Trainee Development and Wellbeing Service

Guidance for Doctors Returning to Training after an Absence

Returning to Training after an Absence: Guidance for Doctors in Training, Clinical and Educational Supervisors, Foundation Programme Directors, Training Programme Directors, and Directors of Medical Education.

This guidance is intended to be used by all doctors returning to training after an absence, and the relevant trainers involved in supporting them with this. It is particularly intended to help guide planning for those doctors who have been absent from work for a period of three months or longer. The guidance does not supersede the employer’s responsibility for managing the return to work but is intended to ensure that the doctor’s educational needs and curriculum requirements are being met whilst also considering their wider individual needs.

Introduction

Taking time out of clinical training is recognised as a normal and expected part of doctors’ careers. Planned absences from training can be for a variety of reasons such as:

Maternity/Paternity Leave
Adoption Leave
Out of Programme (OOP) for Research e.g. pursuing a PhD
Out of Programme Experience e.g. Scottish Clinical Leadership Fellowship
Out of Programme for a Career Break e.g. to pursue an elite sport, or for health or personal reasons.

Sometimes, however, an absence is not a choice, or is unexpected, for example due to ill health.

Returning to clinical training after a period away can be a challenging time for both learners and educators. The returning doctor may have lost confidence that knowledge and skills are at the level they were prior to the absence, and trainers may not be used to supervising a doctor with additional support requirements.

Good communication between employer and training team is crucial to ease the returning doctor back into the workplace and to ensure a positive return to training.

A supported return to training needs to ensure patient safety is protected and that doctors in training retain the appropriate clinical competency commensurate with their role. It is also vital that any additional needs of the returning doctor are addressed to support them in what can be an especially stressful time.

Many factors, including the length and nature of the absence, specialty, stage of training, and individual circumstances, will influence how safely and confidently a doctor can return to clinical training. This framework of a supported return to training is therefore flexible enough to take account of the needs of individual trainees on a case-by-case basis.

Absences of less than three months are unlikely to cause significant issues with returning to training but may still affect confidence and skills levels. Most doctors in these cases should be able to return safely and successfully with careful planning. Occasionally they may require specific support, for example where there has been a change in health status. This guidance focusses predominantly on absences of three months or more.

Overview of Process

This process should be followed for all doctors absent from clinical training for a period of more than 3 months and is optional/recommended for those returning after a shorter period away. Training Programme Directors (TPDs)/ Foundation Programme Directors (FPDs) have the responsibility to ensure this process is followed. However, for core & specialty trainees, the process steps may be delegated to an appropriate depute e.g. an Educational Supervisor (ES). For Foundation trainees this is not usually appropriate. A Flowchart of the process can be found at the end of this document.

GMC guidance for doctors who have taken a longer break from clinical practice, for example those who may be entering or re-entering training after time working in a non-medical post, is available here

Planned Absence

Pre-Absence Meeting

The trainee and their TPD/ FPD should meet before a planned absence from training. This meeting should cover:

Review and documentation of current stage and progress of training
Estimated date of return and likely implications for ARCP/CCT
If known, placement site on return to training
Keeping up to date during absence and whether this is possible/appropriate
Use of Keeping in Touch Days
Any concerns from the doctor in training about the planned return
Point of contact for return – this would usually be the TPD/ FPD

Following this discussion, the TPD/ FPD should fill in the Pre-Absence Form and share this with the trainee. The form should be uploaded to the doctor’s e-portfolio and sent to their training programme administrator to keep on their file.

The National guidance on planning an absence should be followed including completion of a Transfer of Information Form which should be sent to the Director of Medical Education (DME) of the trainee’s returning placement Health Board. The DME or nominated office will ensure all relevant parties have been notified of the return using the return to work checklist.

The National guidance including flowcharts and the most up to date versions of the documents referred to above can be found here

Keeping in Touch (KIT) Days during Maternity / Adoption Leave

Doctors in training who are absent from work are entitled to 10 KIT days while on maternity/adoption leave without it affecting maternity payments. If more than 10 days are worked, then it is classed as returning to work and maternity payments end. KIT days must be taken during maternity leave and not during annual or accrued annual leave.

Days should be agreed with the Clinical Lead/Practice Manager in advance and could be for clinical experience or for attendance at an appropriate course.

Payment for KIT days depends on whether the doctor is in the paid or unpaid portion of their maternity leave. For KIT days worked whilst on paid maternity leave, they will either be paid for their KIT day or that week’s maternity pay, whichever is the higher. KIT days in the no-pay maternity leave period are paid. To process the payment, confirmation of the KIT days worked should be sent to the employing Health Board to arrange payment. It is the responsibility of the employing Health Board to provide instructions on how to do this.

Additional information can be found here:

All Absences

Prior to Return

A meeting between the doctor in training and their TPD/ FPD should be arranged ideally 8-16 weeks prior to the expected return, with the aim of agreeing an individualised plan, taking account of any concerns and learning needs. Each doctor will have different needs when returning to training reflecting their experiences and circumstances and not simply their length of absence. National guidance on the process to follow on returning can be found here

The Academy of Medical Royal Colleges has produced practical guidance on supporting return to work after absence (planned or unplanned) including a useful checklist of questions to be used post-absence to help with identification of issues and facilitate support planning. The full guidance is available here

Checklists for planning an absence and preparing to return are available to download.

