Going abroad Consultant SAS doctor

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Volunteering as a SAS doctor or consultant

medical camp in conflict zone

If you are a SAS doctor or consultant, there are plenty of options for taking time out of employment to volunteer abroad.

The same provisions are available to both SAS doctors and consultants. The right option for you will depend on your professional circumstances and the length of time you plan to take out of employment.

 

  • Time out of employment

    Health professionals working in the NHS have many different professional aims throughout their careers. Many doctors want to take time out of employment in the NHS, including to volunteer, without losing their position in their local service or adversely affecting their career progression.

    It is important that policies are in place to enable NHS staff to flexibly incorporate a period of absence into their careers. This can benefit employers, as health professionals gain valuable knowledge and skills through international experiences. Employee satisfaction and retention can also be improved following a period of time spent practising in a resource-poor setting.

    If you are considering taking time out of employment you should, in the first instance:

    • Contact your HR (human resources) department for information about the terms and conditions of the various options for taking a break from employment
    • Discuss your plans with your clinical manager

    There is no national requirement for individuals to resign from employment to take time out to work overseas in low-resource settings.

    There are different mechanisms for taking time out of employment, according to your specialty, position and location. These are discussed in detail the following sections. When researching which type of time out may best suit your needs, you may want to get advice from both your employer and the medical royal college for your specialty.

    For all types of time out, it is important to find out about the terms of the break. These include notice periods, professional registration needs, and your rights and obligations when you return to work. We strongly advise you to have a written agreement with your employer covering these topics before your period of time out commences.

    Resources for taking time out

    Request a break from employment - template letter

    NHS Employers terms and conditions of service handbook - Section 36: Employment break scheme

  • Short breaks

    Employers may grant shorter periods of professional or study leave outside the UK. Conditions of such leave are agreed by individual employers, subject to their ability to maintain NHS services in your absence. The standard expected should be thirty days with pay and expenses in any period of three years.

    It is worth noting that a Department of Health circular from 1979 established the principle that employers ‘should accept the natural consequences of granting study leave, so that all reasonable expenses associated with the period of approved study leave are paid’ (paragraph 14).

     

    Study leave

    Study leave can be used to work or volunteer abroad for shorter periods if an educational component is the principal reason for absence. You will need to demonstrate the educational content of time out of employment to work in a resource-poor setting, and agree budgetary resources with your employer.

    NHS Trusts or Health Boards may also allow you to use one or more years' study leave allowance (both in time and financing) to enable a longer period of absence. In addition, NHS Trusts or Health Boards have the discretion to grant additional study leave where there is a sufficiently compelling case. The day-to-day administration of study leave rests with the employing NHS Trust or Health Board.

     

    Unpaid leave

    You may also apply to your employing NHS Trust or Health Board for a period of unpaid leave. This can be used separate to or following on from a period of professional or study leave to extend the time available.

  • Longer breaks

    Making a significant and sustainable impact in resource-poor settings often requires a period of absence longer than your annual or study leave allocation can accommodate.

    National employment break scheme

    National contracts for doctors and other NHS staff require that NHS employers provide access to an employment break scheme for all NHS staff. This is set out in Specialty Doctor and Associate Specialist and Consultant National Terms and Conditions of Service for each of the four nations of the UK.

    The NHS Employment Break Scheme is an extended period of unpaid leave available for approved purposes, including working or volunteering abroad in resource-poor settings. Specific conditions apply, and you will need to clearly state the anticipated benefits of taking time out when applying for an employment break.

    Employers will consider break requests alongside service delivery needs. However, an employment break should only be declined if there will be a substantial negative impact on service delivery. If your application is declined, you are entitled to a written reason for the refusal.

    The experiences gained from a break in employment working abroad in a resource-poor setting can enable doctors to develop skills that could not be achieved from regular work in the NHS.

    All Trusts and Health Boards should have policies setting out how employees can take a period of unpaid leave as an employment break. The process for applying may vary between employers. In some cases, the employment break scheme may be incorporated into flexible working policies.

    To use this scheme, you should ask your employer's HR department for their employment break policy and relevant guidance. This should include local policies and requirements, such as length of continuous service and minimum and maximum length of employment break. (Note that the scheme should normally be open to all employees who have at least 12 months' service).

      

    Sabbaticals

    Detailed provisions for sabbatical leave are set out in section 7.4 of the Terms & Conditions for Consultants in Scotland. Consultants in other nations, and SAS doctors in all four nations of the UK, can apply for sabbatical leave in accordance with the policies of their employing organisation.

     

    Agreements with employers

    The details of an employment break should be set out in a written agreement between you and your employer before the break begins. The agreement should cover:

    • Duration - National guidance states that you may take a break of up to five years. This can be taken as a single long break or multiple shorter breaks. It should be possible to extend your break, with appropriate notice, or return early.
    • Continuity of service – Your agreement with your employer will need to be clear about the effect of the break on various entitlements related to length of service. Policies should guarantee that if you return to work within one year, the same job will be available (where reasonably possible). If the break is longer than one year, you should be able to return to as similar a job as possible. Information about the impact on your pension should also be available.
    • Notice periods – You must normally give at least three months’ notice. We recommend giving six months’ notice, or more if possible (see section on Notice periods below).
    • Arrangements for keeping in touch during the break – The agreement should clearly state your responsibilities and those of the HR department or relevant professional development personnel (see section on ‘Recording your experiences’ below).
    • Re-introduction to employment – Agree any re-orientation or training you may need before returning to work.
    • Resignation – You should not be required to resign if you plan to return to the NHS after your employment break.

