Cross Cover by Doctors in Training


Local Education Providers (LEPs) provide the necessary environment for General Medical Council (GMC) approved training placements for postgraduate medical trainees. Health Education England (HEE) is mandated by the GMC to quality manage the training environment of doctors working in these approved placements.

HEE recognises that service demands are, at times, unpredictable and as a consequence trainees may be required to alter their normal duties to maintain a safe patient environment. In exceptional circumstances, doctors in training may be called upon to provide care outside of their usual training programme or placement. It is the professional duty of all doctors to help patients in need and therefore HEE expects trainees to respond appropriately and positively in these circumstances.

These periods of diversion should only occur exceptionally and with the prior agreement of the Postgraduate Dean. It is important that all parties understand that these circumstances are exceptional and that diversion of trainees from their training and usual professional responsibilities does not become normalised (the potential adverse effect on achievement of curricular competences should not be under estimated); a diversion of more than 2 weeks duration is likely to adversely affect trainee progress and may lead to extensions to training and impact on future recruitment to the specialty and to the acceptance of the training location by future trainees.


  1. The LEP should contact the Postgraduate Dean as soon as an exceptional need is identified to agree cover arrangements.
  2. The option of using other professional groups and trained doctors in the area requesting additional junior doctor cover should be fully explored and exhausted before trainees are asked to work outside of their usual training programme.
  3. There must be a named consultant supervisor present in the area that the LEP wishes to move the doctor in training to.
  4. The LEP should inform the Postgraduate Dean of the circumstances that have led to the change being necessary, the expected duration of diversion and the actions that will be put in place to avoid recurrence.
  5. The Postgraduate Dean will take into consideration the trainee’s or trainees’ educational needs as well as any previous periods of exceptional cover before agreeing to a period of diversion. Trainees should not be moved before permission is granted by the Postgraduate Dean. The Guardian of Safe Working should also be notified for triangulation purposes.
  6. Trainees should be made aware of the possibility that they may be called upon to provide cover during their induction to the LEP and of the safeguard outlined herein. It is the responsibility of the LEP to ensure that trainees have appropriate induction to the new clinical area, are fully and appropriately supervised at all times, and are only asked to work within their competence. Trainees should be empowered to decline roles that are outwith their competence with no adverse outcome to them.
  7. The LEP should notify the Postgraduate Dean of the supervisory arrangements during the period of exceptional cover specifically covering supervision of the healthcare outside of their usual training programme.
  8. The LEP should contact the Postgraduate Dean at every 2 working day interval from the start of the period of diversion to provide an update and seek permission for cover arrangements to continue, if required.
  9. Mitigating action should be considered after the period of diversion to ensure curriculum requirements are met.