NES GP Returner Programme (Process)
NHS Education for Scotland
Process Statement on
Returners to General Practice
NES GP Returner Programme
Context
GPs who have gained a CCT in the UK may cease working for various reasons, including caring for family, personal illness, or study. If they have been away from clinical practice for two or more years they may be eligible for funding from NHS Education for Scotland (NES) for a GP Returner post, following completion of which the aim is that they should be assessed as suitable for inclusion on the Performer List as an independent practitioner.
There is no single yardstick against which post CCT competency can be measured. Doctors have been eligible to be included on the Performer List since 2006 by providing evidence of a Certificate of Completion of Training (CCT) or equivalent, full registration with the GMC with a licence to practice, inclusion on the GMC GP Register and two recent clinical references.
The Performer List was not designed to assess doctors’ capability for General Practice and relies on National Appraisal as a measure of skills and knowledge. One problem is the timing of the two processes – a doctor can apply for and be included on the Performer List well in advance of their annual appraisal. There have been a number of high profile media cases elsewhere in Britain highlighting the problem of doctors ‘slipping through the net’ of the system. There is therefore a need to provide some form of minimal standard for GPs who fall outside the normal career pathway, in order to reassure patients as to the clinical excellence and probity of their doctors.
The rationale behind the GP Returner Programme is outlined in the accompanying document ‘2013 NES GP Returner Policy’. Another document entitled ‘NES Statement on GPs Returning to work after career breaks or relocating to Scotland- guidance for those managing Performer Lists’ details the various routes available to doctors wanting to enter Scottish General Practice.
Aims
The aims of the Returner Programme are to:
1. Provide a supportive and clinically relevant educational environment in which GPs can refresh and update their clinical skills
2. Provide a formative assessment for the GP during the attachment
3. Provide a clinical reference through an Educational Review Document (ERD) supported by evidence to those managing the Performer List
Eligibility Criteria
To be eligible for the programme, the following criteria must be met:
1. Certification of completion of GP Training by a competent authority
2. Full registration with the GMC with a license to practice and inclusion on the GP Register
3. Applicant has not been working in clinical general practice for the preceding two years or more
4. Medical Defence Organisation membership
The following are required before an applicant can be considered for inclusion in the GP Returner Programme
5. Interview with GP Director or nominee eg Assistant Director or Associate Advisor (henceforth ‘Deanery Lead’)
6. Funding application completed by Deanery Lead (see Appendix 1)
7. CV and two clinical reference (Appendix 2)
Process
There is no ring-fenced funding stream for GP Returners; monies are assigned as available and there may be a waiting list for funding. NES funds the GP Returner’s salary and ES grant. Courses and travel expenses are not subsidized. Assessment of performance is self-funded.
Once funding has been agreed through a central NES budget stream, the GP Returner is matched with a suitable training practice, and may be asked to set up a meeting with the relevant Practice Manager and/or Educational Supervisor to discuss details. If there are any difficulties in matching, the Deanery Lead will help as necessary.
The attachment will normally be for 6 months full-time, but may be shortened to three months if the time away from practice has been less than five years, at the discretion of the Deanery Lead. If the doctor wishes to work part-time then the minimum that is educationally sound would be 5 sessions per week. There will be a period of induction to the practice with subsequent clinical sessions designed to be appropriate to the GP Returner’s experience. The purpose of the post is to maximise experiential learning in a supported environment.
The GP Returner enters the Programme having been assessed by the Performer List as being conditionally eligible for inclusion.
Teaching and learning
The GP Returner will be supervised by a named Educational Supervisor (ES) who will have overarching clinical and educational responsibility for the doctor. The ES will:
· arrange a thorough induction to the practice and any recent changes to the NHS in Scotland before the GP Returner embarks on the formal agreed timetable.
· facilitate a learning needs assessment using self-rating scale such as Lanarkshire checklist: LanarkChecklist
· Learning needs will be discussed during the first mentoring session with the ES, and a plan designed to meet these needs will be agreed.
· tailor the weekly timetable to the learning needs of the Returner.
· facilitate the provision of an accurate contract between the GP Returner and NES
· provide an educational contract in the first week for mutual signature (modelled on the timetable suggested below)
· send a copy of the timetable to the Deanery Lead (who will be happy to advise re content and suitability), for approval.
· provide weekly educational supervision meetings
· give regular formative feedback to the GP Returner with explicit documented comments about progress
· advise about PDP & evidence required for appraisal and revalidation
Suggested weekly timetable
Day / Morning / AfternoonMonday / Surgery / Surgery
Tuesday / Surgery / Surgery
Wednesday / Surgery / A face to face session with the Educational Supervisor
Thursday / Surgery / Surgery
Friday / Surgery / Self directed learning to address areas identified as weak in PEP, and through educational needs assessment
OR
Planned Educational Session as suggested by ES for example:
· combined surgery
· recorded surgery for submission to WoS
· appraisal preparation
· reflective log entries (see appendix 3)
· CDM Clinic with nurse
· A session is defined as four hours
· A ‘surgery’ is to include direct patient contact, telephone advice, on-call responsibilities, home visits, administration as timetabled by the practice.
· Initially each surgery will require close supervision appropriate to the experience, competence and confidence of the GP Returner.
· The consultation rate should be graduated so that by end of the attachment, the doctor has achieved the standard of an independent general practitioner with an average of 10 minute appointments to include documentation in line with other clinicians working in the practice.
