nw supportt kit event 22nd january 2020

NW SuppoRTT

KIT Event

22nd January 2020

NW KIT Event – January 2020Dr Alison Gale

Associate Dean – SuppoRTT Lead

Housekeeping and aims of day

• Seminars

• 1:1 support

• Information stations

• Networking

• Fire alarms

• Phones

• Privacy

@NHS_HealthEdEng

@NHS_HealthEdEng

SuppoRTT

SuppoRTT Programme

• Enables doctors returning to clinical training following

a period of prolonged absence:

– To regain their confidence and clinical skills

– Quickly and safely

– Thereby enhancing trainee wellbeing and patient

safety

SuppoRTT funding eligibility

• All doctors and dentists in training in England

• who have an NTN/ FTN

• However, principles of the SuppoRTT process should

be made available to all doctors returning after a

prolonged period away from clinical practice

SuppoRTT Programme

• Should be used by all trainees who have had

absence of 3 months or more, for whatever reason:

– Parental leave

– OOP(R), OOP(C) and OOP(E)

– Sickness

– Bereavement

– Disciplinary action

• Those with shorter absences may also benefit

Pre-absence• >3 months absence

• Meet ES to complete

• Bespoke plan

• Discussion:

- keeping up to date

- KIT days/courses/mentoring

- particular concerns

• Contact

• ?Return to LTFT training

• Communication with ES

• Meet 6-8 before return

• Discuss:• Learning needs

• Bespoke period of supervision

• rotas

• Encourage KIT/SRTT days

• Course/bootcamp

Pre-return

• Meet with ES

• Review plan

• Review whether targets met –

WPBAs, reflections

• Mutually agree:• Readiness to return to normal

work/training

• Further enhanced supervision

• ongoing support / mentoring

Post-return meeting

@NHS_HealthEdEng

Remember

• Forward all forms to SuppoRTT.nw@hee.nhs.uk

• School and Trust SuppoRTT Champions in post to

help and guide you

KIT/SRTT days

• Up to 10 days

• Voluntary

• Need educational approval in advance

– Meetings/courses

– Induction

– Supervised clinical work

• Paid at basic rate minus maternity pay

• Payment received by completion of form in LEO

toolkit in same calendar month as work undertaken

@NHS_HealthEdEng

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

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

@NHS_HealthEdEng

Contact

SuppoRTT.nw@hee.nhs.uk

@NHS_HealthEdEng

Thanks and Questions

Demystifying LTFT

Dr Jenny Barber

ST6 in O&G

National Clinical Fellow to the SuppoRTT

Programme

Options

• A slot share - often 60% with 50% on-calls

• A reduced hours post - often 80% with 80% or

100% on-calls

• Supernumerary

• Options for 50%, 70% and 90% also exist

Did you know...?

% in hours determines how your

training is assessed and your CCT

date

% on-calls determines your pay

Money

Considerations

Teaching &

training

opportunities

Childcare

Need to

negotiate

Less involved

in workplaceColleagues'

attitudes

Application Process

HEE will confirm eligibility and send further forms

Submit eligibility form to HEE

Eligibility is under Category 1 or 2 or in some

specialties Category 3

Working out a LTFT rota

•It’s important to separate ‘in-hours’ and 'out-

of-hours’ working

•80% isn’t just 4 days and 60% isn’t just 3 days!

•Work it out yourself rather than just accepting

what HR give you

Calculating 'in hours' and 'out-of-hours' working

Mon Tues Wed Thurs Fri Sat Sun

Week 1 9am-5pm 9am-5pm 9am-5pm 9am-5pm 9am-9pm 9am-9pm 9am-9pm

Week 2 OFF OFF 9am-5pm 9am-9pm 9am-5pm

Week 3 9am-5pm 9am-5pm 9am-9pm 9am-5pm 9am-5pm

Week 4 9am-5pm 9am-9pm 9am-5pm 9am-5pm 9am-5pm

Week 5 9am-9pm 9am-5pm 9am-5pm 9am-5pm Night Night Night

Week 6 OFF OFF OFF 9am-5pm 9am-5pm

Week 7 9am-5pm 9am-5pm 9am-5pm 9am-5pm 9am-5pm

Week 8 Night Night Night Night OFF

Mon Tues Wed Thurs Fri Sat Sun Total in-hours Total OOH

Week 1 8hrs 8hrs 8hrs 8hrs 8hrs 4hrs 12hrs 12hrs 40 28

Week 2 OFF OFF 8hrs 8hrs 4hrs 8hrs 24 4

Week 3 8hrs 8hrs 8hrs 4hrs 8hrs 8hrs 40 4

Week 4 8hrs 8hrs 4hrs 8hrs 8hrs 8hrs 40 4

Week 5 8hrs 4hrs 8hrs 8hrs 8hrs 12hrs 12hrs 12hrs 32 40

Week 6 OFF OFF OFF 8hrs 8hrs 16 0

Week 7 8hrs 8hrs 8hrs 8hrs 8hrs 40 0

Week 8 12hrs 12hrs 12hrs 12hrs OFF 0 48

232 128

• Sarah and Rachael are both returning from mat

leave.

