Returning to clinical practice after absence

The purpose of this guide is to provide secondary care doctors with a comprehensive and transparent approach to returning to work.
Location: England
Audience: All doctors
Updated: Friday 28 June 2024
Career Progression Article Illustration

An overview of returning to clinical practice

The BMA has identified the lack of a clear pathway back in to medicine for those doctors wanting to recommence work as a key issue facing the profession.

Particularly for those with an acquired impairment, following a period of ill health, after caring for a relative, or as a parent caring for a child.

Any legal obligations that you or your employer may have are identified in the text.

The guide assumes that:

  • you are a doctor who has worked, and wishes to resume work, in secondary care
  • you are qualified and have completed your training
  • if you are a doctor in training please also see our guidance on making reasonable adjustments for doctors in training
  • you are returning to the same speciality that you trained in.

 

Defining absence

There is no minimum defined period away from clinical practice that would automatically mean that you would be required to participate in a structured return to work programme.

Since the circumstances surrounding an absence will vary from person to person, needs should be discussed on a case by case basis.

Once you have decided that you want to return to work it is crucial that you are proactive and become involved in your return to work plan from the start. This will help to ensure that it is shaped to meet your needs.

Contact your clinical director to organise a meeting and be clear about the points you wish to discuss.

Where appropriate, involve your GP or specialist, OH (occupational health, the Responsible Officer, and HR (Human Resources).

 

During an absence

Notify your employer

It is essential that you notify your employer of your absence as soon as possible.

At this early stage in your absence, it is worth being very clear with your clinical director and with HR about what level of disclosure you feel comfortable with. Do you want colleagues to know why you are absent?

Your employer should discuss with you how your absence will affect your pay and any other benefits you may receive, such as pension contributions. The exact terms and conditions will vary on a case by case basis.

For doctors with MHO (mental health officer) status a break of five years or more in any pensionable employment may affect your eligibility for MHO status.

For doctors who are clinical academics (with an appropriate dual contract) the return to work conditions may vary from those in conventional clinical employment. Sometimes the absence from work will involve clinical but not academic activities. The provision of support, such as occupational health, may be variable from the side of the University employer.

Maintain contact with clinical networks

Try to maintain regular contact with your clinical networks wherever possible, either through phone calls, emails or by meeting up. You should also expect to be contacted by your clinical director on an intermittent basis.

The aim of this contact is to keep you in the loop with any key changes to the organisation and working practices so that you remain part of the team. It also allows you to talk about how you are doing. Regular contact should not be used to apply pressure on you to return.

If you feel that undue pressure is being applied, a BMA adviser can provide further advice.

It is advisable to discuss with your relevant college, faculty, postgraduate deanery, employing organisation or appraiser what steps you might need to take to stay up to date in your specialty while you are away.

It is good practice to keep a record of any work or CPD (continuing professional development) undertaken during your absence. This should then be taken into account when designing a return to work programme and during revalidation.

 

Assessing readiness to practice

If it is decided that extra training or supervision are needed before full responsibilities can be assumed it is important to agree during the return to work interview how and when your progress will be measured and formally assessed.

The Intercollegiate Improving Working Lives Committee recommends that individually tailored return to work programmes should identify:

  • the anticipated duration of the programme
  • the level of supervision required (direct or indirect)
  • an agreed format for assessment and feedback on progress
  • any targeted training areas
  • the timing of progress reviews and agreed 'milestones'
  • the date when independent practice would formally recommence in the event of a successful return to the workplace
  • successfully participating in a return to work programme, backed by your employer, is an important item of supporting information for your appraisal and revalidation portfolio.

This is because revalidation is very much about demonstrating that you are fit to practise with no concerns about patient safety issues.

Funding

Extra funding may be required to cover the costs of any training deemed necessary as part of your return to work programme.

For a doctor who has not been in paid employment for some time, personally funding a further training programme may be very difficult. A range of funding options exist which may be able to assist in these circumstances. 

The BMA has made numerous representations to the Department of Health in England about the lack of central funding for returner schemes and has called for NHS returner and retainer schemes with appropriate central funding for all branches of practice across the UK.

The BMA also advises members that they should not be forced to work on a 'voluntary', unpaid basis during a phased return.

 

Preparing for a return to work

Meeting with your GP or specialist

When you are considering returning to work following a period of ill health, it is important to talk about the return with your GP or specialist.

As well as discussing whether you are fit and able to return to your post, they will be able to suggest any changes that might assist your transition back into the work place.

Occupational Health

After stating your intention to return to work, you should have access to OH services; these should be provided to you by your secondary care employer.

Occupational health will:

  • assess your mental and physical fitness to practice
  • advise on what additional support or adaptions to the work place may need to be put in place to assist your return.
  • occupational health has a responsibility to provide advice and support to both the individual and the employer.
If you know that you have, or think that you might have, a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague.
The GMC's Good Medical Practice guidance

If an OH professional wishes to contact your GP or consultant for information about you and your health they must first ask for, and obtain, your written valid consent. You must be told what information is being sought about you and why, and you should be advised of your rights under the Access to Medical Reports Act 1988.

