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No doubt you must be wondering what the work schedule or working hours of a doctor in the NHS UK would be like. Are there long hours? Do you get time off for vacations? How often do you have to work on-calls? Let's walk through it together.
How long are the working hours for UK doctors?
Hours of work can vary from specialty to specialty. Some may have straightforward hours of 9am-5pm, 8am-4pm, or 8am-6pm for the normal working day (NWD). Less acute specialties typically only have two sets of hours to take into consideration:
- Normal Wording Day
- On-call Shifts
More demanding specialties like A&E and acute medicine may have afternoon, evening, and twilight shifts in addition to on-calls.
European Working Time Directive (EWTD)
There is also something known as the European Working Time Directive (EWTD) that protects you from working more than you are contracted to.
- The working week cannot average more than 48 hours
- There must be a day off each week
- There must be 11 hours of rest in a 24 hour period
- There must be a break in the working day if it is longer than 6 hours
- There is a right to have 4 weeks of paid leave per year
- Maximum of 4 night shifts per week with a minimum of 46 hours rest after 3 or 4 sets of nights
- Maximum shift length of 13 hours
This law protects all doctors in the UK from working too long, working without breaks and making sure you get enough rest after long shifts (among other things). If you find that your working pattern is not compliant with EWTD, you can raise this issue with the help of BMA.
Rota pattern for UK Junior Doctors
When you start out in a department, you'll be given a work schedule. This is different to a rota in that it's just the framework of what your rota would look like, and gives information related to the length of your rota template as well as the number of hours you'd be expected to work.
Your work schedule can depend heavily on your specialty, grade, staffing, and your work pattern. If you are less than full time or only on a basic rota without on-calls, you can expect to be working less hours or less frequently.
It will also provide you information on your grade, specialty, hospital, the name and contact of your Guardian of Safe Working Hours, etc. This is something you should keep as a reference.
An Example Work Rota
If you look at the example above of what the rota template is, you can see there is a definite pattern. With this in mind, if you know what week you start on, you can always ensure you are working the correct schedule as per your agreed upon template (or rolling rota).
A few weeks before you are due to start in a department or specialty, a rota coordinator will send you a personalized roster that will have your name against dates that you will be working. You have the right to ensure this rota is compliant. What this means is that it doesn't breech the junior doctor's contract in regards to how long/often, etc you may be working.
If you're a member of the BMA, doctors in England can access their rota checking service to ensure the rota given is compliant.
What the actual work hours are like? Do you have to stay overtime?
A lot of UK aspirants are troubled when they think about the hours they must work and if they will be expected to work longer than they are contracted. Many are especially concerned as in their home countries, they may work long hours that are often unsupervised or without breaks.
In many countries (like USA) doctors are not protected for their working hours
Indeed, even in the United States, residents can be expected to work an average of 80 hours a week, with only a 24 hour limit on continuous duty! On top of that, many of us often feel the need to come into work earlier or leave later to show 'dedication' with the hopes that it will bear fruit in their training progression. This, however, is not a practice that should be followed.
EWTD protects UK doctors
In fact, as mentioned above regarding the EWTD, doctors in the UK are well protected in this respect. Now, you may ask what should be done if ever you are working later or miss a break/teaching because of the work you have on the ward. First of all, you need to flag what exactly is causing you to be delayed or miss breaks. Is it because of lack of staff? Is there too much work? Are you unable to manage all of your jobs?
Effective handover is better than staying late
Whatever the reason is, you should try your very best to handover all the jobs you were unable to complete to whoever will be relieving you. For instance, if you are rostered to work from 9am to 5pm, and realize at 4:30pm that there are still a few tasks that need to be done before tomorrow, you can compile a list of jobs for your colleague to complete as part of their on-call duty. Please note that this does not mean you keep tasks you don't want to do or that you just drag out your work until your shift is done to keep a majority of tasks for the handover.
Handing over is just a natural flow of maintaining continuity of care. If you are awaiting blood results, or a scan, or need to inform the doctor replacing you about ill patients, do so. Aim to complete as much as your work as possible, prioritizing your duties to allow you to keep to a good schedule.
If, however, despite your best efforts you are unable to complete all of your work and have had to stay longer than anticipated, you should raise this. The first point of call should be to your clinical supervisor, and then to your educational supervisor. If you are in training, you can also speak to your college tutors/program director.
Another option available to England based doctors is exception reporting. An exception report can be submitted when:
- You are working longer than you are rostered to work
- You're unable to take a break
- You are missing learning opportunities/teaching sessions
- You are understaffed
- You are not well supported
Exception reports are extremely important because it lets the hospital know where there are issues that need fixing. These reports are seen by your clinical supervisor as well as the Guardian of Safe Working Hours, and depending on the reason for the report, you may be entitled to a payment or time off in lieu.
Locum work for UK doctors
Extra shifts or locum shifts are completely different than working overtime. To define, locum shifts are shifts that are empty for some reason and can be picked up by a doctor who is not working that day.
So your chance of getting an extra shift depend on your rota and the availability of the locum shift.
As it was a gap, locum shifts are paid at a considerably higher rate and a good means of earning extra on top of your monthly pay. Please check this article on doctor's pay in the UK.
