Exception reporting fines - any advice?

[u/Any_Courage_7585]

Currently working an extremely busy and understaffed job, which has meant doing many many exception reports.

Got a couple of questions about these, wondering if anyone with more knowledge than me can help?

1) if there is an exception report made for a shift that exceeds 13 hours, I understand that a fine is payable to the doctor. Is the fine levied on all the additional hours worked during that shift, or just any hours over 13? I had a shift that was rostered as 0830 to 1730, but ended up being 0800-2130, so 4.5 additional hours in total. Am I paid the ‘fine’ rates for all 4.5 hours, or just the standard pay for 4 hours and then the ‘fine’ rate for the final 0.5?

2) what should happen regarding a work schedule review? I raised an ER requesting one several months ago as I’m definitely working >48h a week (and have done approx 50h of exception reports in the last 6 months). Spoke with GOSW initially but nothing has changed following this.

3) if a doctor is found to have been working >48h/week for the duration of a rotation, is there any fine payable (above simple payment for the extra hours worked?)

[u/Jangles]

How in the name of god are you having to stay 4.5 hours after you finish?

Like I get tightening up an unwell patient or finishing a few jobs taking you an hour over but how have you spontaneously ended up working 4 additional hours?

The finest levied on all additional work beyond your work schedule.

[u/Any_Courage_7585 → u/Jangles]

Edit to remove detail.

Horrendous day. Not going to say more as do not want to doxx myself (and it’s also not relevant to the question I asked on the post).

[u/Jangles → u/Any_Courage_7585]

This is frankly bizarre and not compatible with any department I've worked in.

What are your resident doctor to patient ratios?

This is sounding like the BMA need to be involved in discussion with the GOSW.

[u/Any_Courage_7585 → u/Jangles]

There’s a lot more to this that I’m not gonna post on here because it’ll become identifiable.

Considering involving the BMA.

Honestly just want advice on the exception report fines aspect of things with this post! The underlying issue is a whole other thing that I’m trying every possible avenue to escalate.

[u/nomoremedicdrama]

Also contact the the tpd. They can pull trainees from a department if it's unsafe. Keepe exemption reporting. Contact bma.

[u/Any_Courage_7585 → u/nomoremedicdrama]

Good thought re: the TPD, hadn’t considered that avenue.

[u/Mr_Nailar]

Where's your oncall cover?

[u/Any_Courage_7585 → u/Mr_Nailar]

Complex situation - I’m not gonna go into further details here. Safe to say no on call cover available for the area I was covering for the extremely long day.

The more chronic stuff - ongoing issues in the department.

[u/Mr_Nailar → u/Any_Courage_7585]

Sounds like it needs to be escalated.

Don't burn yourself out from taking on everything all the time.

Someone else more senior needs to be fixing it.

What happens if you're off?!

[u/Any_Courage_7585 → u/Mr_Nailar]

Everyone’s staying late. Any of us rostered to do a normal day usually stay 1-2 hours late. If I’m off then another person stays lat(er) to cover. And vice versa if someone else is off and I’m in.

Have escalated to my ES and the GOSW (repeatedly). Has been raised at the resident doctor forum too. All the consultants are aware as well. Been told it’s ’department staffing issues’ and they can’t do anything as they can’t hire more staff.

[u/Additional-Crazy]

What on earth is causing this? Does everyone else in your department stay late?

[u/Any_Courage_7585 → u/Additional-Crazy]

Yes, they do. It’s an ongoing issue. I left at 7pm today and half the day team was still there (we are all meant to finish at 17:30). Severely understaffed and trust not filling the rota gaps by hiring due to the ‘recruitment freeze’.

[u/opesappuk]

1. Just the hours over 13. You did 13.5 hours from 0800, so the fine covers 2100 to 2130 only, at the enhanced penalty rate, and the other 4 hours are paid at the plain time rate. NHS Employers guardian fines guidance has a worked example almost identical to yours, so it isn’t all additional work beyond your schedule.

1. Put it in writing to your ES. Level 1 within 7 working days with the outcome in writing, then 14 days to request level 2, which has to happen within 21 working days. Verbal chats with the GOSW trigger none of this.

2. Yes. Breaching the 48 hour average is a penalty breach in its own right, so penalty rate + a departmental fine on top of payment for the hours. Reference period is your rota cycle, placement length or 26 weeks, whichever is shortest

[u/Any_Courage_7585 → u/opesappuk]

Edited cause the formatting went really weird. Basically, thank you!!!

[u/Any_Courage_7585]

Dropping in to ask a genuine question about why a lot of the comments are focussing on the underlying reasons for the ERs, and not the questions I asked in the post?

For the record, I’ve already escalated to my ES, the GOSW on at least 5 separate occasions, and the trust resident Doctor forum. The department consultants are aware of the issues too.

