Article

Exception reporting reform for resident doctors

A framework agreement has been published outlining plans for exception reporting reform for resident doctors in England.

31 March 2025

Today (31 March 2025), the British Medical Association UK Resident Doctors Committee (BMA RDC) has announced it has accepted the framework agreement for exception reporting. The acceptance of the framework agreement has formally ended the BMA RDC’s current dispute with the government and the document has been ratified by DHSC ministers.

The framework agreement is a document outlining the upcoming exception reporting reforms for the 2016 Terms and Conditions of Service (TCS) in England.

12 September 2025, is the implementation date for employers to have in place the agreed reforms.

It has been created in partnership with the Department of Health and Social Care (DHSC), NHS England, NHS Employers, the BMA and employer representatives, during a series of talks since the acceptance of the July 2024 pay deal.

The content of the framework agreement was based on the twelve principles agreed between the BMA and government, outlined below.

Access the framework agreement

Read the framework agreement (PDF) for the new exception reporting reform.

Read the FAQs.

Key points of the deal include:

All educational exception reports will go to the directors of medical education (DME) for approval.
All other exception reports to go to HR or medical workforce HR for approval.
The guardian of safe working hours (GoSWH) will retain oversight of all exception reports.
A three-tier system will be used to determine if hours were indeed worked.
Doctors will have their choice of time off in lieu (TOIL) or pay - except when a breach of safe working hours mandates the award of TOIL.
Additional fines: fines will be introduced to ensure that doctors have timely access to systems and are not prevented from exception reporting. Employers will face additional fines to ensure that doctors are not adversely affected by the unnecessary sharing of exception reporting information.

NHS Employers and the BMA RDC will be agreeing the necessary changes to the 2016 TCS contract, amending existing resources and producing new guidance to help employers apply the reforms.

Webinars

NHS Employers hosted a webinar on 8 April 2025 to outline the upcoming exception reporting reforms for resident doctors on the 2016 TCS in England.

This event was targeted to employers in medical HR, medical workforce lead and guardian of safe working hours roles.

Details of additional webinars will be promoted in due course.

Next Steps

Guidance and Resources - updated guidance and resources will be made available to support employers with the implementation of the exception reporting reforms.
Monitoring - the Resident Deal Implementation Group (RDI) will continue to oversee all monitoring and publications produced until the initial phase is concluded.
Evaluation - this reform will be evaluated by the DHSC, the BMA RDC, NHS Employers (and employer representatives) and NHS England from August 2027.
Rotational Placements - the separate work steam on rotational placements will continue. The DHSC is leading work in partnership with key stakeholders to review the current system of training and rotational placements.

The exception reporting reform was introduced as part of the broader pay offer for doctors in training, initially announced on the 29 July 2024. Twelve guiding principles were established to underpin the reform of the exception reporting process. This pay offer was subsequently accepted by BMA members on 16 September 2024. Following this, an implementation group was formed to discuss and finalise the reform based on these principles.
Doctors must be paid/receive time off in lieu (TOIL) for all time worked above contracted hours subject to making an exception report.
1. Doctors should be enabled and encouraged to exception reports.
2. They should not suffer any detriment as a result of reporting.
3. None of these changes should undermine the Guardian of Safe Working Hours' ability to undertake their roles and identify unsafe working practices.
4. As with all claims for overtime/additional working, there needs to be a sign-off process, but challenges to claims should be by exception rather than the norm.
5. The system for reporting should be clear and straightforward.
6. In reference to exception reports asserting a doctor worked additional hours of two hours or less in one occurrence, the only determination the employer will seek to reach when deciding whether to pay the doctor is whether or not the additional hours were indeed worked; the perceived retrospective merits of the doctors’ decision to work the additional hours should not be considered when determining whether to make payment for the additional hours.
7. Exception reports arising from a doctor having worked more than two hours in one occurrence, should be investigated to ensure safe staffing is maintained and could be subject to a locally determined process, which must be agreed upon with the BMA Local Negotiating Committee.
8. Claims should be based upon clear agreed criteria for what constitutes additional working, for example theatre overruns.
9. All educational exception reports to go to DME for approval.
10. All other exception reports to go to HR or Medical Workforce HR for approval.
11. Review the contractual deadlines to ensure that they are sufficient for exception reporting submission to remove the undue burden from doctors and replace with timeframes that empower doctors to manage exception reporting when convenient to them as professionals.
12. The underlying ethos to this change should be to empower and trust doctors to conduct themselves professionally, and to remove wherever possible, and minimise wherever it is not, the time-consuming aspects of the process.

Exception reporting reform for resident doctors

Access the framework agreement

Key points of the deal include:

Webinars

Next Steps

Related content

Exception reporting reform FAQs

Doctors in training vote to accept the government’s pay offer

Exception reporting reforms webinar

Guardians of Safe Working Hours Conference 2025