· Combined surgeries should be offered on a regular basis to allow observation of an experienced practitioner’s management of patients, time management and other strategies.
· We recommend a maximum of eight general surgeries per week but this should be negotiated in line with the educational needs of each GP Returner.
· The ES will be encouraged to contact the Deanery Lead for any advice needed or with any concerns at an early stage.
· There is no requirement for the GP Returner to work in Out of Hours (OOH) but if the GP Returner anticipates applying to do OOH sessions in future he or she should arrange to do an agreed number of supervised sessions during the attachment, once the ES is satisfied that he or she is ready to do this.
Assessment
Assessment of GP Returners is made as follows:
Minimum requirements:
· RCGP PEP which should be completed within first two weeks of attachment and, if the Returner’s first PEP score is below peer average score, also at the end of the attachment to demonstrate satisfactory progression.
RCGP.pep
· PEP+ modules can be taken by GP Returners with specific interests, but are not required
· Work place based assessments
o at least four each of COT and CBD (paper versions completed by ES, calibrated to same standard as for GP ST3)
o one Patient Satisfaction questionnaire (PSQ)
o one Multi Source Feedback exercise (MSF)
PSQ and MSF can both be used towards appraisal and revalidation; it is thus in the GP Returner’s interests to complete these during a stable funded post. Details of all of these requirements can be found on the RCGP website RCGPAppraisal and through the Scottish Online Appraisal Resource SOAR
· External analysis of consultation skills reviewed through the West of Scotland (WoS) peer review system (four consultations as a minimum).
WoSPeerReview
· Reflective educational diary to be shared with the ES (see appendix 3)
NB Costs incurred for external evaluations such as PEP and WoS peer review are the responsibility of the GP Returner. PEP and PEP+ are free to RCGP Members in good standing.
Outcomes of Attachment
· The intention is that the ES will be in a position to provide an evidence based clinical reference to support the decision whether to recommend unconditional inclusion on the local Performer List
· The possible recommendations will be as follows
i) no concerns
ii) needs further development
Review of progress
There will be a review of progress at the beginning, midpoint and end of the attachment with a summative conclusion being reached at the end of month 6 (or equivalent for less than full time attachments), using the Educational Review Document (see Appendix 4). This will be shared with the GP Returner.
This should demonstrate satisfactory and incremental progress throughout the Programme and continuing ability to reflect and learn from the Returner’s own and colleagues’ practice.
The Deanery Lead will make contact at the midpoint of the attachment to help with any problems
1. The overall time allotted to the Returner Programme will not be extended.
2. A failure to progress in achieving the agreed objectives (reaching the standard of an independent General Practitioner) may result in Performer List action,
3. If a failure to progress raises concerns in relation to patient safety or professional probity, the ES may make a referral to the GMC, after having discussed the situation with the Deanery Lead.
4. If a failure to progress is related to sickness absence, it may be appropriate to defer the completion date of the Programme. The normal quota of annual leave may be taken during the attachment, and this should be pro-rata. Any period of sickness absence greater than that covered by self-certification must be supported by a doctor’s certificate. A cumulative absence due to illness of more than four weeks in six months will trigger a referral to the Occupational Health Service unless seen as unnecessary in the opinion of the ES. Reasons for not making an OH referral will be given.
5. On completion of the programme, the ES will make an evidence based recommendation on the basis of the Educational Review Document, and this will be made available to the Deanery. This is not subject to appeal.
6. The Deanery will provide a report to the Performer List with possible recommendations as follows:
· No concerns
· Needs further developments
Further developments will be evidenced in the Educational Review Document which will be provided to the Performer List. This should be considered equivalent to a recent, and detailed clinical reference, and a decision can be made by the Medical Director with responsibility for the Performer List whether to approve ongoing inclusion on the list.
Appendix 1
Application Number
GP Returner
Name
Phone number
GMC number
Date Request Made
Region
Deanery lead contact Name
Phone number
Estimated Start Date
Estimated End Date
Full/Part Time %
No. of sessions
Other info regarding the request
Budget Authorisation
Authorisation Date
Actual Start Date
Actual Leaving Date
Cancellation Reason
Cancellation Date
Appendix 2
GP Returner Structured Reference Form
For completion by TWO referees as identified by the potential GP Returner
Dear <INSERT NAME>
The following doctor <INSERT NAME> has applied to work in the Scotland GP Returner Programme and has given your name as a referee.
This questionnaire will be treated in confidence, however, please note that the candidate may at a later date have access to this report under the terms of the Data Protection Act.
1. How long have you know the applicant for?years months
2. In what capacity do you know the applicant?
3. Please give your views of the applicant relating to the following areas:
(i) Job Performance
(ii) Attitude/Approach to work
(iii) Skills/Experience
(iv) Interpersonal Skills
4. Please comment on the applicant’s timekeeping.
5. Please comment if possible on the applicant’s attendance record.
(We realise that this may be some years ago, so are looking for a general impression, rather than any specific detail)
6. Does the applicant have a disciplinary record?
YES Not as far as I am aware
(Please tick as appropriate)
If the answer is ‘Yes’ please give details:
7. Do you know of any reason that we should not support this person in the GP Returner Scheme?
YES NO
(Please tick as appropriate)
If the answer is ‘Yes’ please give details:
8. Would you re-employ this person?
YES NO
(Please tick as appropriate)
If the answer is ‘No’ please give details:
9. Any other comments
10. Referee’s signature
Date:
Appendix 3 Reflective Educational Diary