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How to be a Smooth (Return to Work) Operator

We’ve all heard the horror stories of trainees returning from their parental or other long-term leave and just being left to fend for themselves. Sadly, this is all too common and can make a stressful time in a trainee’s life even more daunting. In some cases it can even lead to burn out and the need for even more time away from clinical practice. Most often, the trainee will just “keep their head down”, do the best job that they can in difficult circumstances and they and their patients survive.

However, in some cases, this just isn’t possible and there are obvious patient safety consequences. Cases such as that of Hadiza Bawa-Garba, the paediatric trainee convicted of gross negligence manslaughter following the death of Jack Adcock. Most medical professionals agree that this tragic outcome was primarily the result of a failure of the system. One of the key components of that failing system was the absolute inadequacy of support available to Hadiza, who had only just returned to work, in a hospital in which she had not worked before, in an on-call capacity, on day one of her return from a 13-month maternity leave. You can just see the Swiss-cheese model forming and its more holes that cheese.

If you have never taken a period of extended leave from clinical work for any reason and can’t see how this can be such a big issue, remember how rusty you can sometimes feel after being on holiday for a few weeks. And then consider how out of touch you must feel when returning after a year, often to a new hospital, or a new rotation. For many, this gap in training also follows the most magnificent but life-altering change in circumstances called parenthood. Then imagine returning to night shifts and being handed the on-call baton bleep or phone. If you’ve never been through it before, it’s surprisingly easy to underestimate the impact that taking time out of training can have on your clinical confidence and competence.

So what can we do about it? Well, the good news is that this has been raised as an issue that needs to be addressed and great improvements have been made and continue to be made. As a result of the ACAS Junior Doctors’ Contract Agreement in 2016, Health Education England was tasked with developing innovative and evidence-based initiatives to “remove as far as possible the disadvantage of those who take time out [of training]”. This led to the creation of the national Supported Return to Training (SuppoRTT) programme. In the South West, have now developed clear guidelines on the process that all trainees returning to a training post in England should undertake, to be used in combination with our compatible online user-friendly forms. We have a SuppoRTT Champion in each trust, whose role it is to promote and enable the process. Databases are being developed, to enable the collection and management of the information collected by the SuppoRTT forms; information that will be used to signpost trainees to the support and resources that they can benefit from. Alongside structured meetings with their supervisors (pre, during and post leave), every trainee will be eligible (if required) for a period of enhanced supervision upon their return to work, ensuring that no returning trainee will find themselves unsupervised or working in an on-call capacity until they are ready to do so. We have a peer mentoring programme and are working towards making KiT and SPLiT (Keeping in Touch and Shared Parental Leave in Touch) days more transparent, more easily accessible and more fairly funded. We have also made funding for equivalent, Return to Training Activity (RTTA) days accessible to non-parental leave returners. We are developing and supporting generic and specialty-specific return-to-work courses and "toolboxes" that trainees can access, as well as trialling many other innovative solutions, such as the website, which trainees can access to find information personally tailored to their return. Resources designed to "educate the educators" mean that consultants in the region have a better understanding of the difficulties faced by returning trainees and a clearer knowledge of how to best support them. Although there is still work to be done, we hope that the workplace culture surrounding returning trainees is improving as knowledge of the SuppoRTT programme grows and taking time away from training becomes “the norm” for most.

This is an initiative aimed to support returning trainees, but much of the “SuppoRTT” is being made available to locally employed doctors too. So, if you’re thinking about taking time out, remember that SuppoRTT is there to enable you to plan your best possible return. If you’re already on leave, its not too late. We can help you to achieve a low-stress, smooth return to clinical practice.

For more information on the HEE national SuppoRTT programme find out more here.

For Severn trainees find out more here. For Peninsula trainees find out more here.

Dr Clare Attwood and Dr Amy Slater (Supported Return to Training Clinical Fellows)

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