Terms and Conditions ofService for NHS Doctors andDentists in Training (England)2016Version 9April 20210
Introduction2Abbreviations5Definitions6Schedule 1 - General duties and responsibilities10Schedule 2 - Arrangements for pay12Schedule 3 - Working hours24Schedule 4 - Work scheduling32Schedule 5 - Exception reporting and work schedule reviews38Schedule 6 - Guardian of safe working hours45Schedule 7 – Champion of Flexible Training49Schedule 8 - Private professional and fee-paying work51Schedule 9 - Other conditions of employment54Schedule 10 - Leave57Schedule 11 - Termination of employment67Schedule 12 - Expenses70Schedule 13 - Facilities77Schedule 14 - Sections of the NHS Terms and Conditions of ServiceHandbook applicable to doctors and dentists in training79Schedule 15 - Transitional arrangements80Annex A - Latest Medical and Dental Pay and Conditions Circular89Annex B - Transitional banding questionnaire for Schedule 1590Annex C – Code of practice951
1. This document sets out the terms and conditions of service (TCS) for doctors anddentists (hereafter referred to as doctors) in approved postgraduate trainingprogrammes under the auspices of Health Education England (HEE). It supersedesthe Terms and Conditions of Service NHS Medical and Dental Staff (England) 20021and the provisions currently contained in Schedules to the directions to HEE withregard to GP specialty trainees (GP registrars) when employed in practice settings.These TCS will also apply to a doctor employed in a relevant training post during aperiod of grace approved by the postgraduate dean.2. These terms and conditions are not intended to apply to any doctor or dentist not intraining on a General Medical Council (GMC)/HEE approved training programme, or toa dentist training on a dental foundation training programme.3. These TCS do not apply to any doctor undertaking a period of shadowing immediatelyprior to commencing work as a foundation doctor. Separate arrangements should beused for this shadowing period.4. Sections of the NHS Terms and Conditions of Service Handbook2 which apply todoctors employed under these TCS are listed in Schedule 14.5. This TCS document, the principal statement of terms and conditions (contract ofemployment), and any local employer-level agreements (including employmentpolicies), contain the entire terms and conditions of employment, such that all previousagreements, practices and understandings between the employer and the employee(if any) are superseded and of no effect. Where any external document is incorporatedby reference, such incorporation is only to the extent so stated and not further orotherwise.6. The TCS set out in this handbook shall incorporate, and be read subject to, anyamendments which are from time to time the subject of negotiation by the appropriatenegotiating bodies and are approved by the Secretary of State after considering theresults of such negotiations. A record of amendments to these terms and conditions ofservice will be available in the relevant section of the NHS Employers website.7. The standards of training and education for doctors are agreed between the employerand HEE, and are subject to an annual agreement (the Learning and DeliveryAgreement) between the parties.8. As specified within the ‘Code of Practice: Provision of Information for PostgraduateMedical Training’ (“the Code”) in Annex C, Employers are required to provide doctorswith timely, accurate and detailed information regarding their training posts and1Terms and Conditions of Service NHS Medical and Dental Staff (England) 2002, ments/Pay-andreward/Terms and Conditions of Service NHS Medical and Dental Staff 300813 bt.pdf2NHS terms and conditions of service handbook, https://www.nhsemployers.org/tchandbook2
relevant arrangements in advance of starting work in order to enable them to planahead in an acceptable and meaningful manner. Doctors equally have a responsibilityto provide full information, where requested, to inform recruiting organisations, andupcoming and current employers of their intentions, and ensure they maintain up todate contact details for communications. For the purposes of this provision a doctor issomeone who has applied for and been offered postgraduate medical trainingposts/programmes as referred to in the Code, or who has commenced a trainingprogramme and is due to change employer as part of the training programme.a. Should Health Education England fail to provide all of the information requiredby the Code to the employer, or delay in sending the information so that theemployer is not in receipt of it 12 weeks prior to the commencement of adoctor’s post, or notify the employer of changes to the required information atany point within the 12 weeks prior to the commencement, the employer willtake reasonable steps to provide the required information relating to thegeneric work schedule and the duty roster within the timeframes specifiedwithin schedule 4 of this TCS and the Code. Where this is not reasonablypracticable, the