protection arrangements will be a matter for local determination and employing organisations may wish to seek their own legal advice if required.


9. Will a trainee who has been redeployed out of their hard-to-recruit specialty still be entitled to their specialty flexible pay premia (FPP)?

Yes. Doctors will continue to receive the FPP if redeployed, as they have not left their training programme but have been temporarily reassigned.

Related published updates

HEE guidance on COVID-19 for all professions can be found here.

The Academy of Medical Royal Colleges (AoMRC) has a COVID-19 resource page, covering education, training and workforce, mental health and wellbeing, clinical and governance issues.

GMC information and resources on coronavirus can be found here.

NHS Resolution has published a statement on indemnity cover during COVID-19.

Employers and dentists employed on the Salaried Primary Dental Care Services (England) Terms and Conditions of Service (TCS) are required to carry out an appraisal process annually (TCS ref para 5.4). NHS Employers supports a move to temporarily suspend appraisals for these dentists during the COVID-19 pandemic, to allow both employers and dentists to focus on COVID priorities. 

A joint statement has been released by Statutory Education Bodies which covers the release of candidates and doctors in postgraduate training for recruitment and assessments. The Academy also has a statement on the importance of exams which is regularly reviewed as appropriate.

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