F1 shadowing: payment arrangements 2019

£20 notes

The initial guidance from Health Education England (HEE), published in 2014, remains unchanged and still applies for 2019. Since the guidance was published in 2014, shadowing is considered business as usual for new foundation programme year 1 (FY1) appointees. 

Previously, trusts have made payments for shadowing in a number of ways. NHS Employers asked for legal advice on how trusts can most cost effectively provide the required payment for the four-day shadowing period, and that the period is protected for shadowing and induction. The 2016 terms and conditions (TCS) also state that these terms and conditions cannot be used for shadowing purposes, so any employers who have previously extended the F1 contract to cover this period will need to consider alternative arrangements such as the contract for training set out below.

This page outlines some advice for calculating the payment of a four day programme.

2019 shadowing scheme
Contract for training
NHS indemnity
Consistent payment
Contract of employment
Further information.

2019 shadowing scheme
The 2014 HEE guidance remains unchanged, and still stands for 2019. Trusts will need to arrange for the appropriate payment for undertaking a period of shadowing to be made to F1 appointees.

Read the HEE Guidance on shadowing for appointees to Foundation Year 1.

Contract for training
NHS Employers is keen to ensure that the period, prior to the start of the foundation programme, is protected as an identified period for transition from medical student to employment as a doctor in the NHS. We recommend that appointees are engaged using a contract for training approach on the understanding that appointees will not be required to carry out any substantive duties for the trust for the duration of the contract.  

Appointees cannot be placed on a standard F1 contract during shadowing. Paragraph 3 of the introduction to the 2016 TCS states that “These TCS do not apply to any doctor undertaking a period of shadowing immediately prior to commencing work as a foundation doctor.  Separate arrangements should be used for this shadowing period.”

It is not the purpose of the contract for training to prohibit the F1 appointee from undertaking clinical tasks during their period of shadowing. The amended model contract (para 1.3) explicitly supports the HEE guidance in that the F1 appointee should:

"...be encouraged to assume some clinical responsibility and provide assistance with clinical tasks. This might from time to time include undertaking some clinical tasks under the close supervision of the current F1 and/or senior doctor, in order to consolidate your learning, but this would not be in any formal capacity".

Calculations can be used on the 2016 basic pay values as per the latest pay circular for the shadowing days, NHSE advise that this is contracted separately. Capsticks has drafted a model contract for training  which can be used for this purpose. Payments made under this contract are not subject to pension, tax or employer/employee national insurance contributions (NICs).

Under this contract, F1 appointees should not be asked to undertake tasks that would be beyond the scope of their consolidation of learning or could be perceived as substantive duties for the trust, as this could lead to the shadowing period being considered as work and therefore employment.

For clarity, the wording at the end of para 1.3: 'would not be in any formal capacity' is a reference to the non-employment status of this contract. It is in no way intended to infer that shadowing activities would not be undertaken in an appointee's formal capacity as a provisionally registered doctor.

Contract of employment
Where trusts wish their new F1 appointees to take part in substantive duties for the trust that could be considered to go beyond the consolidation of learning and therefore classed as work, we recommend that a separate contract of employment is provided. 

In line with the HEE guidance, this should be a fixed-term contract for the period of shadowing for which there should be no expectations of additional payments, enhancements or allowances above to this basic pay rate during the period of shadowing. These payments are subject to tax and employer/ employee NICs and pension contributions.

The substantive contract of employment should then commence from the first day of work, for example Wednesday 1 August 2019.

NHS indemnity
The NHS Litigation Authority has confirmed that F1 appointees with contracts for training, as well as those with a contract of employment for the shadowing period, will be covered under the existing NHS Indemnity scheme.


Consistent payment
The HEE guidance clearly sets out the level of payment that should be offered to F1 appointee undertaking this prescribed period of shadowing:

"The shadowing placement should be paid on a F1 basic pay basis or equivalent, pro rata to the hours undertaken, and there should be no expectations of banding or other enhancements to this basic pay rate during the period of shadowing. This reflects the fact that this period of shadowing is preparatory to the formal adoption of clinical responsibility on being employed as an F1 doctor. If local arrangements provide more than is required by the guidance, cost will need to be met locally."

The F1 basic pay for those on the 2016 contract is nodal point 1, and similarly there should be no expectations of any other enhancements or allowances. 

In order to create a level of consistency for trainees on the amount they receive as payment for the period, irrespective of the mechanism by which they are contracted, we have outlined below some advice for calculating the payment for a four-day programme as:

A day’s pay should be calculated as the monthly sum divided by the number of days in the particular month. 

If paid under a contract for training NOT via PAYE 
Amount payable = four days of F1 basic salary (including London weighting if applicable) minus the equivalent of tax and NICs that would have been payable on that amount.

If paid under a contract for training payment via normal PAYE payroll (only use if this is the only option available)
Amount payable = four days of F1 basic salary (including London weighting if applicable) minus the equivalent of tax that would have been payable on that amount and deduct tax* and **NIC at payroll.  
*Please advise trainees they can reclaim the tax deducted at payroll.
**Full employer NICs also payable

Payment made under locally designed fixed term contract of employment
Amount payable = four days of F1 basic salary (including London weighting if applicable) and deduct pension contribution, tax and NICs at payroll.  The trainee cannot reclaim this tax.


Further information
If you have any questions email medicalworkforce@nhsemployers.org

Why Register?

Great reasons to register with NHS Employers

  • A personalised website
    Manage your profile and select topics of interest to you
  • Access your dashboard
    Bookmark useful content to help you quickly find what you're looking for
  • Get involved
    Contribute to our Talking Points discussions, comment on and rate our webpages
  • Keep up to date
    Receive the latest newsletters and media summaries

Log In