By Rachel Pugh
Reports of low morale across the junior doctor workforce and the first-ever strike by these doctors in 2016 have prompted a programme of work to address 'non-contractual training issues’ by Health Education England (HEE), which has made significant progress.
Professor Sheona MacLeod, Deputy Medical Director for Health Education England (HEE) and chairs the working group, Enhancing Junior Doctors’ working Lives, explained that the programme had made significant progress on the most important issues through ‘open and honest’ trials, which can be abandoned if they are not effective1.
She said: “It is vital to get it right as doctors are key to the delivery of the NHS’ long-term plan. But more than that - our work is so much part of how we define ourselves as doctors and individuals, that we have to get this right.”
The NHS is facing several significant challenges, including an ageing population, high patient expectations, cost cutting, staff shortages, the introduction of technology and the pressure of Brexit uncertainty.
All these have put additional pressure on Junior Doctors, who raised a number of training issues with the BMA’s Junior Doctors Committee in 2015-2016 - the most important being problems with last-minute rota notification and fixed leave, deployment issues, including inter-deanery transfers (IDT) and joint applications for couples, opportunities for less than full time (LTFT) training, variability of opportunities for study leave and cost of training.
Progress has been made in the following areas:
- Deployment issues: Processes have been put in place to allow doctors with special circumstances to be allocated early and a review of IDT processes is underway.
- Variability of study leave: Work is still underway on a more equitable and standardised approach.
- Rising costs of those in training: The HEE is working with the Academy of Medical Royal Colleges to increase transparency in costs of training and all colleges have signed up to agreed principles.
The need for more flexible training has been explored through a pilot to allow junior doctors to train LTFT in emergency training. The interim evaluation shows that it improved retention and wellbeing. A new cohort joined in August 2018. It is shortly being rolled out to paediatrics and obstetrics and gynaecology.
Difficulties remain in changing the Code of Practice for rota notification to 12 weeks, but Professor MacLeod said there was now a cross-organisational commitment from NHS INE and HEE to improve the Code of Practice.
Support has now been put into place to allow trainees to return to training if they have to leave it for a significant period of time2.