employer will take reasonable steps to provide the doctor withthe relevant information as soon as possible.b. Where an employer is receiving doctors on an approved postgraduate trainingprogramme and has entered into a lead employer arrangement with anotherorganisation (“the host organisation”), some duties as specified in thisschedule may be devolved to the host organisation. It remains the leademployer’s contractual responsibility to ensure fulfilment of the requirementsrelating to the generic work schedule and the duty roster as specified withinthe Code. Host organisations should themselves comply with the provisions ofthis paragraph 8 and the Code on behalf of the lead employer, or providesufficient information to lead employers to enable them to do so. Where a hostorganisation has failed to comply with the provisions of this paragraph 8 andthe Code itself or provide the lead employer with all the necessary informationto fulfil the requirements relating to the generic work schedule and the dutyroster within the specified timeframes, the lead employer will take reasonablesteps to provide the doctor with the relevant information as soon as possible.c. A work schedule may be subject to review from time to time. If an employermakes changes to the doctor’s post, generic work schedule and/or duty rosterowing to service and/or commissioning requirements, the employer will stilltake reasonable steps to provide an amended generic work schedule and dutyroster to the doctor within the timeframes specified within schedule 4 of thisTCS and the Code . Every effort should be made to anticipate such changesin the work schedule and reach agreement on such changes. Where that isnot reasonably practicable, the employer will take reasonable steps to providethe doctor with the relevant information as soon as possible.d. In the event that a doctor fails to provide the information required by theemployer, as specified within the Code, and/or notifies the employer ofinformation which materially impacts upon the post, the generic work scheduleor the duty roster, the employer will still take reasonable steps to provide anamended generic work schedule and / or duty roster to the doctor within thetimeframes specified within schedule 4 of this TCS and the Code. Where thatis not reasonably practicable, the employer will take reasonable steps to3
provide the doctor with the relevant information as soon as possible.e. Doctors should be able to request leave in advance of the production of theduty roster. Where an employer has met the requirements of the 8 weektimeframe for a doctor’s post, as specified within the Code, this should allowfor individual annual leave requests to be submitted, acknowledged andpotentially agreed, ahead of the duty roster being issued. Following this, if adoctor requests changes to the duty roster, after it being issued 6 weeks priorto commencing a post, such requests will only be accommodated inexceptional circumstances, other than routinely requested annual leave andmutually agreed swaps. Where such requests are granted, the employer willtake reasonable steps to inform other affected doctors of any changes to theduty roster as soon as reasonably practicable.9. NHS Improvement and HEE will be asking all employers to establish regionalstreamlining processes for recruitment and induction by April 2017.10. HEE will be leading a review of the processes which allow transfer between regions,joint applications between married couples (or those in a civil partnership), and trainingplacements for those with caring responsibilities within defined travel times.11. In order to mitigate against any disadvantage that could be suffered by any doctor whotakes time out of training due to illness, caring responsibilities or any other legitimatereason, employers must facilitate as necessary the provisions that will be made byHEE for accelerated learning with the prime intention to enable the person who hastaken time out to catch up. This will include access to mentorship, study leave fundingand specially developed training to be in place by August 2017.4
n Doctor Year 1Foundation Doctor Year 2Specialty RegistrarSpecialist RegistrarAdvisory, Conciliation and Arbitration ServiceCertificate of Completion of TrainingCommittee of General Practice Education DirectorsCare Quality CommissionDirector of Medical EducationFlexible pay premium / premiaGeneral Dental CouncilGeneral Medical CouncilGeneral PractitionerHealth Education EnglandJoint Local Negotiating CommitteeLess than Full TimeNHS ImprovementNational Institute for Health ResearchOut Of ProgrammeOut Of Programme (Career Break)Out Of Programme (Experience)Out Of Programme (Research)Out Of Programme (Training)Public Interest Disclosure Act 1998Senior independent directorTerms and Conditions of ServiceThe Working Time Regulations 1998 (as amended)5