• They both want to work 60%

• Rachael will work Monday, Tuesday and Wednesday

• Sarah will work Wednesday, Thursday and Friday

• They have been allocated to a shared slot on the

rota and asked to divide the on-calls between them.

Action PlanCase Study 1 - 60% - A slot

share• Get full-time rota pattern

• Separate in-hours and out-of-

hours working

• Work out 60% of 'in-hours' work

and 50% of out-of-hours work

(target hours)

• Create two non-working days

• Calculate hours on 60% rota

• Adjust pattern to fit target hours

Case Study 1 - 60% - A slot share Target hours

Total in hours = 232

60% = 139.2

Total OOH = 128

50% = 64

Mon Tues Wed Thurs Fri Sat Sun Total in-hours Total OOH

Week 1 8hrs 8hrs 8hrs OFF 8hrs 4hrs 12hrs 12hrs 28 14

Week 2 OFF OFF 8hrs OFF OFF 8 0

Week 3 8hrs 8hrs 8hrs OFF OFF 24 0

Week 4 8hrs 8hrs 4hrs 8hrs OFF OFF 24 4

Week 5 8hrs 4hrs 8hrs 8hrs OFF 12hrs 12hrs 12hrs 24 22

Week 6 OFF OFF OFF OFF OFF 0 0

Week 7 8hrs 8hrs 8hrs OFF OFF 24 0

Week 8 12hrs 12hrs OFF OFF OFF 0 24

132 64

Mon Tues Wed Thurs Fri Sat Sun Total in-hours Total OOH

Week 1 OFF OFF 8hrs 8hrs 8hrs 4hrs 12hrs 12hrs 24 14

Week 2 OFF OFF 8hrs 8hrs 4hrs 8hrs 24 4

Week 3 OFF OFF 8hrs 4hrs 8hrs 8hrs 24 4

Week 4 OFF OFF 8hrs 8hrs 8hrs 24 0

Week 5 OFF OFF 8hrs 8hrs 12hrs 12hrs 12hrs 16 18

Week 6 OFF OFF OFF 8hrs 8hrs 16 0

Week 7 OFF OFF 8hrs 8hrs 8hrs 24 0

Week 8 OFF OFF 12hrs 12hrs OFF 0 24

152 64

• Rachael and Sarah change rotations and each

decide they now wish to work 80%

• They each have their own slot on the rota

• Sarah wishes to continue to have Monday off

• Rachael wishes to continue to have Friday off

Action PlanCase Study 2 - 80% - Reduced

hours post

• Get full-time rota pattern

• Separate in-hours and out-of-

hours working

• Work out 80% of each of these

(target hours)