Working Less than Full Time (LTFT)
You may hear of something known as 'LTFT'. This is less than full time work that can be done and arranged as needed. When you are working full time, you are considered as 100%. Less than full time can be between 80-50% of your normal working hours.
This is something you'd need to discuss with your hospital or deanery (if you're in training) from the start so that they arrange for a tailored roster. You may be able to manage particular days of the week to work or a certain number of hours per day depending on what works best for the department. The most common types of LTFT options are slot share and jobs share.
This is where a post or more than one post is shared between doctors in a way that all the duties of a full time doctor are covered. There may be some overlap on their schedules, but the educational opportunities are separate.
This is where a contract is typically split 50-50 between two doctors. Pay, work hours, and educational opportunities are also split in half.
Can an IMG work LTFT?
So this is a heavy question. There is a lot of concern regarding indefinite leave to remain (ILR) and less than full time. Currently there is no clear guidance on whether or not you can be less than full time on a Tier 2 visa without potentially jeopardizing your ILR application. You may need to contact UKVI to ask them to further clarify if you'd be able to work less than full time on a Tier 2 visa.
Please note that if you're on a Tier 2 dependent visa, you can set your own hours to work and even be a locum. This is just because the regulations of a dependent visa are more lax than that of an independent Tier 2 visa. So if you are a couple and concerned about working hours balancing with life, you can think about having one of you be the dependent on the other to find a middle ground.
What about Annual Leave?
Annual leave are your allotted vacation days or days you can ask off. Most departments stipulate you must let them know at least 4-6 weeks in advance of the leave you are requesting. Depending on your contract and your work level, you are provided with a certain amount of days off per year.
To keep it simple and more geared towards what most of you will be looking for, if you are a junior doctor on the 2016 contract, you get 27 days of annual leave per year. This does not mean you can outright take 27 days, rather as your rotations are divided, the days are equally divided as well. Typically, it is 9 days per rotation.
Consultants, however, can look forward to 6 weeks of annual leave if they are on the 2003 contract. If they also work in England or Northern Ireland, they will get an additional 2 days after having worked for 7 years.
What are the other types of leave?
Study leave may also be known as professional leave. It is there for you to use if you wish to attend seminars, conferences, teaching, taking exams, etc. You will need to typically ask for this leave 4-6 weeks in advance, and the leave will also be vetted by your post graduate department as well as your educational or clinical supervisor. There is also a study budget you use for these purposes. The amount of this budget varies.
We all get sick. The good thing is that we don't have to come into work if we are ill. You need to inform your rota coordinator and your department as soon as you know you will be too unwell to come into work. You may be asked how long you will be out for if it a relatively short illness.
You can self-certify your absence for 7 days, but any more than that will require a fit note from another healthcare provider. If you will be out sick for a prolonged period of time, it is a good idea to contact BMA alongside informing your employer so that you can ensure you are paid appropriately.
Maternity and Paternity Leave
Starting a family is a wonderful and stressful experience, but you requesting leave should not be. The first and most important thing you need to do is look into your hospital's maternity or paternity leave policy.
All employees have a right to 52 weeks of maternity leave, but you do not have to take 52 weeks. Within this there is a basis of statutory maternity pay. There is also something known as shared paternal leave, where both partners can take leave. We'd again recommend reaching out to BMA to help you understand what works best for you.
Compassionate or bereavement leave is in place in the unfortunate circumstance of a death in the family. It is paid.
This list is not exhaustive of the different types of leave or what you can apply for, but we hope this gives you a basic idea of what you can expect.
Frequently Asked Questions
What if I become ill during my annual leave?
You should inform your rota office as soon as possible. The duration of your illness would then be covered by sick leave and your annual leave would be suspended until you are better.
Can you work during your annual leave?
Yes. You can take locum shifts within your hospital or as an external locum (outside your hospital).
Can I take unpaid leave?
Yes. Sometimes circumstances arise which require you to be away from work for a longer period of time than you would have hoped. You will need to raise this with your employer as soon as it becomes obvious that it will be needed, and as always, contact the BMA if you feel you need any support.
Is annual leave paid in addition to your salary?
Not exactly. Your leave is already calculated within your pay.
What is fixed leave?
Fixed leave is when you have your days off already incorporated into your rota without your having had applied for it. It is not a permitted action under the 2016 junior doctor's contract.
What if I am working on a public holiday?
You are given a lieu day or a day in return if you are working on a bank holiday or if a zero day falls on a bank holiday. You'll need to coordinate with your rota office as to when you can take your lieu day. It is your responsibility to keep track of any and all lieu days you may accrue.
What is a zero day?
After you finish an on-call shift (nights or weekends), you get an appropriate amount of time off to recuperate. For example, if you work Saturday and Sunday on-call, you'd get Monday and Tuesday off in exchange.
Can I opt out of EWTD and work more hours?
You can opt out but it must be voluntary (your employer can not make you do that). You can't opt out of the rest criteria mentioned in the directive. It's an agreement that must be mentioned in your work contract and make sure your hours are well maintained by your employer.
To sum up, working in the UK as a doctor is very structured, protected and to be honest, simple. You are supposed to come at 9 am, you show up at 9 am - if you are done at 5 pm, you are done at 5 pm. But, that being said, you have to know your bit as well so that you don't get tangled into something that is illegal. I hope the working hours pattern for doctors in the UK is clear form this article, feel free to ask any questions.