Acting downActing down is where a doctor is requested by their employer tocover the duties of a more junior colleague within their contractedworking hours, although it may extend to covering the duties of amore junior colleague during unplanned additional hours. Thisdefinition does not apply, however, where the doctor undertakesduties as part of their normal workload which a more junior doctormight be competent to undertake; nor does it apply where a doctoragrees to undertake locum work at a more junior level.Allocated leaveAllocated leave is residual leave which is allocated to an individualdoctor after requests for leave have been accommodated as best aspossible.CaringresponsibilitiesSignificant responsibilities to care for another person, whether solelyor as part of a group (for example of family members). This mayinclude but is not limited to acting as a carer for a child or an ill ordisabled family member.Director of MedicalEducation (DME)The DME is a member of consultant medical staff and an employeeof the employer / host organisation who leads on the delivery ofpostgraduate medical and dental education in the Local EducationProvider (LEP), ensuring that doctors receive a high-qualityeducational experience and that GMC/GDC standards are met,together with the strategic direction of the organisation and HealthEducation England (HEE). The DME is responsible for delivering theeducational contract between the LEP/ lead provider (LP) and HEElocal team.For the purposes of these terms and conditions, where reference ismade to the DME, the responsibilities described may be dischargedby a nominated deputy to the DME.DoctorWherever ‘doctor’ is used in these terms and conditions, it isintended to mean a doctor or dentist in an approved postgraduatetraining programme under the auspices of HEE.Doctor or dentist intrainingA doctor or dentist in postgraduate medical or dental educationundertaking a post of employment or a series of posts ofemployment in hospital, general practice and/or other settings.Duty rosterThe prospective working patten and range of duties expected foreach individual doctor on a rota for that rotation.Educational reviewAn educational review is a formative process which enables doctorsto receive feedback on their performance and to reflect on issuesthat they have encountered. Doctors will be able to raise concernsrelating to curriculum delivery and patient safety. This will includeregular discussions about the work schedule.EducationalsupervisorA named individual who is selected and appropriately trained to beresponsible for supporting, guiding and monitoring the progress of anamed trainee for a specified period of time. The educationalsupervisor may be in a different department, and occasionally in adifferent organisation, to the trainee. Every trainee should have anamed educational supervisor and the trainee should be informed of6
the name of the educational supervisor in writing. This definition alsocovers approved clinical supervisors in GP practice placements.EmployerThe organisation by which the employee is employed and whichholds the contract of employment.Episodes of workPeriods of continuous work within an on-call period separated byperiods of rest.Fixed leaveFixed leave is leave built into the construction of the rota with daysor weeks blocked out for each doctor in advance.Form BForm B is a GMC document which approves a training post at aspecific point in time. It provides an outline of the educational andservice activities and the expected learning outcomes from the post.Guardian of safeworking hoursA senior appointment made jointly by the employer / hostorganisation and junior doctors, who ensures that issues ofcompliance with safe working hours are addressed by the doctorand/or employer/host organisation, as appropriate and providesassurance to the Board of the employing organisation that doctors'working hours are safe.Host organisationAn organisation where a doctor is deployed to work in a post for afixed period of time under a lead employer arrangement. Theemployer can also be, but is usually not, the host organisation.Integrated clinicalacademic pathwayIntegrated clinical academic pathway combines both clinical andacademic components within one training programme (for example,those defined under the auspices of the National Institute for HealthResearch (NIHR)).Lead employerAn organisation that issues and holds the contract of employmentthroughout a doctor’s training programme, during which the doctormay be deployed into one or more host organisations.Long shiftFor the purposes of these TCS, a long shift is any shift that exceeds10 hours in duration.On-callA doctor is on-call when they are required by the employer to beavailable to return to work or to give advice by telephone but are notnormally expected to be working on site for the whole period. Adoctor carrying an ‘on-call’ bleep whilst already present at their placeof work as part of their scheduled duties does not meet the definitionof on-call working.On-call periodAn on-call period is the time that the doctor is required to be on-call(as defined above) by their employer.Period of grace6 months of continued employment after a doctor has successfullycompleted their specialist training. Periods of grace are notapplicable to GP trainees.PlacementFor the purposes of these TCS, a placement is a setting into which adoctor is placed to work for a fixed period of time in a post or postsin order to acquire the skills and competencies relevant to thetraining curriculum, as described in the work schedule.7