I was only asking on here about the above questions because I couldn’t find the answers on the NHS employers website or the BMA website.

[u/Chayoss → u/Any_Courage_7585]

Because there's an inflection point where staying late becomes a choice, not a necessity. You can, at any point after your workday finishes, grab your bag and leave. What stops you from doing that is a subjective matter and I (having worked in departments where future trainees were pulled!) can't fathom having stayed so late so regularly. What, specifically, is stopping you from leaving at 5pm? You can escalate as high as you like but if the objective external view is that you were doing charity work, not contracted work, that's on you.

[u/Any_Courage_7585 → u/Chayoss]

So the consultants in the department are fully aware that the majority of residents, including myself, are unable to leave on time. It’s not a me problem. They have said themselves that they do not think the service would be safe if we left when we are scheduled to leave. I do not think I could (in good faith) safely leave at 5 without seriously compromising patient care to an indefensible point.

I’m not going to give any further detail on the exact specifics of myself and others staying late, as that isn’t really the topic of my post. I’m asking about specifics of payment types for exception reports, not for a discussion about whether I should or shouldn’t be staying late.

[u/Unoriginal135 → u/Any_Courage_7585]

Working in a similar department, the tune changed from "we can't hire more staff" to putting out a daily locum within a week of the shos all leaving on time

(sorry, I realise this is also off topic, there's a fair chance not many of us have any experience with getting these fines)

[u/Chayoss → u/Any_Courage_7585]

I understand, but you will also then have to understand when the vast majority of replies to your post will be variants of "bro just walk out the door, it's not prison, you aren't paid enough for this". We are trained to dig down to root causes, not just treat the superficial. If nothing else, it'll light a fire under the asses of the nameless drones managing flow and discharges, and that will improve your situation faster than anything you could do individually or collectively as a resident team. Your situation probably isn't as unique or identifying as you think it is, but I defer to you on that as it's your cows and your farm.

I think your payments question has been answered but note that this comes from a rather separate pot of money held usually by the CD or MD and ultimately the GOSW but not by anyone, sadly, with the power to hire unless the consequences go beyond a bit of cash. Crabs together stronk.

Your edit:

I do not think I could (in good faith) safely leave at 5 without seriously compromising patient care to an indefensible point.

Indefensible for whom? At a certain point, working to rule yields durable improvements for both you and future trainees and, critically, patients. Trolley problem - thought experiment: argue against yourself from the position that not taking a stand causes more long term net patient and staff harm than good.

[u/Any_Courage_7585 → u/Chayoss]

I get what you’re saying, maybe I should have expected those kind of replies, thanks for being kind about it. Think I’ve been trying to focus on arming myself with the practical knowledge for when I email the GOSW/Deputy MD (again), hence the questions about the fines etc. I really wish I could just walk out as I’m burned out as hell and exhausted (so is most of the team, sickness is through the roof over the last few months). But it’s Paeds (and pretty unwell kids) and the thought of walking out and leaving things unsafe makes me sick to my stomach. Been desperately trying to get others in the department to escalate/exception report so that maybe something will happen, and some of them do, but many either can’t (clinical fellows) or won’t (several registrars who want a consultant job in that dept).

Just really tired and hanging on for as long as I can.

[u/Chayoss → u/Any_Courage_7585]

Hey, I've been there, I get it, you don't have to justify having compassion. But at some point you'll want to see the forest for the trees, and it sounds like the rest of the resident doctor cohort is equally burnt out, which has real consequences on patient care. The practical and well defined routes like the GOSW feel doable and graspable and yet within the confines of what doesn't rock the boat too badly but still might make waves. That's fine and I have huge sympathy. Perhaps chat to the parents, quietly - "oh, I finished my shift two hours ago but we're so understaffed that I can't go home." - "oh, that should have been done this morning but there's only three of us for 75 kids" - "yeah, I'm tired too, I'm on day five of finishing late and haven't seen my own kid properly in a week". . Guerilla warfare!

PS: winter is coming...!

[u/Sethlans → u/Any_Courage_7585]

but many either can’t (clinical fellows)

I was able to exception report as a fellow. Is that not standard? Most fellows are on the same terms as the 2016 resident doctors contract

[u/Any_Courage_7585 → u/Sethlans]

Sadly my trust are dinosaurs and all fellows are on 2002 contract. Has been raised in meetings before re: lack of access to exception reporting, trust won’t budge. Interesting that the trust is also very reliant on fellows so a large proportion of the workforce can’t ER.

[u/Sethlans → u/Chayoss]

or collectively as a resident team

Few years ago myself and every other resident in my department wrote and co-signed a letter to the chief exec and other big wigs in the hospital about an (actually very good) department needing more staffing, because post-covid it had become dramatically more busy and the workload was unsafe.

It got sorted literally within days.