Return to work interview

Before returning to work, and after seeing OH, you should meet at least once with the clinical director to discuss your transition back into the workplace and the development of a return to work programme. This person should remain your key point of contact, and be responsible for overseeing your return, throughout the duration of the programme.

For those doctors who are clinical academics (with an appropriate dual contract) interviews and meetings should be conducted on a 'Follett compliant' basis if you so wish.

In order to get the most out of this meeting, it is helpful to consider what you want to discuss in advance.

Possible issues to discuss at your interview
  • What triggered the absence?
  • If your issues are ongoing, what support would you find most helpful?
  • What level of disclosure are you expecting about the circumstances surrounding your absence?
  • How long have you been away from practice?
  • Are you confident about your skill levels?
  • Do you feel that any additional training or supervision would be beneficial?
  • Have there been any changes to service management and delivery such as new standard operating procedures, NICE guidance, the management of conditions
  • Have new practices or equipment been implemented during your absence?
  • Will you require refresher training, or adaptations to the workplace, as a result
  • Has the absence had an impact on your GMC licence to practise and ability to revalidate 'on time'?
  • Is this something you want to talk to the Responsible Officer about?
  • Are you looking to have a phased return to work?
Making reasonable adjustments

Reasonable adjustments for medical students and doctors with disabilities and long-term health conditions.

 Related content

Reasonable adjustments

Most of the Equality Act came into force on 1 October 2010, repealing and replacing the Disability Discrimination Act 1995.

Under the 2010 Act, an employer has a duty to make reasonable changes - known as 'reasonable adjustments' - for disabled job applicants and employees. This duty is intended to make sure that disabled people do not face substantial difficulties in employment, education or when using services.

According to the Act, a person is disabled if they:

"have a physical or a mental impairment which has a substantial, long term, adverse effect on their ability to carry out day-to-day activities."

Long term illness is taken to mean 12 months or more, however, those with conditions that are likely to last at least 12 months, or for the rest of their life, are protected effectively from the point of diagnosis.

Reasonable adjustments can apply to your working arrangements and could include implementing a more flexible working pattern, providing you with a special piece of equipment to help you do your job, or allowing time off to attend medical appointments.

Reasonable adjustments may also be made to any physical aspects of the workplace, such as installing a ramp or lift. The employer is not entitled (subject to express provision to the contrary) to ask the employee to pay any of the costs associated with complying with the duty.

There is no fixed definition of what is 'reasonable'; this will depend on the particular circumstances, including the effectiveness of the adjustment, cost, practicality, and the extent to which the business or organisation may be disrupted. What is deemed reasonable is ultimately for the courts to decide.

The Equality Act 2010 protects people with caring responsibilities for those with impairments, or who are elderly, from discrimination on the grounds of their 'association' with this person. It would be unlawful to treat the carer less favourably then other employees on the grounds of their caring responsibilities.

However, the Act does not allow reasonable adjustments at work on the grounds of having caring responsibilities, although under the Work and Families Act 2006, carers who meet the eligibility criteria can make a request to work flexibly. There is, however, no automatic right to work flexibly.

The Government has proposed that, from 2014, the right to work flexibly be extended to all employees who have worked for their employer for 26 weeks or more.

Phased return

A phased return involves limiting the number of hours worked over a set period and gradually increasing the intensity. This option should be made available to all returners.

The length of the phased return needs to be determined on a case by case basis; this is something you can discuss with your GP or specialist and OH before any formal return to work interview. The clinical director should consider the advice given by health professionals about the necessity for, and length of, the phased return.

Opportunities to shadow senior colleagues with a similar clinical workload should be made available to you during this period, and particularly during the first weeks back at work, to allow you to re-familiarise yourself with the demands of the role.

'Altered duties' should also be considered during your phased return. This could include restricting clinic or surgical lists until both you and the clinical director decide that full responsibilities can be assumed.

It is unreasonable to be asked to use your annual leave entitlement to facilitate a phased return. If you feel that you are being forced to use your annual leave in this way, please contact a BMA Advisor.

Mentor

You should be asked if you would like a mentor to provide additional support during (and after) your return to work; if this option has not been presented to you, talk to your clinical director. Wherever possible, you should also be put into contact with other returners.

Confidentiality

Confidentiality is of the utmost importance. If you require ongoing treatment, consider if you would prefer to receive it at a different hospital or surgery from the one in which you work. It is good practice for your employer to allow you to take time off to visit a different hospital or surgery.

If your reasons for leave are confidential, this should be respected.

If these reasons could have a bearing on your competency, then the clinical director and a limited number of senior colleagues must be made aware.

The GMC's Good Medical Practice states that: '[Y]ou must disclose to anyone entitled to ask for it any information relevant to an investigation into your own or a colleague's conduct, performance or health'.