Guidance on Breaks from Clinical Practice [planned and unplanned] 1. Purpose This document provides guidance to Doctors around breaks from clinical practice. It directs Doctors to the key sources of advice and the key individuals who can also help with re-entry processes. LMCs are also in a position to advise Doctors planning career breaks and ensure the opportunities for planned re-entry are maximised. To be clear it has to be understood that this is guidance only and will not prejudice or disadvantage, in terms of appraisal, revalidation or return to work, any doctor who does not wish to follow this process. 2. Introduction The Academy of Medical Royal Colleges (AMRC) published a ‘Return to Practice’ Guidance in April 2012 1, and have written their guidance for all doctors returning to the same area of clinical practice as previously practiced following an absence for any reason (including those returning to their usual practice after working in a different area of clinical practice). The guidance states that: “It is the duty of all doctors to ensure that they are safe to return to practice.” The AMRC guidance suggests that there is evidence that an absence of three months or more appears more likely to significantly affect skills and knowledge. The longer the period out of practice, the more robust the re-entry assessment should be, to ensure patient safety. Doctors that have not practiced in the UK for a period of greater than two years for whatever reason will need to have their fitness to reenter UK General Practice assessed by the Deanery. Refresher training may be needed in some circumstances, and will be required for any absence greater than 5 years. Funding for refresher training is limited and cannot be guaranteed to be available for every Doctor requiring it at any given time. The NEPCSA wishes to provide appropriate support to doctors taking planned and unplanned leave of absence from practice, and we have used the AMRC guidance to outline the support available in two phases: 1. Prior to taking leave and the leave period; 2. Planning the return to work and in the early stages of the return period. 1 Academy of Medical Royal Colleges ‘Return to Practice Guidance ‘ April 2012 http://aomrc.org.uk/item/academy-reports-and-resources.html These phases are discussed separately and depend on contact between the Doctor and either their local GP Tutor or the Deanery Associate Director responsible for advising PCTs on fitness to practice of doctors after their breaks. 3. Support to Doctors planning to take extended leave from practice This group will include Doctors planning maternity leave, extended paternity leave, adoption leave, known sickness absence e.g. elective surgery, study leave, sabbaticals and planned travel abroad. Where this is possible, thinking ahead in plenty of time is beneficial to allow effective planning for any support that might be needed. If you are considering an extended leave from practice you should: Step 1 Seek advice from the clinical lead for appraisal and revalidation as to whether an appraisal can be missed or should be rescheduled to a different time of the year and discuss any possible implications for your revalidation of taking a career break. Any deferment of the scheduled birthday month appraisal must be applied for using the form on the NEPCSA booking website https://gpappraisals.nepcsa.nhs.uk and agreed by your responsible officer (RO). Step 2 Consider how you wish to manage your career break including the length of absence etc, this could be discussed with your GP Tutor (the current list of GP Tutors is attached at Appendix 1) or your Appraiser. If the timing is right it will be helpful to review your PDP and see if any modifications need to be made in terms of what is achievable by the time you are likely to have your next appraisal. Step 3 If your career break is likely to be lengthy (more than a year) or there are other unusual circumstances, you should in addition also contact the Deanery Associate Director responsible for advising the NEPCSA on fitness to practice and educational needs of doctors after their breaks. They will be able to advise you on what re-entry assessments or re-entry retraining may be required depending on your planned period of absence. 4. Planning the career break The AMRC has devised a ‘Planning Form’ which may be a useful tool for any planning discussions; this is reproduced in Appendix 2. Whilst planning a career break, it is important if possible for doctors to commit to continue CPD and record this in a learning log as this will make returning easier. Appropriate CPD activities on a career break might include: Continuing to read key journals, NICE Guidance etc recording core learning points; Complete internet learning modules eg BMJ learning, doctors.net, RCGP clinical essentials etc; Attending Self Directed Learning Groups, or locum groups; Attending other local meetings; Attending local CCG educational events if possible; Maintaining contact with a general practice and attending key meetings eg SEA discussions if possible. It is very important to endeavour to maintain clinical networks and contacts where possible as professional isolation can make re-entry much harder and reduce opportunities for returning. Where a career break is unplanned, the doctor should seek advice at the earliest opportunity from the individuals above to discuss the issues some of which are listed above once they are aware that the break may be extended. Once a ‘return to work’ date has been scheduled, it is important to develop a ‘return to work plan’ as soon as possible. 