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