What is exception reporting?
Exception reporting is the process, under the 2016 terms and conditions for doctors in training in England (now usually called resident doctors), for telling your employer when your day-to-day work varies significantly from your work schedule. It keeps schedules accurate, protects training and keeps hours safe. It is not a complaint and it is not about blaming anyone.
Many doctors who trained abroad are used to long weeks and never claiming for extra time. In the NHS, staying a few minutes to finish a task for a patient is normal. Routinely working well past your rostered hours without recording it is not. It hides unsafe staffing, so the problem never gets fixed.
What changed in the exception reporting reforms?
The BMA and Government agreed reforms in 2025, set out in a framework agreement with NHS Employers. They took effect through a new version of the terms and conditions, and all employers in England had to implement them by 4 February 2026.
| Area | Under the reforms |
|---|---|
| Time limit | Submit no later than 28 days after the event, and as soon as you can |
| Who reviews hours reports | HR or medical staffing and the guardian of safe working hours; supervisors are not routinely involved unless you choose to involve them |
| Short claims | For up to two additional hours, the check is whether the hours were worked, not whether you should have stayed |
| Payment or TOIL | You choose payment or time off in lieu for additional hours, except where time off is required because a rest limit was breached |
| Disputes | If HR rejects a report you believe is accurate, the guardian reviews it and decides |
| Educational reports | Missed teaching or training goes to the director of medical education |
| Employer compliance | Fines can apply where employers fail to give access or process reports properly |
BMA guidance also describes processing timescales that tighten during 2026. Details may be updated, so check current NHS Employers and BMA guidance and your local process.
What can you exception report?
- Hours: working beyond your rostered finish time, or starting early to complete work.
- Breaks: being unable to take the breaks you are entitled to.
- Rest: not getting the rest you are entitled to, for example after being called back.
- Educational opportunities: missing teaching, clinics, theatre lists or other training in your work schedule.
- Support: lack of the support you were told you would have, such as no senior available.
Who is involved in exception reporting?
| Person | Role |
|---|---|
| You | Submit promptly and factually through the employer's electronic system, which you should be given access to soon after starting |
| HR or medical staffing | Check hours reports against the rota and arrange payment or TOIL; may change rotas in response to patterns |
| Guardian of safe working hours | Senior post in each employer overseeing safe working; sees reports, reviews disputed claims, can act on serious or repeated breaches, reports to the board |
| Director of medical education | Reviews educational exception reports and can arrange for missed training to be made up |
| Educational or clinical supervisor | No longer approves hours reports, but remains a key source of support if you want to involve them |
How do working hours limits work for doctors?
Your hours are protected by law and by your contract. In Great Britain, the Working Time Regulations 1998 limit average working time to 48 hours a week over a reference period, and give rights to daily and weekly rest and breaks, with some exceptions. You can opt out of the 48-hour average in writing, which some doctors do to allow locum work, but your employer cannot force you, and you can opt back in by giving notice. Northern Ireland has equivalent regulations.
The 2016 terms add stricter safety limits: maximum shift length, maximum hours in a rolling seven days, limits on consecutive long shifts and nights, minimum rest between shifts, and break entitlements. These figures have been revised since 2016, so read them in the current terms or BMA summaries rather than relying on what colleagues say.
Extra locum shifts count towards your total hours for safety, and your contract may require you to tell your employer about other work. If you are on a visa, check whether it limits additional work and seek advice from HR or an immigration adviser if unsure.
How do you write a good exception report?
Keep it short, factual and specific: what happened, why, and what would help. Write it soon after the event. Never include patient-identifiable information.
Stayed late again. Ward was really busy. This keeps happening and nobody cares.
14 October. Rostered long day 08:00 to 20:30; finished 22:00 (90 minutes additional). Reason: two patients deteriorated at 19:30 needing review and escalation to the medical registrar, and I could not safely hand over until they were stable. The night FY1 was covering three wards. Unable to take afternoon break due to four new admissions. Outcome requested: payment for 90 minutes. Suggestion: evening cover on this rota is regularly stretched; consider review.
- Record actual times: Note your real start and finish times, and missed breaks or training, ideally in a quick personal log each shift.
- Give a neutral reason: Focus on the work and the system, not on individuals.
- Choose the outcome: Select payment or time off in lieu where the system asks, remembering that TOIL may be mandatory after a rest breach.
- Submit within 28 days: Sooner is better, while details are clear.
- Keep reporting patterns: If the same problem recurs, keep reporting. Patterns are what lead to rota and staffing changes.
