ltft and supportt: the basics event... · 2019. 6. 13. · 15% in hee nw rise by 37.9% since 2012...

LTFT and SuppoRTT: The BasicsDr Shirley Remington, Deputy Dean for Learner Support

Housekeeping and aims of day

• Seminars

• 1:1 support

• Fire alarms

• Phones

• Privacy

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• Background

• Recent changes to application

process

• New application process

• FAQS

LTFT – The Basics

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Facts and figures 2018 - 5959 less than full time trainees

15% in HEE NW

Rise by 37.9% since 2012

1.5% of foundation doctors

Most common in paediatrics 20% least common in surgery 4%

15% of female trainees 2% of male trainees

Most common in age 30-39 group

71% are for childcare

Introduced in 1969

900 trainees in HEE NW

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LTFTT – Types Eligibility

• Type 1: carer or health including disability

• Type 2: develop special skills/interest

• Approval process unchanged

Funding types

• Jobs share

• reduced hours post

• supernumerary

Minimum 50% ( GMC 2011)

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LTFTT – Types

• New gold guide ( another expected 2020)

• NHS employer guidance-flexible training champions

• GMC statement in 2017 re additional work

• Flexible working law change 2014

• New contract effects

• Return to work support

• Emergency Medicine initiative April 2017 and renewed 2018

• Improving junior doctors lives

• Updated local policy

• Local locum guidance

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New Opportunities

• TIS

• Local Flexible Training Champions

• New contract

• GMC statement 2017

• EM pilot and extension

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Process and Tips

• Eligibility - done once

• Start early.

• Build links with local flexible training lead – specialty and Trust

• Notice to return to fulltime.

• If returning after break ensure Trust are aware

• Use SuppoRTT Opportunities

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Key challenges – LTFT Trainee

• Fitting in

• Personal expectations

• Conflicts in WLB

• Finance

• Rigidity- negotiation skills

• Return to work programmes

• ARCPs

• NTS survey 2018 high

percentage say colleagues

unsupportive

• Isolation

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Common Questions - Answers

• Study leave pro-rata with sessional commitment

• Annual leave pro-rata

• On call pro rata (may do more to max total

working week 40hrs)

• Post approval-only needed if training slots

exceeded

• RHFT work 50-80% time

• Supernumerary up to 60%~(80 in last year

training)

• Slot share 60%

• GMC rule- minimum 50% time

• Responsibilities training programme as full time

• Arcps /revalidation as fulltime

• Locums

• Paid employment

• Bank holidays

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How much notice to start?

3 months.

Why do I need to do a new form every time I rotate?

So your school, LEO and team aware/pay.

How do I go full-time again?

3 – 6 months notice, complete and submit a form, and let your

school know.

Out of hours and daytime percentage is different – which

counts towards CCT?

Where do I get information?

www.nwpgmd.nhs.uk/content/less-full-time-training

FAQs

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SuppoRTT

• All schools have policy

• Everyone not working for 3+months

will follow process

• Lots of available support

• Leads in Trusts and schools to

embed process (temporary funding to

start in next few months)

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What actually happens

• Share with school potential dates of absence and if possible return date.

• Discuss what potential return will look like and plan with either ES or TPD

record on form the plan

• Start planning for return – planned events that can be useful while off, KIT days,

School and HEE offers ( don’t ignore emails)

• Keep in touch with school/trust and prior to starting back meet ES to plan what

return will actually look like

• Confirm date of return

• Firm up plans

• Contact Trust and school return champions

• Meet ES and plan against educational needs including any left from prior to break.

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Transition back to practice

• Induction – even if worked in place before - preferably tailored – things change -

policies equipment

• Update elapsed mandatory training

• Regular meeting with ES to confirm progress starting with one prior to start date

• Extra support if needed and increased supervision initially

• Meet ES at planned point post return and agree full resumption of

responsibilities

• First ARCP – if long return does CCT need extending – panel decision

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Key concerns of all returners

• Confidence- self and support

mechanisms

• Being watched and assessed

• Trainers attitudes

• Ability

• Fatigue

• Managing on call / shifts

• Managing home life

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Support available

Mentoring and coaching

KIT activities – generic specific

Personalised return plans and Human factors and simulation days- school and more general

E learning for health package on returning and LTFT

Educational support and funding for education while off when supporting return

Pastoral support including LEO

Support for trainers and trainees - LTFT

• eLearning for Health - http://portal.e-lfh.org.uk/Component/Details/473676

• HEE NW LTFT

• HEE NW locum guidance

• NHS employers flexible training leads guidance

• Gold Guide

• Academy of Royal Colleges return to practice

• NHS Careers Website

• BMA document 2014

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Overall Satisfaction

75.

76.5

78.

79.5

81.

82.5

84.

