Including special acknowledgments and references
Introduction to the Toolkit
Doctors may take time out from clinical practice for several reasons including parental leave, sickness, burnout, career breaks, to conduct research or to seek out additional clinical experience or training.
Health Education England (HEE) estimates that around 5,000 doctors return to work each year1. Returning to work after a period of absence can precipitate a range of stressors, in particular a decline in confidence in one’s clinical knowledge1. Indeed, extensive work by the Academy of Medical Royal Colleges (AoMRC) published in 2012 showed considerable evidence that a period of absence of more than three months was likely to significantly affect skills and knowledge and that an absence of more than 2 years was likely to require some form of formal re-training2.
It is therefore understandable that doctors returning to work will have considerable anxieties regarding resuming clinical duties, particularly as the situation can be compounded by additional stressors such as starting in a new hospital with unfamiliar systems and protocols, childcare and recovering from sickness.
All of these factors, in addition to a doctor feeling unable to voice their concerns about returning to work can have a huge potential impact on their ability to work and most importantly patient safety1.
It is therefore important to recognise that it is unreasonable to assume that a doctor returning to work after a period of absence will be able to resume their usual, unsupervised duties such as night on calls immediately on return and to function at the exact same level as they had been working pre-absence.
In order for this to change, it is imperative that a cultural shift in attitude towards those who have undertaken a leave of absence is made and that measures are in place to provide a supportive environment.
The AoMRC produced guidance in 2017 recommending a framework of ‘Pre-absence Planning’ and ‘Return to Work’ assessment to enable doctors and supervisors to mutually formulate action plans in which individual needs are recognised and acted upon, a system which is supported by the RCOG2.
Although there are already examples of good practice around the UK where similar systems are in place, it is clear that support is not consistently available in all regions. It is therefore important that a standardised framework of care and support is afforded to all doctors who have had a leave of absence to enable a safe transition back to the workplace and most importantly ensure high quality patient care.
Sukhera Furness – Author, Return To Work Toolkit
Amy Slater – HEE Clinical Fellow
Rebecca Shields – ST6 West Midlands Deanery, Return to Clinical Practice Course
Jo Roper – ST4 West Midlands Deanery, Return to Clinical Practice Course
Ellen Knox – Consultant Obstetrician, Birmingham Women’s Hospital, West Midlands Deanery
Dan Stott – North East London Specialty Trainee
Adalina Sacco – Former RCOG Trainee’s Committee Chair
Susie Crowe – RCOG Less than full time Advisor
Professor Mary Ann Lumsden – Former Senior Vice President RCOG
- HEE Supported Return to Training (SuppoRTT)
- Academy of Medical Royal Colleges – Return to Practice Guidance 2017 Revision
- Pierson A., Plunkett E. & Cullis K. – The Pregnancy Pack, West Midlands Anaesthetic Deanery December 2016
- Taking time out of Programme – BMA
- NHS Employers – Maternity Leave and Pay – Section 15
- Maternity Allowance/How to claim – www.gov.uk
- Sick leave – BMA
- What work can you do during Maternity/Adoption/Shared Parental Leave? – Working Families
- BMA Maternity Leave (for NHS Medical Staff) March 2011
- RCOG O&G Workforce Report 2017
- Managing Trainees in Difficulty (version 3): Practical Advice for Educational and Clinical Supervisors. NACT UK: Supporting Excellence in Medical Education. October 2013