PostFor the purposes of these TCS, a post has approval by theGMC/HEE for the purposes of postgraduate medical and dentaleducation. Each approved post is located within an employer or hostorganisation.Professional leaveProfessional leave is leave in relation to professional work.Professional workProfessional work is work done outside of the requirements of thecurriculum and/or the employer/host organisation for professionalbodies such as Royal Colleges, Faculties or the GMC/GDC. Nontrade union activities undertaken by for a recognised trade union, forexample work on an Ethics Committee would count as professionalwork, however trade union duties and activities are covered throughrecognition agreements.Public holidayHolidays recognised by the NHS in England. Currently, these are:New Year’s Day; Easter Friday (otherwise also known as GoodFriday); Easter Monday; the two May bank holidays; the Augustbank holiday; Christmas Day and Boxing Day.The regulatorGeneral Medical Council or (for dental programmes) other relevantbody.Resident on-callA doctor who is resident on-call is required to be present on site andavailable to work for the whole on-call period, but will not beexpected to be working during that time unless called upon to do so.RotaThe working pattern of an individual doctor or group of doctors.Rota cycleThe number of weeks' activity set out in a rota, from which theaverage hours of a doctor’s work and the distribution of those hoursare calculated.RotationA rotation is a series of placements made by the HEE local officeinto posts with one or more employers or host organisations. Thesecan be at one or more locations.SeniorindependentdirectorNon-executive director appointed by the board of directors to whomconcerns regarding the performance of the guardian of safe workinghours can be escalated where they are not properly resolvedthrough the usual channels.ShiftThe period which the employer schedules the doctor to be at thework place performing their duties, excluding any on-call dutyperiods.Special leaveSpecial leave for any circumstances will be defined by theemployer’s local policy.Study leaveStudy leave is leave that allows time, inside or outside of theworkplace, for formal learning that meets the requirements of thecurriculum and personalised training objectives. This will includeregional educational events where the time is protected.TrainingprogrammeTraining programmes and training posts are approved by the GMCor (for dental programmes) HEE. Learning environments and postsused for training are recommended for approval by HEE for thepurpose of postgraduate medical/dental education. Time spent in8
those posts/environments allows the doctor to acquire anddemonstrate the competencies to progress through the trainingpathway for their chosen specialty (including general practice) andto acquire a Certificate of Completion of Training (CCT).Work scheduleA work schedule is a document that sets out the intended learningoutcomes (mapped to the educational curriculum), the scheduledduties of the doctor, time for quality improvement, research andpatient safety activities, periods of formal study (other than studyleave), and the number and distribution of hours for which the doctoris contracted.Work schedulereviewA work schedule review is a formal process by which changes to thework schedule may be suggested and/or agreed.A work schedule review can be triggered by one or more exceptionreports, or by a request from either the doctor or the employer.A work schedule review should consider safe working, workinghours, educational concerns and/or issues relating to servicedelivery.WTR referenceperiodReference period as defined in the Working Time Regulations 1998(as amended), currently 26 weeks.The Gold Guide as referenced in these TCS, refers to the document entitled A referenceguide for postgraduate specialty training in the UK3 as amended from time to time. Aseparate Gold Guide for dental training entitled A Reference Guide for Postgraduate DentalSpecialty Training in the UK (or any successor document) should be referred to with regardto dental training programmes.3A Reference Guide for Postgraduate Specialty Training in the UK, also known as the Gold Guide, Eighth Edition,is accessible via the COPMeD website -https://www.copmed.org.uk/images/docs/gold guide 8th edition/Gold Guide 8th Edition March 2020.pdf9
