Introduction to ‘Lead
Employer’ and the 2016
Junior Doctors’ Contract
We’d Like to Introduce Ourselves
 Acute DGH Trust employing c.5,000 staff
 Payroll provider for c.30,000 NHS staff covering a variety of different terms &
conditions
 Currently Lead Employer for three HEE regions for c.4,700 Trainees (of which
c.2600 are GP) from Southend to Southport – soon to be four regions with c.
5,500 trainees
 Very well versed in engaging a large number of Trainees whether as new
starters or TUPE transfers in a short space of time from multiple employers.
 Currently implementing the new Junior Doctor 2016 contract, including the
appointment of a Guardian of Safe working who is responsible specifically for
GP’s
 Working with NHS Employers nationally to ensure the new Junior Doctor
Contract is fit for purpose for Trainees employed via a LE
 Engage with over c.1250 Host Organisations including NHS Trusts, GP
Practices and Hospices
We’d Like to Introduce Ourselves
“Our vision is to be the model Lead Employer of best practice through ensuring
that we continuously develop our services”
“Our mission is to assist HEE with their objective to support the delivery of
excellent healthcare and health improvement to the patients and public of England
by ensuring that the workforce of today and tomorrow has the right numbers, skills,
values and behaviours, at the right time and in the right place”
 Our model has been developed to provide you with the assurance to feel
confident that all Trainees will be supported through their employment life
cycle. This gives them every opportunity to safely, and successfully make the
journey from a Doctor in Training to General Practitioner.
 We have implemented a nationally recognised LE model through the
streamlining of systems/processes/policies/procedures and developing new
ways of working. We have achieved this by the innovative use of IT systems
and on-going effective stakeholder engagement.
Who will transition to the Lead Employer, and when?
 We will become the Lead Employer within the East Midlands for all new starters
to GP Training from 2nd August 2017
 Current GP ST1/ST2 Trainees will TUPE transfer to Lead Employer on the 1st
July 2017 on their current given contracts, and they will then be issued with a
2016 Contract by us from the expiration of their current contract end
 Current ST3’s whose contracts expire on the 1st August 2017 will remain
employed with their current employer until termination on this date.
 Out of sync ST3’s that hold a current contract up to the 31st October 2017 or
earlier, will remain employed by their current employer for this period until
termination.
 Out of sync ST3’s that hold a current contract beyond the 1st November 2017
(e.g. LTFT Trainees), will though TUPE transfer their employment to us on the
1st July 2017 on their current given contracts for this period.
N.B. There may be anomalies for ST3’s (further detail in the Implementation Plan)
Next Steps in the transition to Lead Employer:
 Further weekly/fortnightly communications will be issued including FAQ’s which
will clarify a detailed list of our collective roles and responsibilities to ensure a
smooth transition
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Including communications around setting up new systems e.g. Electronic
Staff Record (ESR), E-Expenses and Exception Reporting tools
 We will follow legal due process re TUPE (where required) which will include
formal consultation with BMA colleagues
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We will also require your help when collecting Due Diligence information on
the current trainees within your practices to ensure a smooth transition
 As part of our introduction we will also be attending all of the key forums such as
GP Manager and Trainer Events, HR Directors, Medical HR Specialists, HEE
EM, the BMA and other key stakeholders
2016 Junior Doctors’
Contract
Junior Doctors Contract 2016
 This contract was agreed between NHS Employers and the BMA
- albeit BMA members subsequently narrowly voted against it
 Neither us as Lead Employer, you as trainers or HEE were the
authors of the contract but it is incumbent on us to implement it
 Change is nearly always difficult and concerning especially when
it is as radical as this but we need to make it work nevertheless
 We as Lead Employer will do our best to help and navigate you
through this process
 HEE is there to guide you through the training aspects of the
change
The big picture – who does what? This is
fundamental.
Triangular relationship between Host organisations, Lead
Employer and HEE.
Lead
Employer
Host
HEE
Junior
Doctors
2016
Contract
Nowhere is it more important and imperative that we work
together than with implementing the 2016 Contract
Junior Doctors Contract 2016
IMPLEMENTATION
 Junior Doctors on run through contracts issued pre August 2016 remain
on their 2002 contracts of employment, unless they need a new contract
 However GP Trainees in the East Midlands were not on run through
contracts
 Current ST3 GP Trainees in the East Midlands will not transfer to the
new contract, unless they need a new contract e.g. following an ARCP
 Most other East Midlands GP trainees will transfer August 2017.
Work Schedules
 A work schedule is produced by the host organisation setting out the
 Intended learning outcomes
 Scheduled duties of the doctor including time for quality improvement/
research/patient safety/formal study (other than study leave)
 Number and distribution of hours contracted and pay for those hours.
 All trainees should be issued with a generic work schedule by the Lead
Employer at least 8 weeks before starting post.
 Host Organisations must send the work schedule to the Lead Employer to
meet this deadline NB Failure to do so may lead to a breach of the code of
practice/contract – potentially a short term loss of pay
 Standard template for GP Practices + guidance document issued – it’s
critical this is adhered to – cost and compliance implications – TIL for OOH
 Personalised work schedule is agreed by the Educational Supervisor with
trainee on commencement - based on learning needs and the opportunities
within the placement.