• Create a non-working day

• Calculate hours on 80% rota

• Adjust pattern to fit target hours

Case Study 2 - 80% - A reduced hours post Target hours

Total in hours = 232

80% = 185.6

Total OOH = 128

80% = 102.4

Mon Tues Wed Thurs Fri Sat Sun

Week 1 OFF 8hrs 8hrs 8hrs 8hrs 4hrs 12hrs 12hrs 32 28

Week 2 OFF OFF 8hrs 8hrs 4hrs 8hrs 24 4

Week 3 OFF 8hrs 8hrs 4hrs 8hrs 8hrs 32 4

Week 4 OFF 8hrs 4hrs 8hrs 8hrs 8hrs 32 4

Week 5 OFF 8hrs 8hrs 8hrs 12hrs 12hrs OFF 24 24

Week 6 OFF OFF OFF 8hrs 8hrs 16 0

Week 7 OFF 8hrs 8hrs 8hrs 8hrs 32 0

Week 8 OFF 12hrs 12hrs 12hrs OFF 0 36

192 100

Mon Tues Wed Thurs Fri Sat Sun Total in-hours Total OOH

Week 1 8hrs 8hrs 8hrs 8hrs OFF OFF OFF 32 24

Week 2 OFF OFF 8hrs 8hrs 4hrs OFF 16 4

Week 3 8hrs 8hrs 8hrs 4hrs 8hrs OFF 32 4

Week 4 8hrs 8hrs 4hrs 8hrs 8hrs OFF 32 4

Week 5 8hrs 4hrs 8hrs 8hrs 8hrs 12hrs 12hrs 12hrs 32 16

Week 6 OFF OFF OFF 8hrs OFF 8 0

Week 7 8hrs 8hrs 8hrs 8hrs OFF 32 0

Week 8 12hrs 12hrs 12hrs 12hrs OFF 0 48

184 100

Pay

• Basic pay is pro-rata

• Nights, weekend allowance are also

pro-rata over the course of the rota

• LTFT pay premium - £1000 annual

allowance for all trainees

Annual Leave and Bank Holidays

Bank Holiday Case Study

•Trainee working LTFT 60%

•Bank Holiday allowance = 8 x 60% = 4.8 days

•Normal working days – Wednesday, Thursday, Friday

•Not rota’ed to work over Christmas and New Year

•Rota’ed to work Easter Weekend including Good Friday

•What is their Bank Holiday allowance for 2019/20?

Bank Holiday Day Working / Not Working Allowance

August Bank Holiday Monday Non-working day 0

Christmas Day Wednesday Off 1

Boxing Day Thursday Off 1

New Year’s Day Wednesday Off 1

Good Friday Friday Working 0

Easter Monday Monday Zero day 0

Early May Bank Holiday Friday Off 1

Late May Bank Holiday Monday Non-working day 0

Total 4 days

How does LTFT affect my CCT?

CCT is calculated on ‘in-hours’ training time not % on-

calls

Generally speaking:

•1 year at 60% = 20 months (12 / 0.6)

•1 year at 80% = 15 months (12 / 0.8)

Sarah finishes her 8 year paediatric run-through training and is

successfully appointed to a consultant post.

During training she has:

•Completed ST1-4 full-time 4 years

•Taken 2 years as OOPR to complete a MD 2 years

•Taken 12 months mat leave 1 year

•Completed ST5, 6 and half of ST7 at 60% 4 years 2 months

•Taken 12 months mat leave 1 year

•Finished ST7 and ST8 at 80% 1 year 10 months

Total time = 14 years

•At what nodal point on the consultant pay

scale should Sarah be paid when she starts

her consultant post?

•Year 0

•Year 2

•Year 4

•Year 6

Consultant Jobs

•NHS Pension - tiered system.

% you pay is determined by your basic income

Bands applying to trainees:

£26,824 - £47,845.99 - 9.3%

£47,846 - £70,630.99 - 12.5%

LTFT trainees pay pension contributions according to their salary

•However the rate is determined by their full-time equivalent

•Eg. a trainee who was earning £50,000 basic salary while working

full-time will earn £30,000 basic salary if they become 60% but they

will pay pension contributions at 12.5%

A few final points...

ARCPs

Once every 12 months

Locums

Allowed but must be declared on Form R

•Separate in hours and out of hours

working

•Work your rota out yourself rather

than just accept what HR give you

•Negotiate carefully!

•Pay, annual leave and bank holidays

are pro-rata

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

• Parental leave (up to 52 weeks + AL)

• SuppoRTT schemes implemented by each

speciality 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: https://sharedservices.sthk.nhs.uk/lead-

employer/key-service-contacts/

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 /

0151 290 4677

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 trainee’s /hosts 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 Host and employer in 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 / Surrogacy / Shared

Parental Leave

www.sharedservices.sthk.nhs.uk

• KIT / SPLIT days – Taken during statutory pay period

• Supported Return to Training days – Taken during AL.

• Max 10 days over the maternity leave period.

• Accrued annual leave (calculations)

• Supported Return to Training Days during AL period

An example of how the different elements would work is set out below:-

Week 1- 2

• Maternity leave (a trainee is not allowed to undertake any work during this period as set out in employment law)

Week 3-25

• Maternity leave trainee does not request to undertake any KIT days

Week 26

• Trainee requests to attend ALS course for example 2 days . Trainee will be paid the difference between what they are currently receiving in terms of SMP and OMP and paid a top up to normal pay.

Week 27- 39

• Trainee remains on Maternity leave .

Week 40 – 52

• The trainee is currently in a no pay period of SMP and therefore under HMRC current rules cannot undertake KIT days as there is no SMP to deduct.

Trainee enters accrued annual leave period, for the purposes of illustration this is 8 weeks:

As trainee has used 2 KIT days they would have 8 SRTT days to utilise during this period.

Week 1-8 of AL

• It is agreed that the trainee can job shadow one day a week during the 8 week period. Therefore, 8 days of annual leave would need to be added on to the end of the 8 week period therefore extending the actual date of the supported return to training plan start date by 8 working days.

