Supporting the retention of locally employed doctors
Introduction
Manchester University NHS Foundation Trust (MFT) employs a large number of locally employed doctors (LEDs) and in 2023, it welcomed 223 new LEDs. The trust recognised that it needed to implement new practices to support the retention and progression of its LEDs.
Key benefits
- Longer contracts and improved retention has made the workforce more stable.
- Improvements in the recruitment and retention of LEDs has led to a reduction in locum spend.
- Supporting progression of LEDs has allowed the trust to more easily recruit to senior and hard-to-fill positions.
- Improved retention has reduced the admin burden allowing for greater focus on other areas such as the induction of international medical students (IMGs).
What the organisation faced
MFT employs approximately 800 LEDs, and a large proportion of these posts are in place to support gaps arising in doctor in training (DiT) rotas. Contractual restrictions on working hours, vacant training posts and increasing numbers of requests for flexible working meant additional posts were needed to ensure rotas maintained compliance with the 2016 terms and conditions and services could be delivered.
The trust covers a large geographical area across varied sites so it can provide training on a wide range of services. However, the semi-autonomous nature of the management and HR in each hospital means that it is challenging to provide LEDs consistent support and experience. The trust wanted to address this disparity and improve support to this part of its workforce to improve retention and career progression.
What the organisation did
Recognising the vital role LEDs have within the medical workforce the trust implemented several initiatives to address the disparity of appraisal completion among LEDs compared to other parts of the medical workforce.
LED hub and handbook
The postgraduate medical education (PGME) department developed the ‘LED hub’ that is supported by the associate director of medical education for LEDs. The hub includes information and resources for LEDs that can be quickly accessed and shared.
LEDs are provided with a handbook during their recruitment process to help welcome them into the trust. In the trust 75 per cent of LEDs are IMGs, so the handbook also provides information to support the transition to working in the NHS and living in the UK.
Representation
There are IMGs and LEDs who act as representatives to be a bridge between senior clinical leaders, managers, and the wider trainee workforce to improve communication, engagement and morale. LED representatives attend the resident doctors’ forum alongside DiT representatives, to help to provide equitable opportunities for both groups of the workforce.
LEDs regularly meet with the trust’s guardian of safe working hours are given access to 10 days of study leave and self-development time. The trust's assistant director of medical education for LEDs has oversight of training of LEDs.
LED appraisals
The importance of appraisals as a development tool was promoted at LED and IMG induction. This was especially important for IMGs who may have no prior experience of an appraisal process. LED supervisors were formally allocated 0.25 PAs in their job plans to support professional development and appraisal and the role of ES was expanded to SAS doctors to overcome supervisor capacity issues.
Buddies for new starters
The trust implemented a specialised IMG recruitment team. Once a doctor is recruited, they are paired with a buddy who is an IMG already working with the trust. The initial buddy contact starts from before the doctor arrives in the UK with regular contact thereafter. The buddy system is in place for all new arrivals from overseas and is intended to help new starters acclimatise to life in the UK and within the organisation.
By creating a supportive working environment, the trust can better support retention of LEDs which helps create a more stable, longer-term workforce of LEDs. The trust can better plan staffing and respond to unfilled training posts. This move has enabled the organisation to better plan it’s rosters and has also reduced resident doctor temporary staffing costs.
Development and progression for LEDs
MFT has approximately 1,200 consultants who are accredited and active educators/ trainers and they provide direction, teaching and supervision to LEDs. The trust provides opportunities during LED posts, such as rotational posts and access to training opportunities and continues with supporting LEDs to progress.
Senior LEDs are encouraged to participate in the MFT chief registrar programme, which is a 12-month initiative encompassing a formal leadership and quality improvement (QI) qualification, mentorship from a senior leader and allocation of 20 per cent of the working week to a QI or service development project.
After their initial contract LEDs are often retained on specialty doctor contracts where this is a desire to do so for both parties and applicants meet the eligibility requirements of SAS roles. These individuals are further supported to undertake the portfolio pathway applications to enter the specialist registration or support career progression to autonomous working or to specialist role. This not only allows the trust to retain staff but helps with filling senior posts in harder to fill specialties.
Local contracts for LEDs
To help provide LEDs with more security and improve retention some LED posts have two-year contracts. This also helps simplify the Right to Live and Work application process. All LEDs are employed on local contracts based on the 2016 junior doctor contract and have exception reporting rights. LEDs are encouraged to submit exception reports to flag when their work differs from their agreed-upon work schedule, which ensures that their working and training experience is similar to DiTs.
Contact Details
Professor Sujesh Bansal - Consultant Anaesthetist and Honorary Clinical Professor & MAHSC ADME (LED)
Christine Tudor - Group Medical Workforce Manager.
We would love to hear other examples of approaches to employing LEDs.
If you would like to share the work your organisation is doing please contact us.