5. Planning your return to work and in the early stages of the return period For shorter career breaks of less than a year, your local GP Tutor may be best placed to start off this discussion and the AMRC document in Appendix 3 can form the basis of a ‘return to work’ discussion. The key areas likely to be of most relevance to General Practice are listed below. Clearly some of these areas will need to be discussed with the practice or any other employing organisation. The longer the absence from work, the more important this discussion and for absences greater than 12 months it is likely that more specialist advice from the Deanery AD supporting re-entry programmes, the Appraisal Lead or the RO, will be needed. In this situation it is helpful if you submit a written notification of your career break details and outline any issues that you wish to discuss Appendix 4. The Deanery AD will usually arrange to meet with you to discuss areas including for example: will the return to work be phased? Does the Doctor need help negotiating this with their employer? will the duties be exactly the same or are any new roles planned eg clinical lead areas, training, under-graduate teaching etc ? has the working conditions changed significantly e.g. introduction of a new computer system, new ways of working i.e. ICE /Choose and Book which mean you will need some planned ‘induction’ to new systems? do individual Doctors need any specific support to address areas concern such as lack of confidence or skill levels? what are the likely minimum requirements for the Doctor’s appraisal portfolio having had a career break in terms of revalidation? The RCGP guidance can be seen at Appendix 5. **NEED PARAGRAPH STATING WHAT PERFORMERS LIST REGULATIONS** IS REQUIRED UNDER THE Once you have returned to work it may be helpful for you to maintain email or telephone contact for a few weeks with the GP Tutor, Appraisal Lead or AD to ensure that your return is progressing smoothly and no new concerns have arisen. If concerns arise at any point, either at the planning stage, or at the point of return to work, further advice can be obtained initially from: Dr Iain Lawther, Associate Director for performance and re-entry issues iain.lawther@nhs.net Di Jelley, Clinical Advisor and deanery associate Director for Appraisal di.jelley@nhs.net Dr Paula Wright, Northern Deanery Associate Director for Sessional Doctors pfwright@doctors.org.uk 6. Conclusions Effective career planning is vital to ensure that re-entry into clinical practice is effectively supported to deliver safe high quality care for patients. The NEPCSA will work with the Deanery to ensure Doctors are supported during career breaks. Doctors need to notify career breaks as soon as possible to enable best use of the educational skills and services available. Appendix 1 List of GP Tutors Name Email Area Simon Acey simon.acey@nhs.net Teeside Iain Lawther Iain.Lawther@nhs.net Michael Speight Michael.Speight@nhs.net Johnathan Slade Johnathan.Slade@nhs.net Dave Astley dave.astley@gp-a83636.nhs.uk Paul Bowron Paul.Bowron@nhs.net Ahmed Fuat Ahmedfuat@nhs.net Peter Jones Peter.jones19@nhs.net Ellen Osborne ellen.osborne@nhs.net To be appointed Varun Kaura vckaura@yahoo.co.uk Ashley Liston ashley.liston@gp-a89025.nhs.uk Gerry McBride gerry.mcbride@gp-a89016.nhs.uk Arthur Muchall arthur.muchall@gp-a88003.nhs.uk Steve Blades stephen.blades@nhs.net Janette Foo janettefoo@hotmail.com Julian argreaves julian.hargreaves@nhs.net Durham and Darlington South Tyne of North Tyne of Robin Hudson robinmhudson@btinternet.com Karen Thompson Karen.Thompson9@nhsnet Paula Wright pfwright@doctors.org.uk Appendix 2 Planning an absence from General Practice Recommended Questions and Actions The following checklist of questions is recommended to be used in order to help with identification of issues and facilitate support planning. 1. How long is the doctor expected to be absent? (Is there any likelihood of an extension to this?) 2. Are there any training programmes or installation of new equipment due to take place in the doctor’s workplace in the period of absence? If so, how should the doctor become familiar with this on their return? 3. How long has the doctor been in their current role? Is this relevant in determining their needs? 4. Will the doctor be able to participate in any ‘Keep in Touch’ days or other means of keeping in touch with the workplace? If so, how will this be organised? 5. Does the doctor have any additional educational goals, during their absence? 6. What sort of CPD, training or support will be needed on the doctor’s return to practice? 7. Are there any funding issues related to question 6 which need to be considered? 8. Will the doctor be able to retain their licence to practise and to fulfil the requirements for revalidation? 