Lead employer guidance for exception reporting
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.
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 principles 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.
Lead and host employer responsibilities in trust settings
In a lead/host employer arrangement, the responsibilities for employers are set out below for those trainees working in a NHS trust or NHS foundation trust setting, and includes those working within hospital settings:
Activity | Lead employer | Host employer |
|---|---|---|
Recruitment |
|
|
Access to ER system | Carry out pre-employment checks. | Providing access to an ER system. |
Managing costs associated with ER | No responsibilities, all costs associated with ER borne by host trust | Internal provisions for financial management of access and completion and information breaches, and cost of additional hours worked. |
Work schedules | Issue work schedules |
|
Actioning ER where payment to the doctor or penalties/fines against the employer are required |
|
|
Quarterly and annual reporting requirements | Collate quarterly and annual GoSWH board reports | GoSWH to produce quarterly and annual board reports and share with the lead employer GoSWH |
Lead and host employer responsibilities in non-hospital settings
There are different arrangements in place for managing exception reporting processes in non-hospital settings under lead employer arrangements.
Where a doctor is working in a non-hospital setting for a host organisation that is not an NHS trust (including foundation trusts), the lead employer is responsible for discharging both the lead employer and host employer responsibilities described in the above table (excluding providing work schedules which will need to be provided to lead employers to issue to the doctors in line with the code of practice). Examples of this scenario include but are not limited to: general pactice, public health, palliative care and sexual health host organisations.
The lead employer responsibility includes paying for any costs incurred (that is any fines and claims for additional hours worked) as a result of exception reporting.
Lead employers can recover the costs associated with exception reporting for additional hours worked by doctors in non-hospital settings (primary care/ non-NHS trust settings) from NHS England using normal processes. Lead employers will need to include a new element description/allowance type category in their return (payroll report) which clearly identifies the cost of additional hours which have been exception reported by doctors working in non-hospital settings.
Lead employers cannot recover any costs from NHS England for the following purposes:
- Additional hours worked in an NHS trust setting.
- Process fines (access and completion, and information breach) in any setting.
In line with the responsibilities set out in Schedule 6 of the 2016 TCS, the GoSWH will scrutinise exception reporting patterns to ensure reports are accurate, valid and adhere with the purpose of exception reporting.
One of the key purposes of exception reporting is to allow employers, directors of medical education (DMEs) and GoSWHs to improve working practices. In non-hospital settings, where the lead employer will sign off and pay exception reports, it does not provide the host setting access to this data. Therefore, the GoSWH and DME play a crucial role in coordinating with doctors and host settings to identify and resolve issues that may emerge through the exception reporting process to ensure that safe working practices are being maintained and that agreed educational opportunities are upheld.
Exception reporting data from non-hospital settings must still be included in the quarterly and annual GoSWH reports. The report should distinguish between non-hospital and hospital settings however a separate report is not required for each individual community-based organisation.
