Jeeves Wijesuriya: Rota delays for junior doctors—an endemic problem that undervalues the workforce

It is unacceptable that there are doctors who are yet to receive their August rotas

The process of starting a new job can be many things: exciting, nerve racking, and stressful in equal measure. It is a time of change and the sense of the unknown can cause anxiety at the best of times.

Now imagine the job you are about to start marks the first step in a career that you have already dedicated years of training towards, and one in which you’ll be expected to work in incredibly difficult conditions, making decisions that can have far reaching and grave consequences. You are due to start in a week’s time and you still don’t know what days or hours you’re due to work.

This is the reality facing many junior doctors due to begin their first posts in hospitals next week after graduating from medical school. The BMA has been contacted by doctors across the UK who are yet to receive their August rotas—information they should have been sent more than a month ago. This is completely unacceptable.

In 2016, the BMA renegotiated the Code of Practice in England, which is agreed with Health Education England (HEE) and NHS Employers. This agreement sets out clear deadlines in the recruitment process that should ensure employers are given the information they need to adequately plan rotas and that doctors receive proper notice of when and where they are expected to work. According to this timeline, junior doctors should be told where they are working a minimum of three months before starting the job, receive a generic work schedule and rota eight weeks before their post starts, and get their personalised rota—including their individual shift pattern—two weeks later so that they have all the information needed to begin their role six weeks before starting their job.

Health Education England made the three month target for notifying doctors where they will be working a key performance indicator, committing to publishing the figures for how many achieved this target. Yet despite this, the examples we’ve heard from this past week show that there are still clear failings in the recruitment process that mean these deadlines are being missed.  

Training providers may be giving employers information on time, but then changing this at the last minute, and it is this unpredictability that is having knock-on effects for trainees.

Doctors are having to put their lives on hold, unable to plan even days ahead of starting their jobs—be that for caring responsibilities, family commitments, or annual leave. Such unpredictable working patterns are more than just inconvenient, they can be potentially disastrous. It can mean doctors are forced to miss major life events, find managing childcare arrangements impossible, and put unsustainable strain on families and relationships. For some doctors, this means they are turning up to work on day one, and being told they will need to go home as they will be working the night shift later that evening.

Furthermore, with doctors unable to confirm leave until the latter period of their rotation, at which time everyone will scramble to book time off, existing service pressures are compounded. This leaves hospitals struggling to fill rotas with an already stretched workforce and means the rotas that doctors receive are often changed at the 11th hour—or even after they’ve already started their jobs and made plans. This is poor employment practice.

Two months ago, the BMA and NHS Employers published new rostering guidance, establishing how rosters should be created and maintained and under what conditions they can be changed. This guidance describes how integral these practices are to the safe staffing of services. When this is done poorly, it is more than unfair on doctors, it is unsafe for patients and services.

The junior doctors committee also successfully lobbied that the deadline targets must be monitored by NHS Improvement. The figures will bring into sharp focus the combined issues created by training bodies and employers failing to provide this fundamental information in a timely manner.

Given the impact on not only the workforce, but our ability to deliver healthcare, NHS performance on meeting these deadlines must be subject to  scrutiny and sanctions when they fail to deliver. These deadlines, which are vital for workforce morale and patient safety, must be seen by the CQC as important as the four hour A&E waiting times target—and implemented as such.

Doctors across the UK, supported by the BMA, should be encouraged to come forward locally when these deadlines are missed, to log complaints with HR departments and recruiters, and to use the BMA’s rostering guidance as a practical tool to help ensure these timelines are being implemented properly.

In her speech on long term NHS funding last month, even the Prime Minister highlighted the issue, saying: “Think of the junior doctor with limited choice about where and when she works who has to alter her plans because rotas are changed at the last minute without her having any say.”

This endemic problem is indicative of how junior doctors are viewed in the NHS workforce. Earlier this year we saw hundreds of ST3 doctors have their job offers rescinded due to an admin error, and two months on we continue to see those at the very beginning of their medical careers undervalued.

Employers and training providers must do better. HEE and their equivalents in Scotland, Wales, and Northern Ireland must meet their deadlines and employers must improve their workforce planning to ensure that decisions on rotas are not left until the last minute. Assuming that junior doctors will fit in with their employer’s demands with just a few days’ notice is simply not good enough.

Junior doctors are the future of the NHS. And those entering the health service now are coming at a critical time, when staffing is inadequate and resources are sparse. It is therefore the duty of the government, training providers, and employers to work together to ensure that this essential segment of the workforce is valued for the incredible contribution they make—often in the most difficult circumstances.

The BMA fought hard to get a framework in place that protects doctors. Yet the reality is that unless these measures are acted on, with real penalties and enforcement, we will simply not see the change we are seeking.

Jeeves Wijesuriya is chair of the BMA junior doctor committee. He graduated from Barts and the London School of Medicine and Dentistry in 2013 with MBBS and BSc in medical education. He is currently an academic GP trainee in east London and is completing a masters degree in medical education.

Competing interests: None declared.