Trainees told Health Education England (HEE) that existing out of programme mechanisms (out of programme experience [OOPE], out of programme research [OOPR], out of programme career break [OOPC] and out of programme training [OOPT]) provided a degree of flexibility, however none of these mechanisms recognised that trainees sometimes wish to “pause” their training to undertake an NHS non-training post, gain further experience, take stock of their training, work in another related specialty, or concentrate on their wellbeing. Out of programme pause (OOPP) allows trainees to step out of formal training for up to one year to undertake an NHS or other patient facing UK based non-training post. This flexibility initiative can be a vital tool to support trainee wellbeing.

The initial pilot for OOPP was launched in Spring 2019, where OOPP was offered to Anaesthetics trainees in the East Midlands. Phase 2 commenced in summer 2019, with selected specialties in Wessex, North Central and East London, and the North East taking part, along with the remaining specialties in the East Midlands. The scope of the pilot has been supported by the GMC, and this phase 3 extension of the pilot will now encompass all specialties across England for the next 12 months, in large part as a response to the effects of the Covid-19 pandemic on trainee wellbeing. A robust external evaluation of the pilot is underway.

This pilot initiative also gives trainees the opportunity to have any competencies gained whilst out of training assessed upon their return. This may allow trainees to minimise the impact on the time out of programme has on their CCT date. OOPP differs from out of programme for experience (OOPE) because in OOPE, none of the experiences or competencies/capabilities gained whilst OOPE can be directly counted toward CCT.

If you are on a tier 2 visa sponsored by HEE, please be aware that upon undertaking an OOPP post, your visa sponsorship with HEE will be cancelled and you will need to apply for sponsorship with your new employer whilst undertaking your OOPP placement. Upon returning to your training programme with HEE you will need reapply for sponsorship to the HEE Tier 2 team, you will not need to go through recruitment process again and can commence directly back into training. If you are considering any other immigration route other than Tier 2 while out on OOPP you are advised to contact the Sponsorship team ( england.sponsorship@nhs.net ) before your sponsorship is withdrawn as you may be subject to a 12 month cooling off period, set by the Home Office, before returning to training with HEE.

If you elect to take a period OOPP you must discuss and agree this with your educational supervisor and training programme director. This agreement is to ensure that going OOPP does not destabilise the educational or service sufficiency of the programme you are in. After this, the application can proceed once details of when and where you will be spending the time out of programme have been confirmed. The OOPP section of the OOP form should be completed, together with the OOPP initiation document that sets out your plan for OOPP, your intended scope of practice, indications of possible capabilities you may acquire, plans to return to training and any pertinent indemnity considerations.

Please talk to your employer and/or trade union. You should be aware that any time spent out of programme in a non-NHS setting will have an effect on both your cumulative NHS service you’re your continuous employment. This has practical implications for employment rights such as pay, pension entitlement, maternity leave and pay, parental leave, and other entitlements. If you are considering going out of programme, you can speak to your employer and, if you are a member, the BMA, for further advice on these issues.

The employer will normally be the organisation paying your salary during your period working OOPP.

Whilst on OOPP, your RO will remain your postgraduate dean. The specific considerations around revalidation our outlined below. You will be asked to identify who the RO of the employing organisation you will be working with during your OOPP in your OOPP initiation form, where this is applicable.

To proceed with OOPP you must take a patient facing role with a UK registered organisation. Whilst the majority of roles would therefore be based in the UK, this does allow you to undertake roles overseas with organisations such as MSF.

Should an Out of Programme Post come to an end sooner than expected, you should contact your HEE office as soon as is practically possible to facilitate a return to your training programme. This will be subject to programme capacity. Once returning, the standard process for assessing competence gained whilst in the OOPP post will commence.

Whilst you are not obliged to return to your training programme from a period OOPP, a decision to not return should be communicated formally to HEE in line with an appropriate notice period relevant to the level of training, to indicate your resignation from the training programme and your wish to relinquish your national training number .

You would return from OOPP alongside/after completing any relevant return to training (RTT) programme elements and have an initial educational appraisal meeting with your Educational Supervisor to consider the experience and any competencies gained during your OOPP. A ‘gap analysis’ would be conducted with a judgement on what may have been achieved with respect to both Generic Professional Capabilities and specific curriculum outcomes. This would form the basis of a training plan. Once the initial educational appraisal meeting has taken place, you will have an opportunity to demonstrate your skills and capabilities as part of your prospectively approved training programme. This would ideally be undertaken in the first three months following return to training, to allow you and your Educational Supervisor to ensure the training plan is appropriate and properly focus learning objectives in advance of the next Annual Review of Competence Progression (ARCP); Following OOPP, if you and your Educational Supervisor do not want to count
competences and did not feel an adjustment to the CCT date would be appropriate then there would be no requirement to do so. At the ARCP, a formal determination of outcome would be made with an adjustment to the CCT in light of demonstration of competencies evidenced following return to training and the Educational
Supervisor’s report; this would be in accordance with Gold Guide and GMC guidance .

Other forms of OOP will remain available but applying to go on other OOP opportunities will be subject to the normal procedures whereby the relevant specialty school and the Postgraduate Dean would make an informed decision in each case, in line with all other such applications.