Supported Return to Training (SuppoRTT) Toolkit

Who is eligible for SuppoRRT? 

If you’re a trainee on a Training Programme, or have been allocated a National Training Number (NTN) for an upcoming scheme, and you’re returning to training following a break of at least 3 months, then you’re eligible! Examples can include coming back from: Parental Leave, Sick Leave, Out Of Programme placements (e.g. OOPE, OOPR etc), working in non-training posts, and if you have been Shielding.

What is SuppoRTT about?

Returning to training after a long break can be a challenge for a many. Firstly, knowledge or skills may potentially fade with time when they’ve not been kept up, whilst new developments in clinical practice might have occurred in the interim. Even a small attenuation in knowledge or skills can sometimes impact on confidence, which is another reason why having some additional support around the time of return may be helpful. In addition, trainees can sometimes feel isolated or disconnected from their teams or peers whilst on a break. Finally, even after a trainee returns, the need for childcare or the legacy of an illness, for instance, may impact on how a trainee prioritises and manages their work/life balance.

Supported Return to Training (“SuppoRTT”) is a Health Education England (HEE) initiative as part of the ‘Enhancing Junior Doctors Working Lives’ programme. It has been designed to enhance the experience of trainees, after a period of absence, so they can be transition back to clinical practice safely and confidently.

The SuppoRTT programme encompasses a range of additional opportunities to help provide support - the trainee can choose any number of them depending on their individual needs and circumstances.

How do I apply for SuppoRTT?

To help identify your needs and the additional training opportunities, you and your Education Supervisor should meet at three specific points in time:

Prior to Absence 

• Pre-Absence Meeting between Trainee and Educational Supervisor (approx 3 months prior to absence) 
• Complete Pre-Absense form online and upload to e-portfolio 

Prior to return

• Initial return meeting between Trainee and Educational Supervisor (approx 3 months prior to return)
• Complete pre-return form online with individualised Return Plan and application for funding. Upload to e-portfolio 

Return review

• Follow up review meeting with Educational Supervisor to discuss progress or additional training needs 
• Complete follow up review form online and upload to e-portfolio 

Once you’ve completed the online forms with your Educational Supervisor, you can also upload them onto your e-portfolio. The ‘Initial Return’ form also runs through a suite of options, including on courses and supernumerary working – once this is completed, the local HEE office will then automatically transfer funds to SABP NHS Trust, and they in turn can reimburse you (e.g. for courses, additional shadowing opportunities) or help towards funding locums (to facilitate supernumerary working). For courses, you would also need to complete the regular SABP Study Leave forms so that the Trust can then reimburse you. In all, the SuppoRTT initiative can help provide additional funds worth up to £3,000 per trainee.

For more on SuppoRTT, here are two videos: one which introduces SuppoRTT (“Introduction to SuppoRTT”), and one on the process of applying (“How to apply for SuppoRTT”).

What do I need to consider in the Pre-Absence meeting?

If you know you are planning to take a break/leave, make sure your TPD (Training Programme Director) and Locality Tutor are aware, and arrange to meet your Educational Supervisor for the Pre-Absence meeting, around 3 months before your break. If you are taking leave that was unplanned – no problem, just move to the next step.

Everyone is different, and whilst some people may wish to link in with their team, or access various work/training activities whilst on leave, others may prefer just to take time completely away from work, for example to focus on family (if on Parental Leave), or to concentrate on getting well (if on sick leave). There is no one size fits all, so it’s important to do what’s best for you!

Things you may wish to discuss with your Educational Supervisor include:

• How long you will be away.
• How you want to be contacted whilst on leave. Make sure your Education Supervisor, TPD, Locality Tutor, HR, and team manager etc have the email address you’d like to be contacted on  – this may help keep you in touch with courses or other opportunities, as well as help in organising your return to training (e.g. around rotas, placements, induction, IT access, and whether you’d like to return Less-Than-Full-Time (LTFT)). Please note that your Educational Supervisor may contact you just to ‘check in’ and ensure you are aware of support available – this does not mean they wish to pressure you to return to work any earlier than planned.
• If you’re thinking about going LTFT on your return, you can find more information in this link to our LTFT Guide (at the bottom of the webpage) which also advises on forms to complete.
• If there’s anything worrying you about being off training and/or on returning to it. Is there something you can identify that you could do whilst you are off to help with that? How can the Trust help you?
• If you know what pay you’re entitled to. Speak with HR and the BMA for help with this.
• For those going on Parental Leave, you may wish to consider using ‘Keep In Touch (KiT) days’. Trainees who are pregnant can also seek advice from the SABP “Guidance to Support Pregnant Trainees”.
• And don’t forget to complete the Pre-Absence form!

