In this Spotlight on local innovation blog, resident doctors Dr Elhassan Awadin and Dr Arshia Akhavan-Mofrad describe how they worked with senior leaders at Bolton NHS Foundation Trust to develop a locally led resident doctor welfare plan that has strengthened support for doctors in training at Royal Bolton Hospital.
Improving the working lives of resident doctors is not always about large-scale change. In our experience, it often starts with listening carefully to what doctors in training tell us they need, and then creating the structures, relationships and momentum to act on that feedback.
At Royal Bolton Hospital, part of Bolton NHS Foundation Trust, we have developed a locally led resident doctor welfare plan that brought together associate college tutors, resident doctors and senior medical leaders to strengthen support for doctors in training. Working with doctors across foundation training, internal medicine training and higher specialty training, and from a broad range of medical specialties, we sought to bridge the gap between residents and the support available to them, particularly around training, education and wellbeing.
Our starting point was feedback. Resident doctors highlighted areas where improvements could make a real difference to their day-to-day experience, including induction information, access to clear clinical pathways, annual leave processes and the pressures created by workload. They also raised concerns about cancellations of teaching sessions and the impact of growing service demand on educational opportunities.
In response, we worked with senior colleagues to introduce a range of practical improvements. We established a regular resident doctor forum to provide a route for concerns to be raised and discussed, while also expanding opportunities for resident doctors to become involved in quality improvement projects. We strengthened teaching provision, introduced a peer mentorship scheme for doctors in internal medicine training, launched a new medical induction booklet and enhanced supervision arrangements for doctors who are new to the NHS.
A key part of our work has been aligning local improvement efforts with NHS England’s 10 Point Plan to improve resident doctors’ working lives. This included appointing both a senior lead and a resident doctor peer lead, carrying out a trust-wide wellbeing survey and delivering teaching to help resident doctors understand annual leave and exception reporting processes.
The wellbeing survey highlighted several areas where we were already performing strongly, including inductions, access to rest facilities and psychological support. It also identified opportunities to improve awareness of exception reporting and the Safe Learning Environment Charter. In response, we piloted an audit of the charter within critical care and are planning to extend this approach.
Education has been central to our project from the outset. Through targeted teaching sessions, we have improved awareness of wellbeing services and reporting processes while helping resident doctors feel more confident in accessing the support available to them. The work has also connected us with a wider network of resident doctor peer leads across the northwest of England, enabling us to share learning and spread good practice.
The early results have been encouraging. Within the first 12 weeks of implementation, we recorded a 16% increase in concordance with the 10 Point Plan, with further progress achieved since the initial audit. While these figures are important, we believe the real value lies in creating an environment where resident doctors feel listened to, supported and able to raise concerns.
We have also focused on ensuring that improvements are sustainable. By establishing clear leadership roles, planning for handovers and embedding discussions about wellbeing and support into induction programmes, we are working to ensure that progress continues beyond a single training year.
Our experience at Bolton demonstrates the impact that can be achieved when resident doctors are empowered to shape change. By combining feedback, peer leadership and organisational support, we have developed a practical and collaborative approach to improving training and wellbeing.
Most importantly, this work sends a clear message to resident doctors that their experiences matter and that their voices can help shape the environment in which they learn and work. We hope our experience provides a useful example for organisations across the NHS of how local innovation can deliver meaningful improvements to the training experience, one practical change at a time.