1. Doctors have clinical and professional responsibility for their patients (for doctorsin public health medicine, this is for their population) as set out in the GeneralMedical Council (GMC) guidance Good Medical Practice4 or any successordocuments, as amended or substituted from time to time. It is the duty of adoctor:a. to maintain professional standards and obligations as set out by the GMC andthe General Dental Council (GDC), as appropriateb. to keep patients (and/or their carers, if appropriate) informed about theirconditionc. to involve patients (and/or their carers, if appropriate) in decision-makingabout their treatmentd. to maintain the required level of skills and knowledge, ande. to protect patients and colleagues from any risk posed by their own health orfitness to work.2. A doctor is responsible for carrying out any work related to, or reasonablyincidental to, the duties set out in their work schedule, such as:a. the keeping of records and the provision of reportsb. the proper delegation of tasks, andc. other related duties.3. Doctors will be expected to be flexible and to cooperate with reasonable requests tocover for their colleagues’ absences where the doctor is competent to do so, andwhere it is safe and practicable for the doctor to do so. Where doctors carry out workin accordance with this paragraph and such work takes place outside of theircontracted hours, they will receive either an equivalent off-duty period in lieu orappropriate remuneration at the rates described in Schedule 2.4. A doctor will be prepared to perform duties in occasional emergencies andunforeseen circumstances (for example short-term sickness cover), if they are ableand safe to do so, where the employer has had less than 48 hours’ notice, and theduty is for less than 48 hours’ duration of cover. Commitments arising in suchcircumstances are, however, exceptional and the doctor should not be required orexpected to undertake work of this kind for prolonged periods or on a regular basis.5. A doctor is expected to engage fully with the training programme.6. A doctor is expected to engage constructively with the employer in the designof services and of safe working patterns to support that service delivery.7. A doctor will make all reasonable efforts to achieve agreed training and servicedelivery objectives.8. A doctor employed under these TCS must continue to hold a place in an approvedpostgraduate training programme.4Good medical practice, cal-practice---english-1215 pdf51527435.pdf10
9. A doctor must sit such examinations as are required for the completion of training.These must be completed in accordance with the curriculum, including the timetableapproved by the regulator (the GMC or other body, as appropriate).10. Doctors in general practice (GP trainees, including foundation doctors) working insupernumerary training settings are additional, not intrinsic, to the workforce. Doctors inthese settings contribute to service provision, however the effective running of theservice should not be dependent on their attendance and they will not be used as asubstitute for a locum.11
Pay and other allowances1. Doctors shall be paid a basic salary at a nodal pay point linked to the grade and thelevel of responsibility required in the post to which they have been appointed, at therates set out in Annex A, as reviewed from time to time.2. The basic salary for a doctor employed full time is calculated on an average of 40hours’ work per week.3. The value of basic salary for doctors training less than full time shall be pro rata to thelevels in Annex A, based on the proportion of full-time work that has been agreed.Additional hours4. Additional hours of work set out in a doctor’s work schedule shall be remunerated atthe basic pay rate, 1/40th of weekly whole-time equivalent for each additional hourworked, subject to the provisions of paragraph 20 below.Weekend allowance5. A doctor rostered to work at the weekend (defined as one or more shifts/duty periodsbeginning on a Saturday or a Sunday) at a minimum frequency of 1 in 8 across thelength of the rota cycle will be paid an allowance. These will be set as a percentage offull-time basic salary in accordance with the rates set out in the table below:Frequency1 weekend in 2Less frequently than 1 weekend in 2 andgreater than or equal to 1 weekend in 3Less frequently than 1 weekend in 3 andgreater than or equal to 1 weekend in 4Less frequently than 1 weekend in 4 andgreater than or equal to 1 weekend in 5Less frequently than 1 weekend in 5 andgreater than or equal to 1 weekend in 6Less frequently than 1 weekend in 6 andgreater than or equal to 1 weekend in 7Less frequently than 1 weekend in 7 andgreater than or equal to 1 weekend in 8Less frequently than 1 weekend in 8Percentage15%10%7.5%6%5%4%3%No allowance6. A doctor working less than full time will also be entitled to be paid this allowance whenworking on a rota where the doctors working full time on that same rota are in receiptof such an allowance. The allowance paid to the doctor working less than full time willbe paid pro rata, based on the proportion of the full-time commitment to the weekendrota that has been agreed in the doctor’s work schedule. For example, a doctor12
