Rotational Training in ICM

1. An explicit understanding between IiT and their Clinical or Educational Supervisor (ES) is needed to maximise training opportunities, achieve required capabilities and identify additional opportunities available in each placement. This can be challenging to achieve during short placements.
2. Frequent rotations may limit the opportunities to engage in further activities that are crucial for meeting all aspects of the curriculum (and specialising or excelling in some). Opportunities to participate in local quality improvement projects, teaching, and research may be constrained. 

1. Moving departments impacts on cohesion within teams. Shorter rotations can make it harder for IiTs to establish roots, a sense of belonging in a department, and make a substantial, positive contribution. It takes time to adapt, and IiTs may not have the chance to settle in before being uprooted once more.
2. Teams work best when everyone knows each other. This knowledge and understanding comes with time. After spending a while in a department, engagement in social events is more likely to occur, which for many is key in feeling like an equally valued team member.

1. Moving frequently has a greater impact in those programmes covering larger geographical areas. This leads to longer commutes made, increased travel costs and reduced travel allowances. This is particularly difficult for those with caring roles who may have to regularly alter caring arrangements and established support networks due to changing working patterns.
2. International IiTs moving frequently can be especially isolated and endure challenging times.
3. Historically, many doctors enjoyed free or affordable accommodation, free parking, and good rest facilities. Unfortunately, these benefits are increasingly scarce in many hospitals, requiring IiTs to travel long distances at a significant personal cost, or relocate frequently, with considerable associated costs.
4. The repetition of administrative activities, e.g. ID checks, compounds the disruption caused by changing workplaces. Each hospital has its own protocols, electronic health record systems, and administrative procedures. The frequent need to adapt to these differences can be inefficient and frustrating.
5. Adapting to new environments takes time, and initially, doctors often feel less efficient, confident, and supported. This adjustment period can impact both performance and their mental well-being.

These challenges may be exacerbated for programmes without a lead employer model. In several regions across the UK, adopting this model has already led to improvements for IiTs. Here are a few insights from IiTs in Northern Ireland and Wales on how this approach has enhanced their training experience:

• “A single lead employer model (SLE) was introduced for our specialty in 2021 with the aim of simplifying employment arrangements in rotational training. We have found this to be a positive move. Although each Trust will require some additional paperwork with each move, there is less of a burden on this and documentation such as providing pay slips and proof of address are no longer required at every changeover. Inaccuracies in salary when moving between Trusts in the region have been largely eradicated.  It has not been a solution for all HR issues (for example, sickness absence, family and other statutory leave does require communication with the Trust as well as SLE and is not always seamless) but overall has created a better experience for rotational training.”

– Dr Andrew Steele, ST8 ICM, IiT representative NI

• ‘Old’ System 

  “Having experienced the previous system with eight rotations, I can remember day one of a new rotation including the long process of queuing to be seen by a member of HR to go through documents/evidence, apply for a new DBS check, see occupation health (information was never shared between occupational health departments, so I probably had more blood tests than required to check vaccination status). This would repeat every time we changed Health Boards (HB)! A few Health Boards would request for us to come see them in our own time prior to starting so that paperwork could be completed/cross checked. I often found myself having to investigate incorrect pay for first few months of new rotation, usually being placed on an emergency tax code.” 

  ‘New’ system - SLE 

  “Introduced in 2022 - no longer required to attend any HR or occupational health appointments – hurrah! Transition has (in my experience) been without issue, and a much-needed introduction of change. Front sheets for new rotations with details of placement/hours/pay are issued electronically but do need checking as I am aware some colleagues have had incorrect information which has affected pay. The only thing that was a bit tricky initially was navigating who to contact for queries in my training specialty, but once identified, on the few occasions I’ve needed to get in touch, the team have been responsive and helpful.”

- Dr Sarah Elgarf, ST8 Anaesthesia & Intensive Care Medicine, South Wales

• ‘Pre-SLE era in Wales’

  “Having rotated through 11 different posts before single lead employer (SLE) came into effect, I was glad to hear of its arrival and thought how proactive HEIW and the Welsh NHS were in instigating this. Prior to its introduction, each rotation to a different hospital trust/health board required a completely new batch of paperwork which seemed endless and took hours to complete correctly and return. A HMRC new starter form, health board registration documentation (a booklet in itself), payroll paperwork, occupational health clearance, DBS security check and official documents paperwork were included. The process also required attending the particular health board in person for a ‘check’ in your own time, prior to starting the post, plus any blood tests for occupational health clearance on the off chance the previous health board couldn’t find your previous results, with the fear that your salary would not be paid without these. It was an annual palaver that with time junior doctors came to learn of the inefficiencies of the system. It was predictable that your first month or three’s salary would be incorrect and that you’d be placed on an emergency tax code. This required spending time on the phone, often on hold for periods of time, whilst HMRC/payroll were contacted to sort out the issues. 

  “On establishment of SLE in April 2022, this became centralised and apparently streamlined. There were of course some issues in transition to the new system, which for some doctors took a while to resolve. However now embedded, No more forms and blood tests and in-person checks. There are occasionally still some hiccoughs with payroll, however these are more often than not, resolved quickly. My experience of communicating with payroll and NWSSP (Shared Services Partnership - who deal with junior doctor expenses and study budget), have been very positive, with staff wanting to help us junior doctors. This has been a huge, progressive change of culture in my career over the past 15 years.”

– Dr James Rees ST7 ICM & Anaesthetics, Wales