CAERN

Blog · For doctors and staff

Exception reporting: how to send one and who it helps

By Dr Andy Muirhead-Smith, NHS anaesthetist and founder of Caern
27 October 2026. Last checked 27 October 2026.

An exception report tells your trust that a day did not go to plan: you stayed late, missed a break, missed teaching or felt the ward was unsafe. In England you have 28 days to send one. Each report helps fix the gap behind it, not only your pay.

What is an exception report?

It is a short record that your real working day was different from your work schedule. Since 4 February 2026, resident doctors in England use a new process. Your supervisor no longer signs off reports about hours. HR checks them. The director of medical education checks reports about missed training. The Guardian of Safe Working sees every report.

This post is about England. The other UK nations have their own rules.

How do I send one?

  1. Send it soon. You have 28 days, but the same day is easiest, because you still remember the times.
  2. Use your trust's system. If your trust has no software, it must give you an email address for reports.
  3. For extra hours, add evidence of the time, date and place. The national guidance gives an example: a screenshot of a map app on your phone as you leave, with the clock in view. Do not crop or edit it. If you could not get evidence, another doctor or nurse can confirm your work in writing.
  4. Choose pay or time off in lieu. If the extra hours broke a safe working limit, the trust must give you time off.
  5. If something was unsafe, tell the consultant on call at once. Then mark the report as an immediate safety concern.

For a report of up to two extra hours, HR decides only one thing: did you work them? Your trust must act on each report within 7 days. It must also give you access to the system within 7 days of your start. If it does not, the trust is fined £500 for each doctor for each week. The fines go to training and wellbeing, not to you.

The national rules about location evidence are under review (June 2026). Until they change, keep your evidence.

What do doctors and consultants gain?

You get paid for the work you did. A few unpaid hours each month add up to real money over a year.

Your report is also your record. When the same rota runs late every week, the reports show it in numbers that nobody can argue with.

Consultants gain too. A report is not a complaint about a consultant. It shows that the work is bigger than the team. That is the evidence for another doctor on the rota. A team with enough doctors also makes the consultant's nights safer. More consultants now see that looking after resident doctors helps everyone.

What do patients and trusts gain?

Patients gain when doctors are rested and teams are the right size. The Guardian sees every report, including each one marked as a safety concern. A run of reports from one ward can show a gap early, before it causes harm.

Trusts gain clear information. Exception reports sit next to incident reports as signals that part of the system is not safe or not sustainable. Since August 2025, the NHS England 10 point plan has asked every trust to name a board lead for resident doctors and a resident doctor peer lead. Both report to the board. By January 2026, all 189 trusts had a board lead. Good report data gives that board a true picture. It shows where money for staff will do the most good.

A trust that makes reporting easy also avoids the access fines.

I built a free way to do the evidence step. Message Caern on WhatsApp and share your location as you leave. Caern keeps a timestamped record for your report. It is free for doctors: Caern exception reporting.

Sources

  • NHS Employers, "Terms and conditions of service for doctors and dentists in training (England) 2016", version 14, June 2026, Schedule 5 and Annex D: nhsemployers.org
  • NHS Employers, "Evidencing exception reports", December 2025: nhsemployers.org
  • BMA, "Exception reporting in England: summary and FAQs", checked October 2026: bma.org.uk
  • NHS England, "Getting the basics right for resident doctors" (the 10 point plan), August 2025: england.nhs.uk
  • NHS England, "Update on progress made on the resident doctor 10 point plan", January 2026: england.nhs.uk
  • GOV.UK, "Offer to BMA UK resident doctors committee", June 2026, paragraph 65: gov.uk