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

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/specialty 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. 

7. How should annual leave be managed for junior doctors who are required to rotate between organisations during COVID-19? (added 23 March 2021)

Taking regular annual leave is an important factor in supporting the health and wellbeing of doctors in training and should be prioritised. Due to the ongoing demands presented by COVID-19 we recognised that some doctors in training may not have been able to take their full annual leave entitlement before the end of their rotation. In such circumstances where leave cannot be allocated, or carry over of leave is not requested, or only a portion of annual leave is carried over, payment of the remaining entitlement should be made at the end of the doctors rotation. Any requests made to carry over some of the untaken annual leave will require the agreement of both the current and new employer to give effect.

For further guidance regarding how untaken annual leave could be managed, please refer to the joint guidance that NHS Employers previously developed with the BMA. Whilst the guidance is only applicable to last year’s rotations, it helpfully sets out what needs to be put in place for any transfer of leave between employers where there is local agreement to do so.

8. Are doctors with an ARCP Outcome 10.1 eligible for pay protection arrangements when switching specialties, as per schedule 2? (added 29 April 2021)

Schedule 2, paragraphs 49 to 58 allows pay protection for doctors switching into a hard to fill specialties, having achieved an outcome 1, 2 or outcome 6. NHS Employers and the BMA agree that as a result of COVID-19, if a doctor has progressed and achieved an ARCP Outcome 10.1, and was due to switch into a hard to fill specialty, it is reasonable for such doctors to be eligible for hard-to-fill pay protection arrangements.

Less than full time training (LTFT) 

8. 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

9. 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.


10. 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.

Shielding (added 3 February 2021)

The NHS Staff Council guidance on shielding should be followed for all staff, including doctors in training.

However, the guidance is not explicit on pay for doctors in training who continue to shield, but were due to rotate and issued with work schedules, and therefore unable to commit to the range of activities determined by the work schedule.

In such instances consideration should be given to pay protect the doctors, on what they would have received had they been able to do so, had it not been for COVID-19.

This decision would be at the discretion of the employing organisation and must be in line with their established local interim COVID-19 and pay protection policies.

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 statementon 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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