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.

2016 contract provisions
Consultants and SAS doctors
August rotation
Less than full time training
Annual leave
Related published updates

2016 contract provisions

NHS Employers and the BMA have issued a statement on the application of the 2016 contract limits for the duration of the pandemic emergency. This statement outlines that where an employer is unable to meets its obligations under the definitions of appropriate levels of cover within the limits of the 2016 terms and conditions of service (TCS),  you may agree to suspend contractual provisions in discussion with trainees and, where possible, the guardian of safe working hours. As the contract provisions are in place to ensure the health and safety of trainees, we would advise that departures from the contract limits should be as limited as possible and for as short a time as necessary. Please see the statement for further details. 


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.


Other 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. Is the 2020 national Clinical Excellence Award round going ahead?

This round has been suspended. The Advisory Committee on Clinical Excellence Awards (ACCEA) has confirmed that no further applications need be submitted, and any applications already drafted will be saved.  

5. Is the 2020 Local Clinical Excellence Award round going ahead?

No. Local Clinical Excellence Awards (LCEA) have been halted as a result of the COVID-19 pandemic, with the award money due to be distributed equally among eligible consultants. NHS Employers has agreed a joint statement with the BMA and HCSA acknowledging the current exceptional circumstances, and the significant operational pressures services are currently under.

Take a look at NHS Employer’s updated employer FAQs on the local clinical excellence awards.

6. What other urgent ongoing work is likely to be affected by COVID-19?

We will provide an update on the agreed position as soon as possible on the status of the 2016 terms and conditions of service including:

  • maintenance of exception reporting
  • the role of the guardian
  • application of contractual safety limits scheduled for implementation in August 2020
  • implications of the announcement to delay rotations, including application of work schedule and associated pay issues, use of temporary work schedules, implications for high intensity placements e.g. emergency medicine
  • redeployment of staff opportunities in light of increasing levels of travel restrictions
  • treatment of missed education and training sessions
  • application of Code of Practice notification provisions (August 2020)
  • management of the consultant appointments process.

7. What about arrangements for medical students, new medical graduates and early registrants?

Arrangements for medical students and new medical graduates can be found on our medical students and doctors in training web page. FiY1 doctors will be employed on the same terms and conditions as F1 doctors so the standard F1 documentation should be used.  Medical undergraduate students can be employed to support the pandemic response on appropriate Agenda for Change bands.   

8. 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.

9. Are there any plans to suspend the remaining provisions as outlined in the jointly agreed implementation timeline?

As employers have the flexibility to suspend contractual rules during the pandemic (see our joint statement for full details) NHS Employers believes that it will be difficult to maintain the current implementation timeline for the remaining provisions. NHS Employers will be discussing this with the BMA as part of the commitment made to regularly review the jointly agreed statement and will provide an update in due course on any additional agreements reached. 

10. 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. 

11. The April rotation suspension carries a risk of burnout for all trainees, particularly for foundation year 2 trainees working in high intensity area placements. Could these trainees be rotated?

Employers should consult with the trainees and if local arrangements allow this, or wider clinical circumstances require it, this should be accommodated. Rotations may only occur where departmental inductions, appropriate supervision and support can be guaranteed. If they can rotate those in high intensity placements, then the employer should let the Health Education England (HEE) local office know. If rotation is not possible then extra vigilance to manage health and wellbeing should be taken. 

Please refer to the HEE website for further guidance

12. 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. 

13. Is there a separate contract for the FiY1 (early registered) doctors?

No, there is no separate model contract for FiY1s, the agreement is for them to be put on the standard F1 contract. The model contract for junior doctors can be accessed on the NHS Employers website. For further details about how FiY1s should be employed please see our statement on the deployment of FiY1s and medical students.


August rotation

14. Will there be a delay with the contractualisation of the code of practice as agreed by NHS Employers and the BMA?

There are currently no plans to delay the introduction of outstanding provisions as outlined in the framework agreement. However, due to COVID -19, the joint agreement on the suspension of contractual terms and the HEE announcement in relation to the August rotations, the need for some flexibility with timescales for local implementation is recognised. Both NHS Employers and the BMA have agreed to develop some supporting communications to confirm what will be expected of employers, which will be published in due course.

15. What if we can’t meet the code of practice deadlines?

HEE have said that they will provide trainees and employers with notice of the August and other summer placements as soon as possible, but no later than eight weeks before the intended start date. Providing all the relevant information is sent to employers within this timeframe, all reasonable steps should be taken to send the generic work schedules, allowing the trainee(s) with as much notice as possible so that they have time to plan. Any likely delays should be communicated with trainee(s) as early as possible.

HEE’s statement can be accessed here.


Less than full time training (LTFT) 

16. 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.


Annual leave

17. Does the recent government announcement relating to the carrying over of any unused annual leave for two years apply to doctors in training who are due to rotate onto other NHS trusts?

This is currently under discussion nationally and we will update as soon as there are further developments.



Pay Protection

18. 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.


Pay Progression

19. What will happen to pay progression for doctors in training who were due to move to a post at a higher nodal point before August, but who made the decision to remain in their current post to assist with COVID instead of moving into the higher grade post? For example, an LTFT doctor who is in a ST2 post and would have moved to an ST3 placement in April but remained in their existing placement to support the pandemic response.

In this situation, if the doctor has achieved a satisfactory ARCP and it has been confirmed by HEE/Training Programme Director that the doctor is at ST3 level, then due to these exceptional circumstances the doctor should be paid as ST3 from the date their new post was due to start.


20. 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

A a copy of a letter from the Academy and the four UK education authorities has gone to the service setting out the need to ensure that training is reinstated effectively. 

HEE has a full set of resources (regularly updated) on COVID-19 which includes:

  • coronavirus (COVID-19) Information for trainees, as well as for allied health professions (AHPs) and nurses and midwives
  • HEE coronavirus plans for management of medical and dental training programmes – this notes employment and training management issues and also addresses exceptional circumstances where trainees may have to be moved to other clinical areas or different locations.

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

The ACCEA statement on national clinical excellence awards, and any further updates published, can be found on the website.

Read the GMC’s information and resources pages on its role as regulator during the pandemic.

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. 

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