Health Matters: Can greater flexibility help attract and retain NHS doctors? 

Flexible working gained a lot of headlines as a result of the coronavirus pandemic. Apart from home working and adjusting ‘office’ hours, some employers have trialled a four-day working week, leading to debate about its wider adoption.

Many doctors in the NHS already work flexibly. The Office for National Statistics  reports that 13 per cent of doctors in the UK work part time and an additional 40 per cent of doctors have other flexible working arrangements, though this opportunity has not been balanced across all grades. 

Flexible working has tended to be the preserve of those at Consultant grades, or those who combine roles (such as a clinical and academic role), whilst those earlier in their careers are expected to work full time as part of a 24/7 service.

As our previous Health Matters article on ‘Is the NHS still an attractive employer’ highlighted, NHS vacancies are high and it is a continual struggle to fill roles. These difficulties are experienced at all levels – including in the recruitment of junior doctors, who are recruited for specialist training alongside experiential learning and service provision.

In response to trainee requests for more opportunities for flexible medical training, Health Education England (HEE) has introduced the Less Than Full Time (LTFT) Category 3 initiative across England in three specialities:

• Emergency medicine
• Obstetrics and gynaecology
• Paediatrics 

Previously, trainees were eligible to train LTFT only if they met certain eligibility criteria (eg for caring responsibilities or unique circumstances). In contrast, the Category 3 initiative enables any trainee in these three specialities to request LTFT training to suit their individual professional or lifestyle needs. 

RSM, with Dr Katie Webb from the School of Medicine at Cardiff University, is working with HEE to evaluate the impact of the LTFT initiative in these specialties over a three-year period. Early results are promising (see our report from February 2021), and have shown that:

• trainees report positive impacts on their work/life balance (78 per cent), wellbeing (77 per cent) and job satisfaction (57 per cent), which could be an important step in attracting talented doctors into the NHS;
• trainees who move to working LTFT were more likely to achieve a satisfactory outcome in their Annual Review of Competency Progression (ARCP), compared to their full-time peers in these three specialties (71 per cent satisfied working LTFT, versus 45 per cent satisfied with working full time);
• a greater proportion of those working LTFT (87 per cent) intend to become an NHS Consultant, compared to their full-time peers (58 per cent) – which could be helpful for retaining doctors in the NHS; and
• educators, overall, felt that they were able to maintain a positive relationship with trainees who are working LTFT (65 per cent).

However, the evidence is not yet clear on the impact of trainees working LTFT on service provision. While 52 per cent of trainees working LTFT do not feel that their working arrangements have an impact on service provision, 79 per cent of educators have indicated that the move to less than full time working has negatively affected the creation and amendment of rotas – making this task more complex.

Despite the pressures that doctors and other healthcare staff have faced over the last 18 months, it is positive that steps are being taken to attract and retain doctors in training. RSM will be continuing to support HEE with the ongoing evaluation of this important initiative during 2021 and 2022, as it is expanded to other specialties. 

Our healthcare evaluation team can also support you in assessing the impact of changing policies, new programmes and workforce initiatives.

If you would like to speak to us about impact evaluation in healthcare, please contact Laura Brownlee.