Case study: worried about reporting
Zainab worked for several years abroad before starting foundation training. On her surgical rotation she regularly stays an hour late because the ward round finishes late and discharges pile up. She does not report it, fearing she will look slow or ungrateful, and nobody else on the team reports. At foundation teaching, the guardian of safe working hours explains that reports show where rotas are unsafe. Zainab starts reporting factually, and two colleagues do the same. The department moves the ward round earlier and adds an afternoon discharge session with the registrar. Her hours return to what is rostered, and her supervisor tells her the reports helped make the case for change.
Good Medical Practice expects doctors to raise concerns about patient safety, including staffing and working patterns. A department where nobody reports may look safe on paper when it is not.
Rotas, leave and getting help
Your work schedule should show your average weekly hours and training opportunities. Check your rota line, runs of nights and weekends and the rest days after them, and the deadline for leave requests. If a pattern looks wrong, ask the rota coordinator early; errors in templates are common. Swap shifts only with approval and after checking the new pattern does not breach rest limits. Report sickness by phoning the named person in your local policy.
- Rota coordinator or medical staffing: rota errors, missing work schedules, leave and pay.
- Supervisor: workload, training and support.
- Guardian of safe working hours: repeated or serious hours and rest concerns.
- Director of medical education or foundation programme director: wider training concerns.
- BMA or another union: independent contract advice, rota checks and disputes.
Look after yourself: sleep before nights, use rest facilities if too tired to drive, and spread annual leave across the year. If your working pattern is affecting your health, talk to your supervisor, occupational health or NHS Practitioner Health. In a crisis, Samaritans are available on 116 123.
Learning more
This guide is educational, not contractual or legal advice; your contract and current NHS Employers and BMA guidance take precedence. For a fuller walk-through of rotas, work schedules, hours limits, exception reports, leave and sickness, with worked examples and a reflective exercise for your CPD record, see the Rotas, Working Hours and Exception Reporting course. Your First NHS Job: Induction and Expectations and Your First Week on the Ward cover the wider practicalities of starting work.
Frequently asked questions
How long do I have to submit an exception report?
Under the reformed terms in England, which all employers had to implement by 4 February 2026, you should submit no later than 28 days after the event, and as soon as possible. Earlier reports are more accurate and easier to process. If your contract is different, for example as a locally employed doctor, check your own terms.
Does my supervisor still need to approve my exception report?
Not for additional hours under the reformed process. Hours reports go to HR or medical staffing and the guardian of safe working hours, and educational reports go to the director of medical education. You can still choose to involve your supervisor, who remains an important source of support.
Can I choose payment instead of time off in lieu?
Usually yes. Under the reforms, you can choose payment or TOIL for additional hours, and your choice should be honoured. The exception is where time off is required because a rest limit was breached, for example after an overnight breach of safe working hours, when TOIL is mandatory.
Can locally employed doctors exception report?
It depends on the employer. The reforms formally apply to resident doctors on the 2016 terms in England and others whose employer gives them access. Employers are strongly encouraged to extend them to locally employed doctors, but it is not required. Ask medical staffing and check your contract.
Will exception reporting affect my career or reputation?
It should not. Doctors must not be pressured not to report or treated less favourably for doing so. Reports show where rotas are unsafe and often lead to changes that help the whole team. If you feel discouraged from reporting, speak to the guardian of safe working hours, your director of medical education or the BMA.
What does the guardian of safe working hours do?
The guardian is a senior appointment in each employing organisation. They oversee safe working for resident doctors, see exception reports, review disputed hours claims, can act on serious or repeated breaches and report to the trust board. You can contact them directly with concerns about hours or rest.
Can I opt out of the 48-hour week as a doctor?
Yes. The Working Time Regulations allow workers to opt out of the 48-hour average in writing, and some doctors do so to take on locum work. Your employer cannot force you to opt out, and you can opt back in by giving notice. Contractual safety limits on shift length and rest still apply.
Related courses
Rotas, Working Hours and Exception Reporting
This course is a practical guide for doctors starting work in the NHS on how rotas, work schedules and working hours rules operate, and how to report…
Your First NHS Job: Induction and Expectations
This course is a practical guide to your first weeks in an NHS job, written for newly qualified staff and for professionals who trained outside the…
Your First Week on the Ward
This course is a practical survival guide for doctors and nurses starting on a UK hospital ward. It explains how ward rounds, jobs lists, bleeps and…
Sources and further reading
- Terms and conditions of service for NHS doctors and dentists in training (England) 2016. NHS Employers.
- Framework agreement on exception reporting 2025. NHS Employers and British Medical Association.
- Pay and Conditions Circular (MD) 4/2025. NHS Employers.
- Exception reporting reforms: summary and FAQs. British Medical Association.
- The Working Time Regulations 1998. legislation.gov.uk.
- Good Medical Practice 2024. General Medical Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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