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A Junior Doctor’s Guide to Exception Reporting

Formal medical training teaches junior doctors the anatomy, physiology, communication and practical skills they need to be valued members of the medical workforce. But very few are taught about their working conditions and pay or given the tools they need to ensure they are being treated fairly. Medics.Academy’s new Junior Doctor Contract course, devised and written by junior doctors with personal experience of working under the new contract, aims to equip junior doctors with the knowledge they need to ensure they are working safe hours and being adequately reimbursed for them. Sign up to our comprehensive Junior Doctor Contract course here.

In the second blog in our Junior Doctor Contract series, we’re looking at exception reporting. Do you know what you would do if you were required to stay late to stabilise an unwell patient, or come in early to prepare for the ward round? What about if you missed weekly teaching because you were talking to a relative? Exception reporting is made for exactly these occasions!

What is exception reporting?

Exception reporting is the process of reporting any deviations from your agreed work and training schedule and the actual hours you have worked. It is a formal, real-time process that aims to flag up issues as they arise and safeguard your health and that of your patients, as well as protecting time dedicated to training and education.

Exception reporting allows doctors to be fairly reimbursed for the hours they work and allows trusts to track trends and collect data to target interventions where they are needed. There is no limit to the number of exception reports a trainee can submit, and the British Medical Association (BMA) describes exception reporting as a junior doctor’s ‘right and responsibility.’

Under what circumstances can you exception report?

According to the BMA, doctors are entitled to submit an exception report if:

  1. Actual hours worked differs from the agreed hours on their work schedule or rota, including starting early, staying late or spending extra time on site if on non-resident on call

  2. Breaks are missed – doctors are entitled to a 30 minute paid break for a shift of over 5 hours, and two 30 minute paid breaks for shifts of over nine hours

  3. Training or education opportunities are missed

  4. Levels of support are not adequate during your time at work

How do you exception report?

Exception reports should be completed as soon as possible; ideally within 14 days of the incident, or 7 if you are claiming payment for extra hours worked.

Most trusts will have an electronic form on the trust intranet that can be used to submit your exception report. If you are unsure, ask your educational supervisor, a peer or a senior.

Your exception report should be sent to your educational supervisor. If the issue you are reporting relates to safe working hours, it should also be sent to your Guardian of Safe Working Hours. If the issue is regarding missed training or education sessions, you should also copy the report to the director of medical education for your place of work.

What happens after you submit your exception report?

Your educational supervisor will meet with you to agree a solution to the issue. Strategies for resolving exception reports include:

  1. Time off in lieu of the extra time working

  2. Payment for extra time worked

  3. Rearrangement of training and education opportunities

  4. Discussion of sustainable solutions to avoid future problems

If you find you are repeatedly submitting exception reports to accommodate a particular task, for instance, consistently staying late to ensure that patients are safely handed over, you can request a work schedule review to see if these tasks can be built into your work schedule.

What if my exception report is rejected?

Educational supervisors can reject your exception report if they feel the situation you described does not fall under the guidelines outlined by the contract. If this happens, and you feel that your situation or incident does merit exception reporting, you can contact your Guardian of Safe Working Hours to help you resolve the situation.

Where can I find more information?

Medics.Academy junior doctors Dr Emma Cox and Dr Vidushi Golash have devised and written a totally free online course that outlines issues relevant to doctors working under the 2016 Junior Doctor Contract. Sign up here.

About the Author

Anna is a soon-to-be final year medical student and

Medics Academy Fellow. She is interested

in women’s health, education and journalism.

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