Exception reporting

The Royal College of Physicians (RCP) supports the implementation of exception reporting as a standardised way to highlight issues with training and workload. This guide is designed to help minimise problems with the process.

Key recommendations

  • Exception reporting will work better in practice if it does not rely wholly on educational supervisors to action the reports; clear local guidance is therefore needed for all the individuals who are involved in the process.
  • National monitoring systems are required to assess patterns of exception reporting in order to prevent under- or over-reporting. These systems are currently not in place, but it is essential that they are created if the benefits of exception reporting to the NHS are to be realised.
  • Exception reporting will uncover examples of poor practice and highlight rotas that are understaffed. It is necessary if we are to improve how we develop and train our doctors and deliver safe and high-quality care.

Background to exception reporting

A new contract for junior doctors is currently being introduced in England. This contract (and its terms and conditions of service (TCS)) is being introduced for all core medical trainees (CMTs) and higher specialty trainees (HSTs) who are working in NHS trusts, and it will be fully implemented by the end of October 2017.

Exception reporting is the formal mechanism that doctors on the new contract can use to register variations from their agreed work schedule, in terms of their working hours and training. It allows issues to be escalated to responsible individuals so that they can be resolved and monitored.

Who is responsible?

Several key individuals are involved in the process of exception reporting:

  • individual doctors
  • clinical supervisors
  • educational supervisors
  • guardians of safe working
  • RCP tutors.

Exception reporting and professionalism

The RCP supports the General Medical Council (GMC) guidance on exception reporting. The RCP is clear that it believes that unsafe working hours and poor training environments are unacceptable and that exception reporting is a means to highlight such instances so that action can be taken.