Case Study: Enhancing Doctors’ Working Lives

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The flexible training agenda remains central to HEE’s work to enhance the working lives of doctors in training. We recognise the importance of flexibility in training in maintaining a healthy work life balance and ensuring the development and retention of a diverse medical workforce. Increased flexibility remains a consistent priority in feedback from doctors in training, but it is also what patients and service providers need as medical care continues to advance

Professor Sheona MacLeod, Medical Director Reform and Professional Development, HEE

Summary

The Enhancing Doctors’ Working Lives programme was established in March 2016, to address a range of issues that were impacting on the quality of life of doctors in postgraduate training.

The programme is a cross-system collaboration to drive and deliver improvements to postgraduate medical training. HEE worked collaboratively with doctors in training and system partners including the Academy of Medical Royal Colleges, the GMC, NHS Employers and the BMA to identify and address issues and provide trainees and stakeholders with yearly updates on our progress.

Impact

Key achievements from this programme:

• Less Than Full Time Training (LTFT): Over a three-year period HEE initiated, evaluated and subsequently expanded a pilot programme that allowed doctors to train LTFT for any reason. The initiative has significantly improved doctor wellbeing and work life balance as well as increasing the likelihood of doctors remaining in training. It is now available across all Postgraduate training programmes.
• Flexible Portfolio Training (FPT): With the Royal College of Physicians (RCP), HEE launched an initiative to give doctors one day a week protected time for specific development (under four pathways). To date, over 70 doctors in training have started FPT delivering numerous projects across clinical informatics, medical education, quality improvement and research benefiting health services where they are based, supporting  their development as well-rounded clinicians and protecting against burnout.
• Out of Programme Pause (OOPP): HEE developed and piloted the OOPP initiative to support doctors in following flexible, personalised training pathways, by offering the opportunity to step out of training whilst continuing to work in the health service with any relevant experience gained being recognised upon return. This has been taken up by nearly 400 trainees across every region in England and in a range of specialties and in  2023 steps will be taken towards normalising OOPP as an offer to all trainees in England. Feedback to date is positive from doctors who welcomed a break from training to stop burnout.
• Supported Return to Training (SuppoRTT): HEE developed a package of support and resources available for all doctors returning to training from a break of 3 months or more. This programme has supported over 7000 doctors return to training and delivered over £10m investment annually since 2017 helping doctors  back into training safely and confidently.

Further highlights:

• Individualised opportunities to develop and address wider health issues in local areas such as the Population Health Fellowships.
• Supported the roll out of a system-wide support package to ensure all staff have a health and wellbeing induction as per the NHS People Plan via through the HEE ‘NHS Staff and Learners’ Wellbeing Commission’. This also included establishing NHS workforce Guardians in all NHS organisations and published advise for learners and supervisors.
• Supported the development of a more flexible recruitment process for doctors in training, benefitting both doctors  and employers.

Future direction

The work undertaken by this programme is central to supporting doctors in training today and in the future. A suite of future initiatives to build on this work is currently being developed. This includes recognising the fluidity of medical careers and enabling doctors to take more control over the pace of their training, to take time to develop broader experience, and still return to the traditional training pathway.