The action plan should take into consideration:

How the doctor has learned effectively in the past
How and when it will be assessed whether the learning needs have been met
How this learning will fit in to the doctor’s job plan
Arrangements to support the initial return to work
- Phased return to work if required
- Any adjustments advised by Occupational Health
- Consideration of temporary or longer-term adjustments to working hours (e.g. LTFT)
- Supernumerary arrangements or a period of observation, if required
- Supervision arrangements
- Mentoring or buddy support
- Skills refresh

The plan should consider whether any specific training requires to be undertaken whilst away (where appropriate) or immediately on return. Adjustments to patient lists and/or workload and additional supervision may be required.

It is essential this meeting happens in good time to allow rota adjustments if required. Arranging this meeting is a shared responsibility between the returning doctor and their TPD/FPD.

Absence due to ill health

Where ill health (mental or physical) is a reason for absence, an occupational health opinion should be sought for advice on a phased return and/or reasonable adjustments to the doctor’s work environment, duties and working pattern, prior to return. Consideration to a longer-term contractual reduction in working hours (LTFT) can also be considered.

After Return

When returning to work, it may be appropriate for a doctor to be offered a short period of supernumerary time, direct supervision, or targeted training. The agreed plan for each individual will be dependent on the reason for, and duration of, absence, the specialty and level of prior experience, and whether the doctor has been able to maintain any clinical practice during the absence.

In line with the Once for Scotland Attendance Policy

any trainee who returns to work on a phased return as recommended by occupational health will be entitled to be paid for a period of up to 4 weeks at their normal contractual pay
if the phased return needs to extend beyond this period, the trainee will be expected to contribute any untaken accrued annual leave - however, if a trainee does not wish to use their annual leave, they can opt to be paid according to the actual hours worked during the phased return period
phased returns should not normally last for periods of longer than 8 weeks
the type of work and the work pattern that the trainee is asked to undertake during a phased return needs to take into account any advice received from occupational health

It is recommended that a further meeting between the trainee and FPD or TPD (or depute for core/ specialty) is arranged prior to any additional arrangements ending to ensure the trainee feels confident and ready to return to normal duties. As part of the discussions about returning to work, an appropriate date of return should be considered. For example, returning on a public holiday when staffing may be reduced, or to a night shift, may feel more challenging and anxiety provoking for the doctor returning to work.

Additional Resources

General support

Return to training

Detailed guidance on returning to practice after an absence

https://www.aomrc.org.uk/wp-content/uploads/2017/06/Return_to_Practice_guidance_2017_Revison_0617.pdf

Trainee Development and Wellbeing Service (TDWS)

NHS Education for Scotland’s confidential advice and support for doctors in training.
https://www.scotlanddeanery.nhs.scot/trainee-development-and-wellbeing-service

Careers guidance

scotlanddeanery.nhs.scot/trainee-development-and-wellbeing-service/careers-information/

Less Than Full Time training guidance

Less Than Full Time Training | Scotland Deanery (nhs.scot)

NHS Scotland Workforce Attendance policy

Attendance Policy Overview | NHS Scotland

NHS Scotland Workforce Special leave policy

https://workforce.nhs.scot/policies/special-leave-policy-overview/

GMC

Resources for return to work planning for doctors in training.

https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/welcomed-and-valued/how-can-postgraduate-training-organisations-apply-their-duties/return-to-work

BMA Support Services

https://www.bma.org.uk/wellbeingsupport

Royal Medical Benevolent Fund

Help for doctors, medical students and their family members who are in serious hardship due to age, illness, injury or bereavement.

https://rmbf.org/

Health conditions and disability

Access to work

Government support for work with a disability or health condition.

https://www.gov.uk/access-to-work

https://www.diversityandability.com/access-to-work/

Sick Doctors Trust

For doctors with addiction.

http://sick-doctors-trust.co.uk/

Disabled Doctors Network

Support for doctors with a chronic illness or disability.

https://www.disableddoctorsnetwork.com/

Working with Cancer

https://workingwithcancer.co.uk/

Mental health support

Your GP

If you are in crisis, contact your GP and ask for an urgent appointment. Out of hours, contact 111 and choose the mental health support option.

Emergency Department

If you feel unable to keep yourself safe, attend your nearest emergency department and ask to speak to the psychiatric liaison team.

If you are unable to do any of the above and feel you are unable to keep yourself safe call 999.

Mental Health Support for doctors in training

TDWS Crisis support resources

BMA Counselling and peer support services

Free and confidential 24/7 counselling line and peer support service open to all doctors and medical students on 0330 123 1245. There is always someone you can talk to.

National Wellbeing Hub

https://wellbeinghub.scot/

Resources to support mental and physical wellbeing.