Maternity / Adoption / Surrogacy / Shared Parental Leave

continued…

• Risk assessments – every trimester during

pregnancy + upon return

• Support and guidance for 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

Telehealth Technology

• Lead Employer have recently rolled out the use

of ‘telehealth’; a secure video chat platform

which enables trainees, educators and hosts to

have ‘face to face’ conversations without the

need to travel.

• Lead Employer can facilitate these meetings if

required, to discuss support plans for trainees

when returning from time out of training.

Any queries – please get in touch!

www.sharedservices.sthk.nhs.uk

https://sharedservices.sthk.nhs.uk/lead-employer/key-service-contacts/

MY TIPS AND EXPERIENCES

Jennifer McLeavey, EM ST4

National SuppoRTT Fel low with HEE

GO TO SLIDO.COM

Enter #SRTTNW

What helps you find balance in your life

How do you recharge

What makes you happy

S E L F C A R E !

Read your emails a little

Stay in touch with (nice) colleagues

Facebook groups- PMGUK etc

K E E P I N C O N TA C T

Twitter

College websites

E-Learning

SuppoRTT website

S TAY U P - T O - D AT E

Plan ahead!

Consider childcare - sometimes hard to arrange

Use RTT-A application form

C O N S I D E R K I T/ S P L I T/ S R T T D AY S

WHILE OUT OF TRAINING:

Book a holiday!

Make some social plans

Online groceries

Get a cleaner!

C O N S I D E R Y O U R B A L A N C E

Enhanced supervision

Rota pattern

Learning needs

M E E T Y O U R S U P E R V I S O RLTFT

Induction and mandatory training

Restart indemnity

SuppoRTT meeting forms

F O R M S F O R M S F O R M S

Start settling in sessions early

Constant lurgy

C H I L D C A R E

BEFORE YOU RETURN TO TRAINING:

Do you need more help?

Do you need more leisure time?

What do YOU NEED to feel yourself?

C O N S I D E R Y O U R B A L A N C E

Discuss any issues

Ready to be signed off?

Ongoing learning needs

Forms!

M E E T Y O U R S U P E R V I S O R

ARCP?

Exams take a LOT LONGER to revise for

Courses

Leave requests

B E O R G A N I S E D

Don't feel guilty for using it!

Check days they're closed

Babysitter

C H I L D C A R E

AFTER RETURNING TO TRAINING:

RETURN TO WORK FOLLOWING OOPR

Sumita Chhabra

ST5 Paediatric Surgery

OOPR

• 3 years 5 months out

• Hirschsprung’s Disease stem cell therapies

• Keeping up skills:

• Collecting specimens and attending theatre / assisting

• HSCR clinics

• Regional / National teaching

• On call rota (1 in 9) - stopped 9 months prior to returning

• Some assessments

HOW I FELT

• Petrified

• Lost all my skills

• No knowledge

• Not up to date

• All systems have changed

• Not fluid or efficient

RETURN TO WORK (NW DEANERY)

• Half day at deanery Return to Work meeting

• 2 consultants

• 3 trainees ( 2 coming back from maternity leave)

- What to expect

- What paperwork to fill in

- Few scenarios

- Informal

SUPPORT COURSE (HEE)

• Day 1 – lectures, group discussion, avoiding error,

resilience, strengths and weaknesses, how to manage

stress

• Day 2 – clinical based scenarios, tailored to O&G and

Paediatric Surgery (really useful feedback)

• BSS resource box (beforehand)

Confidence

Purposefulness

Adaptability

Social Support

PHASED RETURN TO WORK

• 2 weeks of ’shadowing’

• Not very well organised

• No senior registrar to be on with

• Not all registrars wanted me to be on with them

• Comments like ‘you don’t need to shadow when you’ve

been doing on calls’

• Reading around cases

• Approached theatre staff and asked about instruments

• Observant

• Had a book which I wrote tips in

• Use for lists and clinics so don’t forget tasks

• For op notes

• Keep logbook up to date

• Do lots of PBAs (found really hard previously)

• Paperwork

AFTER PHASED RETURN

• Three clinics in one day (Upper GI, Lower GI, Urology)

• Patient, took time operating, calm

• Told myself I could do it

• SUPPORT course - really encouraging feedback about my manner and approach to things which has stayed with me

• Planned holiday start of Dec (no time after finishing OOPR)

• Feedback at ARCP

STUDY LEAVE

• TPD denied study leave initially

• Deanery guidance – 7 days for studying for exams

• Deanery Study leave administrators – also denied study

leave

• Programme Support Manager (School of Surgery) – HEE

Deans agreed to grant study leave