What are ‘Keep In Touch (KiT) days’?

If you’re taking Parental Leave (>3 months), you are entitled to take up to 10 remunerated KiT days, taken individually or consecutively. These are funded by the NHS Trust, and applications are made via HR. KiT days do not extend the Parental leave period, and you cannot work during the two weeks of compulsory maternity or adoption leave.

Trainees should work with their Clinical/Educational supervisor to consider what activities would be beneficial and feasible – any such days would need to be done by agreement. KiT days can be used for a whole range of purposes:

• shadowing colleagues in clinical setting, such as clinics or on-call.
• clinical work (under supervision).
• attending clinical/professional/work-related meetings, including meetings with supervisors.
• conducting audit, research or QI projects.
• attending courses - external, internal, statutory/mandatory training, or induction days.

If you are involved in any clinical work, it would be important to ensure that a contract with the Trust remains in place (for governance/insurance purposes) and your own medical defence cover.

If you’re moving Trusts (e.g. due to inter-deanery transfers etc), KiT days are paid via the Trust you last worked at, since they are paying your maternity leave. If however you plan to use the KiT to shadow or engage in clinical work in your new Trust, you would need an honorary contract with them for governance/insurance purposes.

Please note that remunerated KiT days are confined only to Parental Leave. Although you can take KiT days during periods of Annual Leave before returning to training, these are not remunerated – instead, you can take corresponding days in lieu once you’ve returned to training.

In terms of remuneration, there are a number of variables that may determine how much you will receive for the KiT day, including the amount of Parental Leave already being paid at that moment in time. It is therefore important to discuss remuneration with HR, and agree in advance in writing how much you will be paid for working a KIT day. There may also be scope for reimbursement of childcare costs, although this is not a mandatory requirement on the Trust.

Any work undertaken on a KiT day - even if just an hour - will count as “one KIT day”. You will however only be paid for the hours worked on a KiT day, whilst hours worked which exceed the normal working day are not paid. Please note that working over 10 KiT days automatically terminates the Parental Leave.

A risk assessment needs to be carried out if you’re breastfeeding, and facilities must be provided, including for rest breaks.

Please note that for Shared Parental Leave in Training (SPLIT) days, the BMA have stated that the rules are the same for SPLIT days as KIT days.

What do I need to consider in the Initial Return meeting?

Around three months prior to returning to work, contact your Training Programme Director (TPD) to confirm the post you will be returning to, and HR to confirm rota arrangements. Arrange the Initial Return meeting with your Educational Supervisor.

Things you may wish to discuss with your Educational Supervisor include:

• What are your main concerns about your return to training? Sharing worries is not a sign of weakness! It helps people put in support if and where you need it.
• Do you need an occupational health review prior to return to work? Access this via your TPD.
• What will your first few weeks back at work look like? What will you be doing? When? With whom? Who will be supervising you, and how frequently? What Work-Based Assessments would be useful in the early stages back?
• And don’t forget to complete the Pre-Return form. This runs through a suite of support options, including on courses and supernumerary working – once this is completed, the local HEE office will then automatically transfer funds to SABP NHS Trust (via the “LDA system”), up to £3,000 per trainee. In turn, the Trust would reimburse you for courses - you would also need to complete the regular SABP Study Leave forms too.  It’s best to put as much as you think you need on the form, whether or not you end up taking up all the options.

What additional support options are there?

