nw supportt kit event 22nd january 2020
TRANSCRIPT
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 [email protected]
• 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
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: [email protected] /
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
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