Exception reporting in the NHS

There is chronic under-staffing in the NHS. This is because of multiple reasons:
1. British medical graduates find it extremely stressful to work in the NHS 

2. The pressure on doctors is more than ever.

3. Introduction of new services - Small hospitals are shrinking and this puts pressure on the bigger local hospitals

I can keep going on with this list which most doctors working in the NHS will know about, those who do not can read about it online. 

Here are some official websites:

https://www.bma.org.uk/advice/employment/contracts/junior-doctor-contract/exception-reporting

https://www.nhsemployers.org/your-workforce/pay-and-reward/medical-staff/doctors-and-dentists-in-training/rostering-and-exception-reporting

I am going to address exception reporting in the form of FAQs

What is exception reporting?

This is when you, as a doctor are asked to stay over your usual contractual hours in order to manage patients on a regular basis.

I do not understand this. 

For example, you are working in the care of elderly ward. Your shift pattern is 9 am to 5 pm. However since the past 3 weeks, you have to stay in till 7 PM because, let's say the 2 other doctors who are supposed to be with you are on call/off sick/on annual leave. 

In this case, you should exception report. 

Okay. I get it. But what is this report? Do I have to make a 10 page report and present it?

No, This is a form which you fill in and explain why you had to stay in late. You then submit it to the relevant people. It is self explanatory. 

Where should I get this form from?

You should ask your rota team/HR/supervisor. It is usually available on the intranet.

What happens when I fill this form?

This goes to the rota team and they see that there is a chronic under staffing in your ward. They will try to fix this issue by asking other juniors to help, asking the consultant to come to the ward on a regular basis to ensure that there are no ill patients you have to deal with, etc. 

Wait! So this exception report will go my consultant?

Yes, it will go up the chain so that everyone can try to implement change to ensure you leave on time. 

Will I be paid?

Yes, you will be paid for the number of hours you stayed late. 

This means the whole team will think I am ratting out. I have just started and I told my consultant I am a hard worker. 

I understand, however you are working over your contracted time. You must raise this issue with the relevant people. This way, they will ensure you leave on time. 

Why is leaving on time so important?

You need to rest, spend time with your loved ones, work on your own professional development. This is something which even your consultant will understand. 

But I do not have any commitments right now. 

Yes, we are all very driven when we start. However remember, this is a long term thing. Eventually, you will want to prepare for exams, work on your projects ( like QIPs), soon you may have a family, you may want to go out. Just imagine what will happen if you are working from 9 AM to 8 PM everyday for a few months- you will get burnt out and frustrated. Balance is very important from your first day. 

I am still very worried that I will be looked down upon if I exception report. 

For the sake of your mental and physical health, it is advisable that you work ONLY during your contracted hours. Working overtime without getting paid/appreciated will burn you out. 

You have to take care of yourself. 

But I have plenty of money. I do not need the extra through exception reporting. 

This is not only about money. It is about patient safety. As a human, we can function for a certain period of time. If we do not get our rest, we become sick ( mentally and physically). No patient will want to be seen by a sick doctor. So do not let yourself go down that route. Nip the evil in the bud. 

I had to stay on the ward because there was a sick patient one day last week. Should I exception report?
This does not warrant exception reporting. This was a one off event and if you were well supported, then there is no reason to raise this. 

Are there any other ways of escalating such concerns?
This is the best way to do so. As it is an official policy of all trusts in the NHS. 
You can also discuss these issues in your local junior doctors meeting (ask your line manager and rota team to tell you about this). You can also discuss this with your supervisor directly. 

I am a non trainee doctor. Can I exception report?
Yes you can. 

I have just started working in the NHS. I was supposed to shadow my colleagues. However I have been left all alone on the ward with no support. 
You must raise this immediately with your HR and supervisor. This is unsafe and even if things have not gone wrong, you can always make a mistake because you do not know the system well yet. 

Will this count as exception reporting?
No, this needs to be discussed ASAP with your consultant and HR. 

I have been told by my trainee colleagues that exception reporting is useless. No one checks it. 
If you do it once, then yes it may go unnoticed however if you do it on a regular basis, appropriate action will be taken. 

Have you personally witnessed it?
Yes, I have. A department got another doctor because everyone from the FY1 to the registrar exception reported.
In another instance,one junior doctor exception reported daily for a few days. 
The rota team chose a minimum number of juniors on each ward after discussion with the appropriate specialties and put this minimum number on the rota as well. This way, no extra leaves were granted and other specialties were asked to cross cover immediately if there was an unexpected leave ( like sickness) on a particular ward. 

I understand now. So exception reporting does not show that I am not efficient enough. It brings about change to improve patient safety and the health ( and morale) of doctors. 
Yes, this is correct. 

So to summarize, 
Be a safe doctor, always think about your patients. Work hard but work smart as well. Do not tire yourself. It is not worth it- you will only end up getting physically and mentally sick thus being unable to do your job properly. Raise your concerns early. Anyone can raise concerns. Do not belittle yourself. You have a voice. Make yourself heard ( in an appropriate way). You are not only improving your work conditions but also the conditions of future doctors. 
At the end of the day, it is all about patient safety. Never ever compromise on that.