Barriers to the implementation of exception reporting at a busy district general hospital.

Abstract

One change implemented with the 2016 junior doctor contract was the advent of a system of exception reporting. This enables doctors to report either loss of educational opportunities or breaches of safe working hours (including working extra hours, inability to take breaks and unsafe conditions). The outcomes of exception reporting could include compensation (with time or pay), with the process enabling unsafe working conditions to be flagged up to relevant stakeholders. The novelty of exception reporting means that there is a paucity of data regarding uptake or improvement outcomes. One recent study from Barts Health NHS Trust explored this issue.1 The authors surveyed junior doctors within the trust and found that 35% had submitted an exception report, with 29% of respondents reporting being told not to exception report by their seniors. Following discussions with junior doctors, it was observed that the numbers of submitted exception reports might not reflect those anticipated, given known issues with staffing levels and rota gaps. Therefore, this study was designed to establish what percentage of eligible shifts are exception reported by junior doctors in a busy district general hospital, and the reasons behind any discrepancies in the observed pattern of exception reporting.