• External courses specific for Returning to Training – courses may come and go, so it’s worth checking the London & KSS SuppoRTT website for an up-to-date list. Relevant courses available in 2020 include the Maudsley Learning Personal Skills and Wellbeing course (a one-day course for psychiatry trainees returning to clinical practice after an absence) and Health Education England “V-SPACE virtual group programme” ( a facilitated meet-up in virtual space for a small group of up to 15 returning doctors across all specialties).

You can also apply for regular clinical or professional training courses – mandatory, optional or relevant aspirational. Courses can be reimbursed via the SABP Study Leave form; the Trust can then claim the money back from HEKSS for courses beyond which is normally covered by Study Leave via the “LDA system”. The SuppoRTT funding offer generally applies to courses that occur within a window 3 months on either side of the return date. For those on Parental Leave, you can apply for both a KiT day (to cover that you’re effectively ‘working’) and also funding from SuppoRTT (to cover course fees).

When applying for these specific “returning to training” courses (as opposed to curriculum-based courses), please use the code “SRTT0001” on our Study Leave form (and also when referencing the course on the SuppoRTT online forms too).

• SABP Simulation Workshops – either before or after your return to work, we provide 1:1 or small group simulation specifically for returning trainees. If you are interested, please notify the SABP Simulation Lead (Dr Vimal Manali) to arrange a session. In addition, you can also join any of the trainee simulation workshops offered in the Trust. These include monthly sessions delivered to Foundation Trainees at West Park Hospital Epsom (email Medical Education department to arrange a place) or the simulation sessions offered as part of some Academic Programmes (email the respective Locality Tutor).
• ‘Human Factors’ Return-to-Training workshop – we have secured places on the East Surrey GP Training Scheme for SABP trainees to access workshops, which particularly look at some generic aspects of Returning to Training, and include both developing skills and discussing any concerns or issues arising when it comes to returning. Please contact your SuppoRTT Champion for details on upcoming sessions.
• Coaching - via the HEE London & KSS ‘Professional Support Unit’. Coaching is a way of developing your skills, abilities, self-confidence, and resilience. A central feature is that the individual is able to take charge of their own decisions and development to realise their full potential.  The coach is there to facilitate this process through structured questioning, often challenging the status quo, helping the coachee to find their own solutions, in a coaching relationship that is open, honest and respectful.
• HEE London & KSS’s ‘Professional Support Unit’ - also deliver various courses (e.g. on achieving work-life balance, consultation and communications skills, managing exam stress, assertiveness training etc). Many are small-group teaching and utilise role-play.
• Supernumerary working – you have the opportunity to shadow, either during the run up before your return date (probably best taken as a KiT day for those on Parental Leave), or in the initial days of your return. The HEE SuppoRTT office funds Trusts £200 per day, which can either be used to pay you directly (e.g. to shadow a colleague, either prior to your return date or observing them as part of an on-call) or potentially help fund a locum to free you up to shadow or to help cover on-calls. If supernumerary working is something you’re interested in, please do note the maximum you think you’d need on the form, even if you end up changing the details later on.

• Enhanced supervision – more frequent supervisions in the initial weeks of returning to training can be arranged with your Clinical Supervisor, as well as planning Work Place Based Assessments to help give you feedback in those early days.

What do I need to consider in the Follow-Up Review meeting?

This meeting’s an opportunity to review how the return has gone, approximately a month or so after your return. That said, if you’re struggling to cope don’t wait for this meeting– go and get help if you need it in the interim. At the meeting, it is decided whether this period of additional support needs to be extended, or whether it can be ‘signed off’ via the Follow-Up Review form.

Case Study

Jasmine is a Psychiatry CT2 Trainee who applied to take time out of training for maternity leave (9 months) after the arrival of her son.

At the Pre-Absence meeting with her Educational Supervisor, she reflected on her feelings of apprehension about feeling out of touch with her work life, and particularly about whether she would feel out of her depth on her return. They discussed using KiT days to help with this, and she liaised with HR to discuss logistics and payment.