making a 50 per cent contribution to the rota would be paid 50 per cent of the value ofthe availability allowance paid to a doctor making a full contribution to the rota.LTFT allowance7. A doctor who is training less than full time and is in receipt of the 2016 pay provisions,will be paid an annual allowance of 1,000 for as long as they continue to train lessthan full time basis This is a fixed amount which will apply to all LTFT doctor and willbe paid in addition to any other sums, as set out in this schedule. The allowance willbe spread out over the year and paid in monthly instalments. This allowance will comeinto effect from December 2019.8. Doctors who are already in receipt of the 1,500 transitional LTFT allowance willcontinue to receive this as per schedule 15 paragraph 20, but will not be entitled tothe 1,000 permanent allowance on top of this. When a doctor’s entitlement to thetransitional LTFT allowance ends, they will then be entitled to receive the 1,000permanent allowance.On-call availability allowance9. A doctor on an on-call rota who is required by the employer to be available to return towork or to give advice by telephone, but who is not normally expected to be workingon site for the whole period, shall be paid an on-call availability allowance.10. The value of the allowance described in paragraph 9 is set out in Annex A and isbased on 8% of a full-time basic salary for the relevant grade.11. This allowance will take the form of a cash sum set out in Annex A, as amended fromtime to time.12. For doctors employed on a less-than-full-time basis, in any grade, the value of theon- call availability allowance shall be paid pro rata, based on the proportion of fulltime commitment to the rota that has been agreed in the doctor’s work schedule. Forexample, a doctor making a 50 per cent contribution to the rota would be paid 50 percent of the value of the availability allowance paid to a doctor making a fullcontribution to the rota.13. This allowance will not be payable where a doctor’s working pattern does not includeany periods of work that meet the description in paragraph 9 above.Payment for work undertaken whilst on-call14. Doctors shall be paid for their average hours of work (as defined in schedule 3paragraph 35) undertaken while on-call, either in the workplace or remotely, at therates of pay described in this Schedule. The hours paid will be calculatedprospectively across the rota cycle and the estimated average hours at each rate ofpay will be set out in the work schedule. For the purposes of pay, these totalestimates shall be converted into equal weekly amounts by dividing the total numberof prospective hours at each rate by the number of weeks in the rota cycle. Theweekly amount will then be turned into an annual figure and the doctor shall be paid1/12th of the annual figure for each complete month, or a proportion thereof for any13
partial months worked (as per paragraphs 83-85 on annual salaries).15. If, across the rota cycle, the doctor works a greater number of hours than theprospective average estimate, the individual doctor will be appropriately compensatedfor these hours using the process set out in paragraphs 73-82 below.Hours that attract a pay enhancement16. An enhancement of 37 per cent of the hourly basic pay rate shall be paid on anyhours worked between 21.00 and 07.00, on any day of the week.17. Where a shift is worked which begins no earlier than 20.00 and no later than 23.59,and is at least 8 hours in duration, an enhancement of 37 per cent of the hourly basicrate shall also be payable on all hours worked up to 10:00 on any day of the week.Where such a shift begins before 20:00, rostering guidance must be adhered to asdefined in schedule 3 paragraph 6.18. Where a shift ends after 00:00 and before 04:01, the entirety of the shift will attractan enhancement of 37 per cent of the hourly basic rate.19. The number of hours in the rota for which an enhancement is paid will be assessedacross the length of the rota cycle (as set out in the work schedule), as described inparagraph 14 of Schedule 4 of these TCS and converted into equal weekly amountsby dividing the total number of hours to be paid at each rate by the number of weeksin the rota cycle. The weekly amount will then be turned into an annual figure and thedoctor will be paid 1/12th of the annual figure for each complete month, or aproportion thereof for any partial months worked, as per paragraph 81-83 on annualsalaries.Counting of hours20. Average total hours, and average hours that attract an enhancement, will beassessed in quarter hours, rounded up to t
Schedule 5 - Exception reporting and work schedule reviews 38 Schedule 6 - Guardian of safe working hours 45 Schedule 7 – Champion of Flexible Training 49 Schedule 8 - Private professional and fee-paying work 51 Schedule 9 - Other conditions of employment 54 Schedule 10 - Leave 57 Schedule 11 - Termination of employment 67
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