Exception reporting: key changes for guardians of safe working hours
What is exception reporting and who it applies to
Exception reporting applies to all doctors and dentists in training (referred to collectively hereafter as ‘the doctor’) who are substantively employed under the Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016 (2016 TCS) and to those whom the provision has been extended locally. It is recognised that the 2016 TCS are widely mirrored in other employment contexts, and we encourage employers in England to make every effort to extend exception reporting where appropriate*.
The purpose of exception reporting is to ensure prompt resolution and / or remedial action to ensure safe working hours are maintained, secure patient safety, and safeguard the delivery of agreed educational opportunities. Exception reporting is also the mechanism used by doctors to ensure compensation for all work performed and uphold agreed educational opportunities.
This exception reporting guidance is intended to provide direction and advice on how to interpret and implement the changes to exception reporting being enacted via version 13 of the 2016 TCS. This guidance seeks to provide recommendations and best practice approaches to implementing and adhering to these changes.
The overriding principle of these changes is to trust doctors to conduct themselves professionally, and to remove previously existing barriers to exception reporting.
*For example: Academic trainees who hold a national training number/deanery number and are substantively employed by universities. For these doctors, it is encouraged that their exception reporting provision should be extended by clinical employers through a standardised contract. Armed Forces trainees who hold a national training number/deanery number. Public health trainees. Locally employed doctors whose terms of employment substantively mirror the 2016 TCS. Locally employed doctors whose terms of employment do not substantively mirror the 2016 TCS, but to whom ER has already been extended at a local level by their employers.
Roles and responsibilities
GoSWH
The GoSWH will review the outcome of the exception report to identify whether further improvements to the doctor’s working hours are required. The full scope of the GoSWH role can be found in detail in Schedule 06 of the 2016 TCS which includes monitoring and reporting.
HR/medical staffing
HR/Medical Workforce HR will action all additional hours exception reports for 2 hours or less. See the further information section below for links to HR/Medical Workforce HR guidance.
The director of medical education (DME)
The DME will review the outcome of the educational exception report to identify whether further improvements to the doctor’s training experience are required. See the further information section below for links to DME exception reporting guidance.
An overview of the changes
The processes outlined in the new 2016 TCS reflect that:
- The GoSWH will retain oversight over all exception reports, but this has been extended to cover those reports which have been withdrawn after submission by the doctor.
- All educational exception reports will go directly to the DME for review.
- Exception reports for additional hours worked will go directly to HR/medical workforce HR.
- Educational/clinical supervisors must no longer have access to personally identifiable data related to exception reporting, without the doctor’s specific consent, except in the reasons outlined in Annex D paragraph 28.
- Doctors are entitled to choose to receive payment or time off in-lieu (TOIL) for additional hours worked, except in cases as detailed in TOIL guidance.
- Identifiable data related to exception reporting may only be accessed by HR, the GoSWH and DME (for education reports). Additional consideration will need to be given to teams with small numbers of doctors, that is, 10 doctors or less.
- Where sharing information that may incur an information breach fine is required in order to action reports, this must only be done with the doctor’s consent, except for in specific circumstances described in the 2016 TCS. For example, the DME having to approach an appropriate individual within a department in order to reinstate a missed educational opportunity.
- Proven breaches of confidentiality will be subject to an information breach fine as per Schedule 05 paragraph 26 of the 2016 TCS.
- The doctor must action a test exception report, which will be sent to the GoSWH for cross-validation (as per Schedule 05 paragraph 18 of the 2016 TCS). The cross validation can be done by generating a list of all eligible resident doctors, their contract type and grade using ESR and completing a comparison with a list of resident doctors with access to exception reporting systems. If issues preventing a doctor from accessing or submitting an exception report are not resolved within seven days of them raising the issue, the GoSWH will investigate the concern raised and, if proven, issue an access and completion fine as per Schedule 05 paragraph 27 of the 2016 TCS.
- The doctor will need to evidence their exception report. If the cause of the doctor being unable to provide either form of evidence (time/date/location or corroboration) is systemic, rather than a singular occurrence, then action should be taken to address this if possible. If a pattern emerges of exception reports being submitted without either form of evidence provided, and there is no underlying systemic cause for this inability to provide either form of evidence, then the GoSWH will investigate these reports in accordance with the process and procedures set out in Schedule 6, paragraph 13 of the 2016 TCS.
What has stayed the same
- Exception reporting does not apply to occasions where an individual may choose to undertake additional activities for personal or career development purposes beyond the eligible reasons listed in Schedule 5, Paragraph 2 of the 2016 TCS. The GoSWH will retain oversight over all exception reports
- The GoSWH will oversee production of a quarterly and an annual report on exception reporting for the trust's board.
- The GoSWH will convene regular resident doctor forums.
- The GoSWH will identify patterns in exception reporting and work with departments, where necessary, to identify changes in rota patterns to maintain safe working hours and adherence to the work schedule.
- Breaches related to working hours, as defined in Schedule 05 paragraph 23 of the 2016 TCS, will attract financial penalties on the department for additional hours worked.
- The GoSWH will have oversight of the disbursement of money raised through fines, which must be used for the benefit of the education, training and working environment of residents.
The GoSWH remains the final escalation point for disputed reports around additional hours worked.
