Resident Doctors Committee response to 10 point plan to improve resident doctors’ working lives
The Association of Anaesthetists Resident Doctors Committee welcome the publication of NHS England’s 10 Point Plan to improve resident doctors’ working lives, but we are disappointed by its content and lack of ambition. Resident doctors are crucial to the anaesthetic workforce and there are multiple problems affecting morale currently. Unfortunately, many of the points made in the plan lack detail, accountability, and ambition and we are doubtful of their ability to bring about real change.
Much of the plan represents a list of basic requirements for any employee to flourish and are central in many other caring and responsible organisations. Having access to parking, food, drink and rest areas whilst working out of hours are essential not desirable provisions. The ability to take annual leave fairly and be paid correctly and on time should not need to be monitored nationally.
Some of the points listed in the plan are already contractual obligations for NHS trusts. For example, it has been a requirement for trusts to release a rota 6 weeks in advance since 2018 [1]. Exception reporting was introduced nearly ten years ago in 2016 through the updated terms and conditions of service for resident doctors. While employers fail to adhere even to mandatory obligations, it's no surprise that resident doctors often feel disenfranchised by government initiatives that claim to offer comprehensive solutions to their concerns.
We welcome the commitment to extend the Lead Employer scheme nationally. This scheme originated in some regions in the 1990s; it has been received well by resident doctors in regions where it has been introduced, however, beyond creating a business plan no timeline is given for implementation of this approach.
There are other positive inclusions in the plan, but most do not go far enough. The requirement for resident doctors to be reimbursed for education related expenses as soon as they are incurred is welcome given the cost of many courses. Given the high cost of exams, we are disappointed to see that consideration has not been given to covering the costs of these too.
The move to include resident doctor leads that report to trust boards is encouraging. However, we are concerned that rushing this process in 6 weeks as the plan suggests may not result in the best candidate taking the role. At the Association of Anaesthetists, resident doctors sit on the board of trustees meaning their voice is heard throughout the organisation and they receive training in effective governance. It seems a shame that the opportunity for each trust to nominate a board member who has specific responsibility for resident doctors, to take forward issues raised by the resident lead has not been taken.
With many anaesthetic resident doctors choosing to train less than full time (LTFT) and match their average weekly working hours to the rest of the population, it is disappointing to see LTFT residents not mentioned in the plan. They are disproportionately affected by rota and payroll issues and are often balancing complex caring responsibilities. Rotational training is particularly disruptive to this group but beyond a timeline to launch pilot programmes for reforms there is little detail in how this will be improved.
Ultimately, our primary concern is the lack of accountability underlying many of the issues we have outlined. There is no detail about how trusts will be compelled to address the plans stated with many of them already shirking their contractual obligations for basic employment issues. If these points had been accompanied with a detailed timeline for delivery and a clear mechanism for enforcement, it may have instilled some confidence. Instead, in the absence of such reassurances, the plan risks becoming yet another set of well-meaning but ultimately ineffectual commitments that fail to deliver meaningful change to the lives of resident doctors.
References
- NHS Health Education England. Code of Practice: Provision of Information for Postgraduate Medical Training. 2017. (https://www.hee.nhs.uk/our-work/medical-recruitment/code-practice-medical-recruitment).