Table 3

Recommendations

Key principles:
  1. Increase flexibility in all aspects of work and training, ensuring junior doctors are treated as individuals rather than faceless workers.

  2. Consider context when planning changes—one size will not fit all.

  3. Work in partnership with junior doctors when planning, implementing, and evaluating changes, using a bottom-up approach.

ThemeRecommendationNational bodies which support recommendations
Working conditionsReduce workload to ensure sufficient time is available for training, development and breaks during working hours, and it is possible to leave work on time.GMC, BMA27 86
Include time for mandatory activities (eg, ePortfolio completion, examination preparation) within rotas.HEE24 25
Evaluate exception reporting process to ensure junior doctors are confident reporting and reports are used to guide change.GMC27
Allow all junior doctors the option to work less than full time.HEE, GMC24 25 87
Improve rota management by distributing safe rotas with no gaps at least 6 weeks in advance of a placement and improving processes for taking annual, study and sick leave.GMC, HEE, BMA27 28 86
Improve facilities in the workplace.HEE, GMC23 27
Support and relationshipsChange the current supervision system to ensure supervisors have enough contact with trainees to provide meaningful feedback, including recognition of good work.GMC27
Increase availability of senior clinical support for junior doctors and make debriefs following challenging situations routine.HEE23
Ensure managers are visible and work closely with junior doctors on retention and wider issues.GMC27
Improve accessibility, availability and acceptability of formal and informal well-being support.HEE, BMA23 86
Make changes which help junior doctors integrate into medical and multidisciplinary teams.HEE, GMC25 27
Prioritise eradication of bullying, discrimination and stigma within the NHS.GMC27
Learning and developmentEnsure service work supports training requirements and is complemented by regular, formalised, protected teaching.AOMRC88
Facilitate development activities such as participation in research, leadership and teaching within training programmes.GMC27
Ensure career guidance is available to all junior doctors.HEE24
Continue to increase flexibility of medical training, including application timing, deferral options, transfer between specialties, and placement locations.HEE, GMC25 28 87
Improve induction processes, ensuring they are comprehensive and take place at the beginning of every new placement.AOMRC88
Change the rotation system so that doctors have more stability and choice in their placement locations and specialties.HEE, GMC23 27 28
Modify assessment processes for junior doctors so that they evaluate clinical aptitude and preparation is not required during rest time.GMC27
  • AOMRC, Academy of Medical Royal Colleges; BMA, British Medical Association; GMC, General Medical Council; HEE, Health Education England; NHS, National Health Service.