Returning to Practice Following a Prolonged Absence

Returning to Practice Following a Prolonged Absence

Returning to Practice Following a Prolonged Absence

Returning to practice following a prolonged absence from anaesthetics can be daunting. This may apply regardless of whether you are returning to work from maternity leave, following a period of ill-health or have been pursuing other professional goals. The Medical Women’s Federation published a report in 2013 looking at career breaks for NHS and University Doctors. This document details definitions of career breaks, the effect these breaks have on career progression and the factors which can affect the transition back to work after a break1.

The Academy of the Medical Royal Colleges (AoMRC) has recently published new guidance on returning to practice (including those returning to their usual practice after working in a different clinical field)2. The AoMRC was concerned that there was a perceived lack of guidance on supporting a return to practice, potentially compromising patient safety, and so established a working party.

The recommendations of the working party define a prolonged absence as more than three months and give examples of checklists which should be used pre and post absence to allow an individualised action plan to be formulated to support the doctors’ return to practice1. The Royal College of Anaesthetists have subsequently updated their return to work guidance using the framework suggested by the AoMRC3.

The Wessex School of Anaesthesia have successfully introduced a return to work programme for those trainee anaesthetists with no on-going health, conduct or capability issues who expect to return to practice in a short period of time. You can read about it in Anaesthesia News4 and access examples of the paperwork (flowchart,pre-absence and return to work forms) used to support a successful return to work on the AAGBI website5.

Returning to work following maternity leave

This is the most common reason for anaesthetists to have a prolonged period of absence from training. Most will expect (or be expected) to return to practice within a short space of time. As this is a planned absence it is worth giving your return to work some thought even before you go off. In particular think about whether you plan to return to work less than full time as the application will take some time. (See chapter on “Less than full time working”).

Think about the things you can do during your maternity leave to keep up to date. This may simply be making the effort to do some reading however you may also wish to attend some courses or meetings or take advantage of keeping in touch (KIT) days. You are contractually entitled to up to 10 KIT days during your maternity leave. These must be agreed prospectively with your employer and can be used to have some supervised clinical time, attend departmental meetings or to attend courses etc. You will be paid at the basic daily rate for each KIT day taken.

Prior to your return to work it is important you make contact with your Training Programme Director and College Tutor/Educational Supervisor if a trainee, or Clinical Director if a consultant, at the hospital you will be working at to ensure your return is as smooth as possible. The level of support you will require will depend on various factors including length of absence, reason for absence and experience. It is useful to agree an appropriate period of supervised practice prior to returning to out of hours work and your educational aims. If you are returning to work LTFT it may take you longer than you expect to regain your clinical confidence – this is not unusual.

The Bulletin of the RCoA published articles with more advice on preparing for maternity leave6and a personal view of returning to work following maternity leave7.

Returning to work following an illness or with a disability

Returning to work following an illness or with a disability is more complex and doctors in this situation are likely to need much more support than those returning from maternity leave. The type of absence is likely to be unpredictable in its onset and length so early communication with your Training Programme Director/Clinical Director and human resources is advisable.

Occupational Health will deal with your situation in confidence and may prove very useful in helping to arrange an individually tailored return to work programme. There have been several articles detailing a return to work following illness or disability through the eyes of those who have experienced it; Returning to work in a wheelchair8; Returning to work – as a disabled anaesthetist9; Returning to work – a personal view10.

Returning to work courses

There are several national returning to work courses. The AAGBI have run a two day refresher seminar (contact for the details of the next seminar). The RCoA have also arranged a “Return to work: How to succeed” meeting (contact for details of future events). A national multicentre (London, Bradford and Bournemouth) return to work course has recently been established which focuses on scenario based simulation and interactive tutorials. For more information and future course dates the GASagain website is

Trainees and your CCT date

If you are a trainee the Royal College of Anaesthetists (RCoA) will need to be informed of your intention to take maternity leave (or any other leave). Your CCT date will be suspended until your actual return to work, allowing any unplanned extension to your maternity leave to be factored in. Upon returning to work you must notify the training department of your return date and whether you are returning on a less than full time (LTFT) basis and a new CCT date will be calculated.

A recent position statement from the General Medical Council (GMC) provides guidance on the management of absences from training and their effect on a trainees CCT date. From the 1st April 2013 any trainee who has been absent for more than 14 days in any 12 month period (excluding annual leave or study leave) will have a review to decide whether they need to have their CCT date extended. This review of absence will occur at ARCP and Deaneries will administrate the process in consultation with the RCoA. Deaneries are expected to implement this guidance flexibly to reflect the nature of the absence, the timing and the effect of the absence on the individual’s competence11.

Historically three months of one maternity leave could be counted as exceptional leave without affecting a trainees CCT date. Although exceptional leave will cease to exist providing a trainee can demonstrate that all the necessary competencies have been achieved then the RCoA may still allow some maternity leave (or other leave) to be “counted”.

References

  1. Career breaks for NHS and University Doctors. The Medical Women’s Federation, January 2013. (
  2. Return to practice guidance, The Academy of the Royal Medical Colleges, March 2012. (
  3. Returning to work after a period of absence, The Royal College of Anaesthetists, May 2012. (
  4. King W, Haigh F, Aarvold A, Hopkins D, Smith I. Returning to work the Wessex way, Anaesthesia News June 2012: 299; 18-19. (
  5. AAGBI Trainee Updates: Returning to work after a prolonged period of absence. December 2012. (
  6. Cullis K. Pregnancy and preparing for maternity leave. Bulletin of the Royal College of Anaesthetists 2011: 66; 12-14. (
  7. Cullis K. Returning to work after maternity leave. Bulletin of the Royal College of Anaesthetists 2011: 65; 20-21. (
  8. Rugen J. Returning to work in a wheelchair. Anaesthesia News October 2011: 291; 8-9. (
  9. Fossati N. Returning to work – as a disabled anaesthetist. Bulletin of the Royal College of Anaesthetists 2011: 66; 26-28. (
  10. Jobling L. Returning to work – a personal view. Bulletin of the Royal College of Anaesthetists 2011: 66; 29-31. (
  11. Position Statement: Time out of training. General Medical Council, November 2012. (
Top View