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Optimum Employment Models (Lead Employer)

As part of work to improve staff experience, we are currently working with partners to enable staff to move more easily between NHS organisations. This aligns with key objectives in the NHS People Plan, the NHS Long Term Plan and the 2016 Junior Doctors Contract negotiations.

Whilst all NHS employing organisations have the same overarching legal, regulatory and national policy frameworks within which they employ staff, there is still unwarranted variation between the policies, processes, practices and standards that sit under these frameworks. This was noted in Lord Carter’s report, ‘Operational productivity and performance in English NHS acute hospitals: unwarranted variations.’  

There are three strategic pillars of the Enabling Staff Movement (ESM) programme and we will focus on: 

Optimum Employment Models – reducing the need to transfer employment. Within Health Education England the focus has been on Lead Employer (LE) models.

Currently, organisations often take it upon themselves to be satisfied that individuals pass the relevant pre-employment checks, even if they are moving from another NHS organisation at which they have completed these checks previously. In response to this, the Enabling Staff Movement (ESM) programme has been established to improve staff experience by reducing duplication in form filling, employment checks and mandatory training, freeing up more of their time to spend with patients.  

Our role 

Whilst we are currently playing a key role in the context of the Enabling Staff Movement (ESM) programme more widely, in particular we have significant responsibilities in the context of the Optimum Employment Models specifically. Health Education England commissioned – and in many cases directly funded – many of the Lead Employer (LE) arrangements already set up. In the case of Lead Employer (LE) arrangements within Health Education England, the case for change centres on supporting doctors and dentists in training. 

Lead Employer (LE) Models explained

The primary function of a Lead Employer (LE) Model is to provide a single employer for doctors and dentists in training for the entirety of their training programme, to ensure that they have a positive employment experience, and in doing so provide an excellent service to the NHS and its patients. 

The Lead Employer (LE) Model is 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 (LE) – Overall employment responsibility including, for example, contracts of employment, employment checks, pay (including expenses) (in accordance with Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016), restrictions/exclusions and disciplinary matters, etc. The Lead Employer (LE) 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 via clinical & educational supervisors during the period in which the trainee is based in the location. 

  • Health Education England (now part of NHS England) – Responsible Officer for supervision of training & progress in training. The Responsible Officer ensures consistency with the handling and resolution of concerns raised relating to training capability. 

Lead Employer (LE) Models can also be an effective collaborative workforce arrangement between organisations in an Integrated Care System (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 primary function of a Lead Employer (LE) Model is to ensure that trainees have a positive employment experience by: 

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Implementation Toolkit for Medical and Dental Lead Employer (LE) Models 

The ‘Implementation Toolkit for Medical and Dental Lead Employer Models’ provides information, advice and guidance to support decision making and, where a decision to pursue a Lead Employer (LE) Model is made, provides practical guidance on how to implement an ‘optimum’ model.  The toolkit will help ensure all those who implement a model to act consistently and follow current best practice in implementing ‘optimum’ models.   

The toolkit was developed using the expertise and experience of NHS staff, current Lead Employers (LE), those who have been involved in previous implementations and the work done to date by the Enabling Staff Movement (ESM) programmes in NHS England and Health Education England. The toolkit also includes sample documents and case studies from 3 Lead Employer (LE) organisations.   

The Enabling Staff Movement (ESM) programme carried out detailed scoping work from January to March 2022, with the aim to test the feasibility and desirability of expanding the use of Lead Employer (LE) Models to all doctors and dentists in training in England.

To find out more, please email enablingstaffmovement@hee.nhs.uk   

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