85.5

2012 2013 2014 2015 2016 2017 2018

FT LTFT

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Contact

ltft.nw@hee.nhs.uk

SuppoRTT.nw@hee.nhs.uk

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Thanks and Questions

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The Lead Employer Model – Supporting

Trainees Following Time Out of Training

www.sharedservices.sthk.nhs.uk

Time out of training

• Long term sickness cases (+28 days)

• OOP

• Maternity leave (up to 52 weeks + AL)

• SuppoRTT schemes implemented by each

specialty school

www.sharedservices.sthk.nhs.uk

Who does what? – Employment Services

www.sharedservices.sthk.nhs.uk

• Pre-employment checks

• Issue contracts

• Process maternity / paternity / adoption / shared parental leave

• Process excess mileage / removal of expenses

• Process work schedule changes

• Answer generic employment-based queries

Contact: lead.employer@sthk.nhs.uk

Who does what? – HR Case

Management

www.sharedservices.sthk.nhs.uk

• Provide HR advice and support

• Process occupational health referrals

• Provide guidance about key HR policies including attendance

management, conduct, grievance

• Manage long term sickness cases in line with Trust policy

• Link in with HEE regarding the on-going management and support of

trainees

Contact: leademployer.casemanagement@sthk.nhs.uk

Long term sickness

www.sharedservices.sthk.nhs.uk

• The majority of the work the LE does with regards to returning to

training is with trainees who have been off work due to long term

sickness (+28 days)

• ‘Training Clock’ – The difference between returning to work and

returning to training.

• Referrals to Health, Work and Wellbeing

• Working with trainees to implement any restrictions / adjustments

recommended by HWWB clinicians

• Support the trainee in undertaking fewer / restricted duties / working

at a slower pace etc.

• Anything longer than 12 weeks – contractual change

Supportive measures

www.sharedservices.sthk.nhs.uk

• Phased return to work

• Amended hours e.g. varied start / finish times

• Induction / period of shadowing

• LTFT

• Adjustments to duties e.g. no on calls / OOH / night work

• Buddy / mentor scheme within the department / host organisation

• Access to Work input

• Reasonable adjustments – the balance.

Health concerns & The Equality Act

www.sharedservices.sthk.nhs.uk

• Definition of a disability:

• S6(1) Equality Act 2010 – a person has a disability if they have a

physical or mental impairment and the impairment has a substantial

and long term adverse effect on their ability to carry out normal day to

day activities

• EqA Schedule 1 – the effect of an impairment is long term if it has

lasted for at least 12 months, it is likely to last for at least 12 months

• Recurrent conditions

Reasonable adjustments – in line with

the Equality Act

www.sharedservices.sthk.nhs.uk

• Purpose of a reasonable adjustment is to avoid or eliminate a

disadvantage to a disabled person

• What is reasonable will depend on the employer and the

circumstances

• The onus is on the employer to investigate and suggest adjustments

(with advice from HWWB)

• Medical advice can assist

• Access to Work input

Maternity / Adoption and Parental Leave

www.sharedservices.sthk.nhs.uk

• KIT days – Taken during SMP period

• Supported Return to Training days – Taken during AL

• Max. 10 days over the maternity leave period

• Accrued annual leave (calculations)

• Risk assessments – every trimester during pregnancy + upon return

• Support and guidance re breastfeeding

• HWWB support if needed

• Management information – picking up on trainees who resume work

in line with rotation days

• Avoidance of immediate return to duties with less supervision

Out of Programme

• Differentiation between different categories of OOP

• Gold Guide with regards to OOPC

• HWWB input for OOP cases – Declaration + support if needed

• Avoidance of immediate return to duties with less supervision

Any questions

www.sharedservices.sthk.nhs.uk

TOP TIPS FOR RETURNERS

Dr Jenny Barber

ST6 in Obstetrics and Gynaecology

NORTH WEST KIT EVENT

Expectation! Reality!

Top Tips for Returners

Just like riding

a bike?

Anxious

Guilty

Under-confident

Lonely

Looking forward to more mental

stimulation

Adult company

Personal fulfilment / sense of self

Tired

Technical skills

Organisational demands

Decision-making

Better doctor?

Prioritisation

Time management

Team awareness

Empathy

Overwhelmed

Family support

Nursery times

Sleepless nights

Nursery lurgy!

Exams

OOH / On-calls

Specialty demands /

expectations

Portfolio

It's not the same for everyone!

Partner's job

CV

Nursery lurgy!

Commute

Some Practical Tips

• Sort out childcare (including a Plan B!)

• Think about LTFT

• Make contact with work early to plan your return -

Educational supervisor or College Tutor

• KIT days

• Book some annual leave

• Plan meals

• Be open and honest

• Speak to other trainees

• Accept (organised!) chaos

It will be ok

But what if it's not?

• Educational supervisor

• College Tutor

• TPD

• Other trainees

• SuppoRTT programme

And Finally...

Don't make any rash decisions!

Be kind to yourself!