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Returning to clinical practice - 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. In addition to assessing your mental and physical fitness to practise, OH will advise on what additional support (eg reduced working hours, no on-call) or adaptations to the work place may need to be put in place to assist your return.

The guidance in the GMC's Good Medical Practice states that "[i]f 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."

Occupational Health has a responsibility to provide advice and support to both the individual and the employer. 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.

Further information

Know your rights under the Access to Medical Reports Act 1988 - see our guidance on confidentiality and health records

 

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 cover at the return to work interview include:

  • 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?

 

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.

Case study

Read our real-life case studies which highlight the inconsistent provision of reasonable adjustments in the workplace

Watch our video case study about making reasonable adjustments in the workplace

 

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.

Case study

Read our real-life case study on a doctor's phased return to work

 

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.

Information iconIt 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 on 0300 123 1233.

 

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'.

 

References
The Equality Act 2010 defines substantial as being 'more than minor or trivial'.
General Medical Council (2009) Good Medical Practice. Guidance for Doctors. London: GMC.