Benefits

Currently within NHS England (the former Health Education England element of the organisation), the primary function of the Optimum Employment Model is to provide a single employer for Medical and Dental trainees for the entirety of their training programme, to ensure that trainees have a positive employment experience, and in doing so provide an excellent service to the NHS and its patients. 

The current Optimum Employment Models are designed to be a collaborative operating model within a given region, with the responsibilities of the traditional employer shared between three key stakeholders, who are: 

• Lead Employer – Overall employment responsibility including, for example, contracts of employment, employment checks, pay (including expenses), restrictions/exclusions and disciplinary matters, etc. The Lead Employer itself offers a single point of contact, coordinating with all stakeholders including third party agencies, e.g., Police, Safeguarding, etc. 
• Host Organisation (Placement Provider Organisation) – Provides day to day management and day to day supervision of training by clinical & educational supervisors during the period in which the trainee is based in the location. 
• NHS England – Responsible Officer for supervision of training & progress in training. NHS England ensures consistency with the handling and resolution of concerns raised relating to capability and health matters. 

A Lead Employer Model can also be an effective collaborative workforce arrangement between organisations in an ICS – supporting delivery of the ICS people function. It can streamline employment processes and create economies of scale in a system, while enabling staff to more easily learn and work across different settings and localities. 

The existing programme of work will expand Lead Employer arrangements to all doctors in training (of over 60,000 doctors in training, currently approximately 40% are under Lead Employer arrangements, with the planned move to extend to all doctors in training by the end of 2026).

What are the benefits of an Optimum Employment Model (such as Lead Employer)?

More than 90% of stakeholders previously interviewed (including hosts, doctors in training and the BMA) feel the Lead Employer Model has improved employment services since they were implemented.

For the trainees:

• Increased overall satisfaction reported by doctors in training.
• Increased number of days available for clinical time otherwise required for rotation-based admin.
• Less time form filling and supplying data.
• Less duplication in statutory and mandatory training.
• More repeated immunisation, vaccination or screening tests.
• Continuous management and support brings continuity from a health perspective.
• Equitable treatment of trainees.
• Named Lead Employer Medical Director to provide support and ensure a fair and due process.
• Improved trainee experience for Equality, Diversity & Inclusion as Lead Employer able to see trends and work strategically across the system.

800+ FTE wasted time was found in the doctor in training case for change

For NHS organisations:

• Less hours spent by administration teams overall on rotation related tasks.
• Less duplication in checks.
• Lower bank and agency spend as less wasted time during rotations.
• Reduced sickness absence.
• Higher retention of staff on training programme and in local area post training.
• Decrease in length, number and cost of tribunals.
• More cost effective service achieved through economies of scale in management, technology and workforce.
• Shorter recruitment processing times.
• Named Lead Employer Medical Director to provide support to trusts and to act as case manager in Serious Untoward Incidents (SUIs).

£26m+ estimated lost doctors' time per annum

For the system:

• An end to end trainee employment life cycle.
• Investment and support in technology from NHS England for Lead Employers.
• Better management of occupational health cases.
• Speed of response in effective case management.
• Lower training costs.
• More aligned funding flows with doctors in training.
• Better governance in Lead Employers when training completed.
• A platform for regional staffing interventions such as regional banks.
• Ability to see trends and work strategically across the system; for example the Equality, Diversity & Inclusion agenda to improve trainee experience.
• Improved data quality.