During Maternity Leave, she applied to use: five KiT days on separate individual days to shadow a colleague in psychiatry clinic and attend team meetings; three KiT days to attend the Academic Programme to help keep in touch with some knowledge and skills; one KiT day to attend the East Surrey “Human Factors workshop”, and one KiT day to attend the Maudsley’s SuppoRTT course just prior to her return. Given she was keen to be in touch with work during her leave, she also gave her Gmail address to the team manager, Educational Supervisor, and a couple of trainee colleagues, who periodically liaised with her via email.

At the Initial Return meeting, she met with her Educational Supervisor and identified various options for support, noting this on the online SuppoRTT “Initial Return form”. Before doing her own on-call out-of-hours, she arranged to shadow colleagues for five separate on-calls (all taken as part of the evening) to gain more confidence and to catch up on knowledge and skills. This was specifically identified on the form, so the HEE SuppoRTT team paid a total of (5 x £200 =) £1000 to SABP Trust, who in turn reimbursed her for the respective additional hours.

She accessed six free coaching sessions via the HEE Professional Support Unit during the first few weeks of her return. She was quite dubious of this at first, but was surprised by how helpful it turned out to be! It helped her manage her concerns around feeling out-of-depth, her thoughts about achieving a work/life balance that best suits her, and helping her identify her overall developmental goals.

She arranged to attend Trust’s Simulation workshop in the month of her return, set up by emailing Anthonia in the Medical Education Department. She arranged some additional Work Place Based Assessments with the Clinical Supervisor in order to provide some additional feedback on progress, so two Mini-CEX’s and two CBD’s were arranged for the first month. She also attended a RCPsych course on psychotropic medication in the second month – she completed a Study Leave form for the Trust, who reimbursed her at the next paycheck; as she also recorded the course on the SuppoRTT online form, the Trust were reimbursed themselves from the HEE SuppoRTT team.

At the final Follow-Up Review session one month in, Jasmine reflected on her experience of transitioning back to work. Although it had all been quite a large adjustment, both logistically and emotionally, she felt that it had gone well overall, and the additional support was valuable in helping with the transition.

Who’s who in the SuppoRTT process, and what are their roles?

Step 1: Identifying trainees Pre-Absence and advising on next steps 

Trainees taking break to inform HR, ES, CS, TPD. 

• Trust HR/DME can include question in New Starter Recruitment Process
• Trust HR/DME can identify trainees at induction 
• School of Psychiatry will know if trainee has applied for OOP 
• Liaison between: Trainee, Trust HR, DME, Locality Tutor, ES, CS, SuppoRTT Champion, TPD and School of Psychiatry - keeping each other updated, including on date of absence/return 
• Trainee and ES to do Pre-Absence meeting (and complete respective online form) 3 months prior to absence 

Step 2: Identify trainees Pre-Return and advising on next steps

Trainees returning from break to inform HR, ES, CS, TPD. HR/ DME to identify trainees on recruitment on new starters. 

• Trust HR/DME can identify trainees at induction 
• Liaison between: Trainee, Trust HR, DME, Locality Tutor, ES, CS, SuppoRTT Champion, TPD and School of Psychiatry - keeping each other updated, including on date of return 
• Trainee and ES on the Pre-Return meeting (and complete respective online form) 12 weeks prior to date of return 

Step 3: Implement Return-To-Training support 

• Once Return-To-Training plan agreed, key individuals informed (e.g. Locality Tutors over any rota adjustments; Clinical Supervisors if enhanced supervision; Occupational Health if needed, SuppoRTT Champion to advise on courses etc.)
• HR to send out rotas 12 to 16 weeks in advance of return
• Additional support measures implemented post-return 

What about for GP Trainees?

GP Training is usually based in secondary care in the first two years of training (trainees rotate between various locations and specialty posts), followed by placement in primary care for their final year. They are employed by a Lead Employer based in a specific region.

GP Trainee’s Role & Responsibility
If you know you are planning to take leave or an OOP, there are some key individuals you need to inform: TPD, LEO, Specialty School and the outgoing Trust/Department. If you are rotating to a different department/specialty, please contact your LEO for details of the post.

Lead Employer Role & Responsibility
Once LEO is informed of Trainee’s upcoming absence, they can send the Trainee an information pack with SuppoRTT information and encourage a Pre-Absence Meeting.