NHS Practitioner Health

https://www.practitionerhealth.nhs.uk/regulated-nhs-care-staff-in-scotland

Free, confidential service for doctors and dentists with mental health or addiction problems who are working or looking to return to clinical practice.

Doctors in Distress

https://doctors-in-distress.org.uk/

A UK based independent charity that promotes and protects the mental health of all healthcare workers and prevents suicides in the medical profession.

Mind

Returning to work - Mind

Support line 0300 102 1234 9am-6pm Monday-Friday

Samaritans

https://www.samaritans.org/

Call 116 123 for support 24 hours a day, 365 days a year.

Shout UK

https://giveusashout.org/

Text SHOUT to 85258

Free, 24/7 confidential mental health text support in the UK, a place to go if you’re struggling to cope and need mental health support.

Suicide Prevention UK

www.spuk.org.uk

Supporting those at risk of suicide in the UK.

DocHealth

https://www.dochealth.org.uk/what-we-offer/

Confidential, not for profit, psychotherapeutic consultation service for all practising doctors.

Breathing Space

Free confidential helpline: Tel: 0800 83 85 87

Maternity/Paternity support

BMA

https://www.bma.org.uk/pay-and-contracts/maternity-paternity-and-adoption/return-to-work/returning-to-work-and-your-rights-as-a-working-parent#:~:text=Providing%20notice,at%20least%2028%20days%20notice.

BMA guidance on returning to work and your rights as a working medical parent.

NHS Advice: Maternity and paternity benefits and leave

https://www.nhs.uk/pregnancy/finding-out/maternity-and-paternity-benefits-and-leave/

NHS Advice: Breastfeeding and going back to work

https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-and-lifestyle/back-to-work/

NHS Workforce Policies: Adoption, Fostering and Kinship Policy

Adoption, Fostering and Kinship Policy Guide for Employees | NHS Scotland

NHS Workforce Policies: Breastfeeding policy

Breastfeeding Policy | NHS Scotland

NHS Workforce Parental Leave Policy

https://workforce.nhs.scot/policies/parental-leave-policy-overview/parental-leave-policy/#:~:text=Employees%20are%20entitled%20to%2018,remaining%2014%20weeks%20are%20unpaid.

Royal College of Surgeons Edinburgh

Pregnancy and Surgery

https://www.rcsed.ac.uk/professional-support-development-resources/career-support/return-to-work/pregnancy-and-surgery

Royal College of Surgeons Edinburgh

Maternity Leave, Paternity Leave, and Shared Parental Leave

https://www.rcsed.ac.uk/professional-support-development-resources/career-support/return-to-work/maternity-leave-paternity-leave-and-shared-parental-leave

Returning to Work After Pregnancy Loss

Tommy’s Org

Returning to work after a stillbirth.

https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/returning-work-after-stillbirth#:~:text=It's%20important%20to%20take%20some,a%20couple%20of%20months'%20notice.

Miscarriage Association

Returning to work after a miscarriage.

https://www.miscarriageassociation.org.uk/miscarriage-and-the-workplace/employees-information-and-support/going-back-to-work-after-a-miscarriage/

Ectopic Pregnancy Trust

Returning to work after an ectopic pregnancy.

Returning To Day-to-Day Activities - The Ectopic Pregnancy Trust

Carer support

Carers UK

Carers returning to Work

https://www.carersuk.org/help-and-advice/work-and-career/thinking-of-returning-to-work/#:~:text=There%20are%20sometimes%20grants%20you,of%20different%20grant%20giving%20organisations

Scot Gov

Carer's Allowance

https://www.gov.uk/carers-allowance/if-youre-working-

Carers Trust

Carers Returning to Work

https://carers.org/resources/all-resources/104-factsheets-for-carers-looking-to-get-back-into-work-or-already-in-work

Bereavement

Suicide Bereavement UK

https://suicidebereavementuk.com/

Marie Curie

https://www.mariecurie.org.uk/help/support/bereaved-family-friends/work/employee-resources/return-work-after-a-bereavement

Specialty specific resources

There are many specialty-specific guidelines and resources to aid the return to training after an absence e.g. clinical skills courses for craft specialties. An active search for these resources is recommended in advance of returning to training. Some examples are listed below:

Royal College of Obstetrics and Gynaecology

Return to Work Toolkit

https://www.rcog.org.uk/careers-and-training/starting-your-og-career/workforce/return-to-work-toolkit/

Royal College of Anaesthetists

Flexibility in Training

https://www.rcoa.ac.uk/training-careers/training-hub/flexibility-training#:~:text=To%20apply%20for%20LTFT%2C%20an,months'%20notice%20is%20usually%20required.

Royal College of Paediatrics and Child Health

Returning to work in paediatrics - guidance for doctors

https://www.rcpch.ac.uk/resources/returning-work-paediatrics-guidance-doctors

Academy of Medical Royal Colleges

Return to practice guidance.

https://www.aomrc.org.uk/wp-content/uploads/2017/06/Return_to_Practice_guidance_2017_Revison_0617.pdf