Exclusive: Tens of thousands of junior doctors working beyond contract

According to data obtained through Freedom of Information Act requests from more than 200 NHS trusts, there have been 63,309 exception reports from almost 36,000 trainee medics since the introduction of the controversial new junior doctors’ contract in August 2016.

Exception reporting is part of the junior doctors’ contract and allows a doctor to file a report when they work beyond their contracted hours or work without breaks, as well as other contract breaches.

This is the first national analysis since the contract was introduced and reveals the scale of demands being placed on junior doctors in the NHS, including regularly being expected to work beyond their contract.

Under the terms of the contract, hospitals should give trainees lieu time for overworking, pay them additional money or review their working patterns. A guardian of safe working can also levy fines against a trust, with the money then held in a pot to be spent on doctors’ educational needs.

According to the data, the highest number of exception reports was 2,569 at London North West Healthcare Trust, which employs 440 junior doctors. The second highest was 1,935 from over 590 junior doctors working at Sheffield Teaching Hospitals Foundation Trust.

However, some junior doctors told HSJ they were encouraged not to exception report contract breaches, while others were told to log overtime as bank shifts, meaning a lower number of reports is not necessarily indicative of a better working culture. 

HSJ’s analysis also revealed that there was an average of 2.1 exception reports per junior doctor employed on the 2016 contract between August 2016 and July 2018.

The highest per doctor was 8.5 reports at Croydon Health Services Trust, which reported 1,748 exception reports from 205 doctors. This trust also accumulated the highest number of fines levied against a trust at over £25,000. A trust spokesperson said it had worked to create an environment that “encourages reporting of incidents as well as exceptions”.

The data did not consistently show a correlation between trusts employing a high number of junior doctors and the number of exception reports. For example, Barts Health Trust, which employs over 1,000 junior doctors, had 526 exception reports during the timeframe, less than one per doctor.

Four trusts reported zero exception reports. They were Sussex Community Foundation Trust, The Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, The Royal Orthopaedic Hospital Foundation Trust and The Walton Centre Foundation Trust.

The most common outcome of an exception report was paying overtime, which happened 31,000 times between August 2016 and July 2018. Ashford and St Peter’s Hospitals Foundation Trust spent £514 on lunches described as “forum of trainee safe working meetings”, at the request of doctors.

As many as one in eight reports, however, resulted in no further action.

HSJ has also learned of junior doctors being actively discouraged from exception reporting by their senior colleagues. In other examples, technical barriers prevented reports from being submitted.

One trainee at Queen’s Hospital in Romford said: “I have experienced a culture where exception reporting is strongly discouraged. When one of the registrars found out I had exception reported he said it was entirely the result of poor time management.”

The trainee added: “I have been encouraged by the administrative staff to submit exception reports as locum shifts. This has the effect of reducing the number of reports I send and makes it look like I am working bank shifts rather than exceptional overtime.”

Another anonymous doctor told HSJ people are “fearful of reporting” and said colleagues worry they will be seen as inefficient if they report.

“I suspect cases of exception reporting will underestimate the number of doctors working beyond their contracted hours,” the doctor said. “Often the process is difficult or bureaucratic.”

As exception report was introduced under the new contract, following a bitter dispute between junior doctors and the government, it is not possible to compare with working conditions under the previous rules.