Exception reporting reforms for resident doctors in 2025: What you need to know
From 12th September 2025, significant changes to exception reporting will take effect across England, reshaping the process for resident doctors. These reforms aim to enhance transparency, fairness and oversight, creating a framework that supports clinicians and organisations as they navigate the process of exception reporting.
For NHS managers, understanding these updates is essential for ensuring compliance and supporting your teams effectively. This blog explores the key reforms, what they mean for your organisation, and how technology from Patchwork Health is already aligned to help you adapt.
What’s Changing in September 2025?
The new framework introduces three key updates designed to improve how additional work hours are recorded, verified, and resolved.
- New Approval Routes for Reports
- Educational exception reports will now go directly to Directors of Medical Education (DMEs). All other reports will be routed to HR or Medical Workforce HR.
- Working hours reports for under two hours go straight to HR. Reports over two hours will involve the educational supervisor, with a greater focus on safe staffing, rather than contesting clinical judgement.
- The Guardian of Safe Working Hours (GoSWH) retains overall oversight, ensuring compliance and surfacing unsafe working patterns.
- A New Three-Stage Review Process
A structured, standardised process now applies across all trusts:
Level 0 – Standard: HR reviews evidence and approves payment or TOIL if everything aligns.
Level 1 – Clarification: HR contacts the doctor if discrepancies are found.
Level 2 – Escalation: If the doctor maintains the report is accurate despite rejection, GoSWH makes the final decision.
This consistent approach ensures fairness, reduces disputes, and ultimately improves transparency.
Note: Reports over two hours follow a slightly different route involving educational supervisors, but with an emphasis on safety – not questioning clinical judgement.
- TOIL or Pay – your choice
Doctors can now choose between Time Off in Lieu (TOIL) or additional pay for extra hours worked. However, if a breach of safe working limits occurs, TOIL becomes mandatory to protect clinician wellbeing.
This empowers doctors to align work compensation with their needs – while keeping rest and safety front and centre.
How Patchwork Health supports the new exception reporting framework
Adapting to these reforms doesn’t have to be a challenge. Patchwork’s existing exception reporting system already reflects these principles – meaning no need for costly overhauls or operational disruption.
Here’s how our platform is ready to support your trust:
✔️ Confidential, role-based access
Reports can be easily funnelled directly to HR and GoSWH – ensuring appropriate access and reducing conflicts of interest. Our system supports configurable review access, meaning, for example, clinical supervisors won’t see exception reports under two hours – removing concerns about raising reports having a negative impact.
✔️ Seamless submission and approval
Clinicians can submit exception reports via our app. Reports are automatically configured to the correct approver – HR, DMEs, or GoSWH – reducing delays and manual admin. The system notifies all parties that reports should be actioned within 7 days, reflecting best practice set out in the reform. Built-in notifications keep everyone updated, and all parties can track the status of their reports in one place.
✔️ TOIL or Pay preferences built-in
Clinicians can clearly state their preference for TOIL or pay at the time of submission. These choices are securely logged – streamlining HR and payroll follow-ups while ensuring compliance with the 2025 framework.
✔️ Tiered review and in-system disputes
Our review system supports multi-level escalation – perfectly aligned with the new three-stage model. Should any disputes arise, they can be resolved within the platform, minimising admin while preserving consistency and fairness.
✔️ Easy onboarding and visibility
We make onboarding seamless. Clinicians can upload documents quickly, non-clinical staff have visibility into required actions, and automated notifications cut down the back-and-forth, keeping processes flowing smoothly and actively encouraging sign ups.
Why these reforms matter for NHS managers
The 2025 exception reporting reforms are more than policy changes – they are a critical step towards building an NHS workplace culture that prioritises fairness, safety, and sustainability. Here’s why they matter:
- Improved safety for clinicians and patients
By standardising reporting routes and introducing mandatory TOIL for unsafe breaches, these changes protect doctors from burnout and ensure better care quality.
- Enhanced transparency and trust
Clear approval processes and structured verifications help build trust between clinicians and management while ensuring that systems are fair and equitable.
- Reduced administrative burden
Automatic routing, consistent procedures, and other tools reduce workloads for HR teams, DMEs, and GoSWHs, allowing them to focus on strategic priorities.
- The value of fighting for safe working hours, fair compensation, respect for doctors’ time, and restoring the profession.
Resident doctors with the choice between TOIL and pay allows greater flexibility and control over their workloads, creating a more supportive and empowered working environment. The reforms demonstrate a renewed commitment to reviews focusing on safety, rather than questioning clinical judgement, fostering a culture of professional respect.
NHS managers and HR teams play a vital role in bringing these changes to life and these reforms reflect the NHS’s commitment to fostering not only safer working conditions, but sustainable too, whilst importantly attracting and retaining top talent within the healthcare service.