Exception Reporting
 Informs host/employer when work varies significantly and/or regularly
from the agreed work schedule e.g. hours, education, support
 Report sent by trainee within 14 days (7 if claim for pay) to Educational
Supervisor + Guardian (hours) or Director of Medical Education (training)
 Anticipated that the Directors of Medical Education for GP practices will
be the Directors of GP Education
 Each host will have its own exception report tool but the Lead Employer
will provide one while in GP Practice via our Allocate system – to be
communicated to trainees and GP practices
 Where an immediate and substantive risk to safety arises this should be
raised immediately (orally)
 Can lead to a work scheduling review
 National guidance
Work Schedule Review Process
 The doctor, educational supervisor, manager, or the guardian can request a work
schedule review
 Consider safe working, working hours, educational concerns and/or issues
relating to service delivery.
 Level 1 – informal resolution - meeting with Educational Supervisor (or CS) within
7 days – can lead to
 No change to the work schedule
 Prospective documented changes are made to the work schedule
 Time off in lieu or compensation for additional hours worked (NB out of the GP

Practices budget)
Organisational change
 Level 2 – if trainee not satisfied with stage 1 - trainee, service representative, ES
(CS) and nominee of Guardian or DME
 Level 3 – If trainee not satisfied with stage 2 - conducted as final stage of Lead
Employers grievance procedure – DME/nominated deputy present
Role of Educational Supervisor
 Defined in the contract as being responsible for supporting, guiding and
monitoring the progress of the trainee
 Can be delegated to Clinical Supervisor if ES not in host site
 Agree personal work schedule with trainee
 Discuss learning experience with trainee regularly
 Receive exception reports
 Conduct/participate in work schedule reviews
Guardian of Safe Working
 Ensures that issues of compliance with safe working hours are
addressed by the doctor and/or employer/host organisation
 In larger hosts their Guardian is responsible for Lead Employer trainees
- overseen by a Lead Employer Guardian, Mike Chadwick
 Lead Employer has a appointed a Guardian covering GP practices and
other smaller hosts - Peter Arthur
 Responsibilities include:
 Acting as the champion of safe working hours for doctors
 Providing assurances to doctors/employers that doctors are safely rostered
 Receiving copies of exception reports in respect of safe working hours
 Escalating issues in relation to working hours to an executive director
 Requiring intervention to mitigate any identified risk
 Requiring a work schedule review to be undertaken
 Intervening in any instance where the safety is compromised
 Distributing monies received as a consequence of financial penalties
Safe Working Hours Constraints
There are many constraints in the contract (schedule 3) which include:
 Standard 40 hours pw – additional hours paid at 40 of weekly pay
 Maximum average weekly hours 48 (NB HEE only funding 40) - maximum in
any 7 days 72 hours -penalties if exceeded. NB Can opt out to max 56 hours
average if undertaking locum work(must offer to NHS and inform employer/ES)
 Maximum daily hours 13 hours
 A maximum of eight shifts of any length can be rostered on the trot
 Minimum 11 hour break every 24 hours - less than 8 hours = penalties
 On call (available at home for patient care), nights, weekend working allowed,
attract additional payments – financial constraints on practices
 ½ hour paid break if shift 5-9 hours, 2 x ½ hour break if shift > 9 hours
NB If in GP practice the template work schedule is followed the practice will
normally be compliant – subject to managing OOH
Out of Hours
 ST3 72 hours in 12 months
 ST1/2 24 hours in 4 months
 Scheduled in accordance with availability and with agreement of
supervisor
 ST3 No more than 6 weekends pa
 ST1/2 no more than 2 weekends in 4 months
 ST3 no fewer than 12 and no more than 22 of these hours to attract
night enhancement (21:00 – 07:00)
 ST1/2 no fewer than one and no more than 8 of these hours to attract
night enhancement (21:00 – 07:00)
Safe Working Hours Constraints and Out of Hours
 When 6 hours ‘Out of Hours’ is worked time in lieu (TIL) will need to be
provided from Standard 40 hour week in the work schedule.
 This can sometimes be allocated at the discretion of the GP Practice
and the trainee and need not always necessarily be in the same week.
 However dependent on when the out of hours is worked it may be
necessary to structure the TIL to ensure compliance with the contract’s
maximum working day and minimum break requirements
 In these cases it could be that the TIL has to be taken from working
hours on the day the out of hours is worked or from the day preceding
or following day.
 Remember where the minimum rest requirement of 11 hours is reduced
to fewer than eight hours those hours below the 11-hour rest period will
attract a penalty
Conclusion
Memorandum of Understanding between the Lead Employer & all Hosts to
be finalised & issued in the coming weeks – facilitates contractual
compliance
NB In the unlikely event that any Host is unable to accept - cannot provide
for trainees under their auspices
GP Practices need to be encouraged to gain an awareness of the new
2016 Terms & Conditions, to use the work schedule template & to send in
their work schedules.
Useful Guidance:
Work Scheduling:
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http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Guidance%20for%
20managing%20work%20scheduling%20in%20general%20practice%20settings.pdf
http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Worked%20exam
ple%20GP%20work%20schedule%20ST2.pdf
http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Worked%20exam
ple%20GP%20work%20schedule%20ST3.pdf
Exception Reporting
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http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Training%20issue
s%20flowchart.pdf
http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Safe%20working%
20flow%20chart.pdf
http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Guidance%20for%
20managing%20exception%20reporting%20GP%20setting.pdf
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Please do not hesitate to forward any questions you may have in
respect of the Junior Doctor Contract to:
[email protected]
[email protected] / [email protected]