The LEO will identify at recruitment those trainees who will be starting training following an absence. For trainees already on the programme returning from a break, the Lead Employers need to inform the trainee which location and post they will be returning to. The LEO team will also need to inform the host trust’s HR and DME about the return.

Trust Role & Responsibility
The Trust HR should have a method to identify and inform the LEO, Medical Education Department and Clinical Supervisor the dates of the trainee’s period of absence.

When the GP Trainee is returning, the Trust HR/Medical Education Team need to ensure the clinical supervisor is aware the trainee is returning from an absence and can be contacted by the trainee. Trust HR should provide duty rotas within 12 weeks of the trainee’s return date and make accommodations as per the trainee’s Initial Return Plan. If necessary, liaise with the Trust SuppoRTT Champion.

Specialty School /Healthcare Education Team Responsibilities
The GP Trainees approved for OOPE/C should be directed to SuppoRTT processes and advised to have a pre-absence meeting. HET should inform the LEO the dates of trainee absence in advance.   

TPDs and GP SuppoRTT Champions can highlight courses for return to work in the primary care setting, and generic courses if the trainee is in their final year. However, if trainee is returning to another specialty, they can contact Specialty School Champions to help identify relevant local courses.  They should also encourage the trainee to complete the SuppoRTT Initial Return form online. They should liaise with Clinical Supervisors in the departments in trusts (when required) to ensure Trainee Return plans are in place and the trainee is well supported in the post they will be returning to (they will be sent the schemes by the LEO).

Why was the SuppoRTT initiative set up in the first place?

There are approximately 50,000 doctors in England who are currently undertaking postgraduate medical training. At any given time, there are approximately 10% of postgraduate doctors taking approved time out of programme. This is a normal and expected part of many doctors’ progression through training and life.

They may take variable lengths of time out of training for numerous reasons which includes: Parental leave, Carer’s leave and Sickness. It may also include a formal Out of Programme period for Experience, Research, or a Career Break.

The Academy of Medical Royal Colleges (AoMRC) suggests a period of absence of 3 months or more is likely to have a significant impact on a doctor’s clinical skills and knowledge. In some cases, trainees who have had a prolonged period of absence have been expected to immediately return to full duties, including on-calls without a re-introduction period, which potentially has negative implications for the trainee and patient safety.

The 2016 Acas junior doctors’ contract agreement committed Health Education England (HEE) to develop innovative, evidence-based initiatives to “remove as far as possible the disadvantage of those who take time out”. The Secretary of State for Health reaffirmed this government commitment in his keynote speech to NHS Providers in November 2016 and the Department of Health recurrent annual funding from the 2017/18 financial year to support the delivery of this commitment.

HEE has taken this work forward under the working title Accelerated Return to Training, and sitting within HEE’s Enhancing Junior Doctors’ Working Lives programme. The consensus from stakeholders across the board was that any national Return to Training programme should provide trainees with a bespoke, individualised package of support, and that many of the items of support already exist; however, a defined process and more centralised co-ordination would ensure better equity of access to appropriate resources for all trainees.

The Supported Return to Training Programme (SuppoRTT) was developed to enhance the experience of doctors returning to clinical practice, enabling them to regain their confidence and previously required skills quickly and safely, significantly benefiting patient safety and quality of care. It has been designed to be flexible, taking into account the differing nature and length of absence, as well as the specialty and experience of the trainee, to ensure that the individual can safely and confidently return and practice within their training programme.

Resources

• SABP SuppoRTT Champion – Dr Aaron Vallance aaron.vallance@sabp.nhs.uk
• SuppoRTT website
• Videos - Introduction to SuppoRTT and How to apply for SuppoRTT
• Case Studies in SuppoRTT
• Forms – Pre-Absence and Pre-Return and Follow-Up
• More information on SuppoRTT from LKSS
• Courses - Maudsley Learning Personal Skills and Wellbeing course and Health Education England “V-SPACE virtual group programme”. (CNWL also put on occasional courses for returning psychiatry trainees – information will be disseminated at the time.)
• London/KSS Professional Support Unit (PSU)