9. Are there any issues relating either to the doctor’s last or their next appraisal which need to be considered? If so, the Responsible Officer/representative may need to be informed. Signatures Doctor …………………………… On behalf of the organisation ……………………………. Date …………………….......... Date ..................................... Appendix 3 A Doctors return to practice Recommended Questions and Actions The following checklist of questions is recommended to be used in order to help with identification of issues and facilitate support planning. 1. Was a pre-departure checklist completed? (If so, this should be reviewed.) 2. How long has the doctor been away? 3. Has the absence extended beyond that which was originally expected? If so, what impact has this had? (If it was an unplanned absence, the reasons may be important.) 4. How long had the doctor been practising in the role they are returning to prior to their absence? 5. What responsibilities does the doctor have in the post to which they are returning? In particular are there any new responsibilities? 6. How does the doctor feel about their confidence and skills levels? 7. What support would the doctor find most useful in returning to practice? 8. Has the doctor had any relevant contact with work and/or practice, during absence e.g. ‘keep in touch’ days? 9. Have there been any changes since the doctor was last in post? For example: The need for training such as for new equipment, medication, changes to infection control, health and safety, quality assurance, other new procedures, NICE guidance, or anything that the doctor needs to learn? Changes to common conditions or current patient population information. Significant developments or new practices within their specialty. Changes in management or role expectations. What time will the doctor have for patient care? Are there any teaching, research, management or leadership roles required? Are there outstanding issues in relation to their annual appraisal/revalidation which need to be considered? Appendix 4 Enquiry form for GPs returning from a Career break Personal Details Name Address Email Mobile DOB Work or home landline Date of Qualifying as a GP Date of last appraisal Date of next revalidation VTS scheme Current Employment Status Role (s) prior to career break Number of GP sessions worked Role (partner, salaried, locum) Practice[s] where recently employed Other non GP work Medical performers list (MPL) Please indicate which medical performers list you have been on in the last 5 years and the date when you were removed from a MPL. MPL Dates from /until Date removed from MPL (if not currently on an MPL) Have you confirmed whether you are still currently on an MPL ? Details of career break[s] over last 5 years Start date End date Duration Reason eg(months) Maternity, sickness, sabbatical, suspension, Unemployment Relocation Working in another role [specify] Further details about the career break and any clinical work done whilst out of practice in local area if appropriate Appraisal history Dates of last 3 appraisals Date of last audit or quality improvement initiative you have produced* Date of last patient survey* Date of last colleague survey* CPD hours-if any- (evidenced in log) carried out during your break.* Please describe the CPD you have done, if any, whilst you have been on a career break, or attach a copy of your learning log over the period you have not been in clinical practice. * required for revalidation not appraisals Please indicate what questions you are seeking advice on : END OF SECTION TO BE COMPLETED BY CAREER BREAK DOCTOR Deanery action Referral to Appraisal Lead for advice on timing of next appraisal Y/N Referral to I&R lead (IL) for assessment of need for formal or informal re-entry training Y/N Referral to GP Tutor for support with preparation for appraisal Recommendations: 1 2 Y/N 3 4 Appendix 5 Minimum Portfolio for Revalidation The RCGP revalidation guidei (version7) states that doctors taking a break of 2 years or less are still required to submit a “minimum portfolio” to the Responsible Officer. “When revalidation is fully established over a 5-year cycle the RCGP proposes that the minimum supporting information that a Responsible Officer will normally need before a GP’s portfolio can be considered for revalidation will be: 1. active participation in approved appraisal with a PDP agreed and a review of a previous PDP in at least 3 of the 5 years in the revalidation cycle; 2. demonstration of 50 learning credits in each of at least 3 of the 5 years in the revalidation cycle; 3. documentation of at least 200 clinical half-day sessions (equivalent to 1 day a week over a period of at least 2 years) in the 5 years in the revalidation cycle (of which 100 should be undertaken in the 2 years prior to revalidation). A half-day would normally last 4 hours and include at least 2.5 hours of face-to-face clinical contact and be conducted in an approved environment within the United Kingdom. The sessions will be undertaken as a generalist and require the doctor to be on the GMC’s GP Register but can be within a range of settings. COGPED (national) guidance http://www.cogped.org.uk/index.php http://www.cogped.org.uk/document_store/1311754694dzwF_cogped_induction_and_refr esher-returner_schemes_(revised_jun_2011).pdf i http://www.rcgp.org.uk/revalidation/revalidation_guide.aspx Date: November 2012 Version 1