    You are normally not allowed to undertake any paid work during an employment break. There may be exceptions if, for example, work overseas or charitable work could broaden you experience. If you have agreed private practice sessions, you should clarify the terms of the local practising privileges policy with your private employer and NHS employer.

    In some cases, doctors working or volunteering abroad are paid a modest living allowance and travel expenses, for example, by a charitable organisation. This should not normally be a reason to refuse an employment break. We suggest that you ask your overseas employer to confirm your salary in writing and share this information with your employer when you apply for an employment break.

     

    Application process

    If you are employed by an NHS Trust or Health Board, your manager normally signs your application for an employment break. Their manager or the head of department will then approve it. You should also tell your HR department.

  • Notice period

    You must discuss your intention to take time our of employment with:

    • Relevant colleagues
    • Professional mentors
    • HR representatives

    Three months is the minimum notice period recommended by national guidance. This will help your employer to make sure that your patients' needs are met while you're away. 

    Let the staff who are responsible for approving applications know about your plans to take time out as early as possible. This will ensure you have plenty of time to resolve any queries or issues. It is normally acceptable to give notice with the understanding that you will confirm the final details later.

    Minimum notice periods vary depending on your employer, but are usually at least three months. We strongly recommend that you to give at least six months’ notice, or more if possible. Starting the process early, particularly informing key staff, can increase the likelihood of your application being approved.

    You may find it helpful to review the Terms & Conditions of the national contract you are under:

      (i) Schedule 25 of the Terms & Conditions for Consultants (England) (2003)

      (ii) Appendix 12 of the Terms & Conditions for Consultants (Scotland)

      (iii) Schedule 25 of the Terms & Conditions for Consultants (Northern Ireland)

      (iv) Schedule 22 of the Terms & Conditions for Specialty Doctors (each of the four nations of the UK - 2008

      (v) Schedule 23 of the Terms & Conditions for Associate Specialists (each of the four nations of the UK - 2008)

  • Appeals

    If you feel that a decision or process regarding your application to take time out is unfair, you can appeal.

    Appeals processes provide:

    • The opportunity to resolve incorrect decisions or improve processes
    • Feedback to employers about how systems are working
    • Lessons for you, your employer and any other parties involved

    It is important that all parties commit in advance to respect the final appeal decision, regardless of the outcome. This will help to maintain the professional relationship between you, your colleagues and your employer.

    You can appeal if your application for an employment break is refused by your employer. However, your appeal will not normally be considered if your application was refused because you did not submit the required documentation.

    Reasons for appeal may include:

    • Your employer has not followed the correct process for assessing your application
    • Evidence of prejudice or bias in how your application was assessed

     

    Appeals process

    There are no national standards for what appeals processes must look like.

    Local employment break policies should normally ensure that you are given a reason, in writing, if your application is refused.

    You may also use the Trust's or Health Board's grievance procedure if you feel that your request for an employment break has been unreasonably refused.

    Your request for an employment break may be declined or postponed if your employer believes it may have a substantial negative impact on service delivery. This may be because your employer is not able to recruit additional staff or reorganise work amongst existing staff.

  • Recording your experiences

    You should discuss with your manager or head of department how to maintain contact while you are overseas.

    It is important that you stay informed about professional developments, such as service or training changes in the NHS or your area of specialty. This will help you to re-enter the health service when you return.

    HEE and the NHS Overseas Volunteering group have developed a toolkit to help NHS staff record examples of their professional development while volunteering abroad. The toolkit provides a framework for volunteers to collect evidence about knowledge and skills gained when taking part in international health projects, no matter what job role or grade.

    If you choose to maintain your GMC registration during your time abroad, you must continue to meet GMC requirements. You will need to show that you have kept up to date with CPD in order to return to practise in the UK.

    It is important to find out how your absence will affect your CPD. If possible, try to maintain UK-standard CPD practices during your absence. It may also be helpful to ask your medical royal college for advice about equivalent CPD.

  • Returning to the UK

    If your employment break lasts less than 12 months, you and your employer should agree on an appropriate re-orientation or induction for when you return.

    If your employment break lasts 12 months or longer, your NHS employer may arrange training to re-introduce you to the workplace. Your employer should agree this with you in advance.

    SAS doctors and consultants can find clear and detailed information about arrangements for returning to work in SAS NTCS and Consultant NTCS.

    We strongly recommend that you agree the requirements for returning to work with your employer, and record them in writing, before your break in employment begins. This should include the funding, training and other support that will be available to support your re-induction to work.

    Reporting back to colleagues

    You may wish to share the knowledge and skills you have gained by working abroad in a low-resource setting with your UK colleagues.

    This can also help you to organise your clinical experience for future job applications, and for appraisal and revalidation.

    There are several options for reporting back, including:

    • Lunchtime seminars
    • Presentations to medical and other staff within your organisation
    • Articles in journals
    • Blogs or online articles, such as in the ‘Doctors as volunteers’ forum on our the BMA’s social media platform, Connecting Doctors