Frequently Answered Questions
Why have I been referred to the Professional Support Unit (PSU)?
Your referrer should have discussed the referral with you, and the type of support they hope may be provided. You will be able to further discuss the reasons for the referral with your case manager.
What happens now?
Once you have been referred to the PSU, you will be contacted by the PSU Admin team and will be offered either an appointment to meet with your case manager, a phone call or some support measures available to you by email. These steps will provide an opportunity to discuss any issues, and to raise any concerns you may have.
Who will my case manager be?
Your Case Manager may be a senior clinician from the Region or, a Non-Clinical Case Manager, who has a wealth of experience in supporting trainee's requiring additional support, advice or guidance.
Do I have to come to the meeting?
You are not obliged to engage with the PSU, but the purpose is very much about supporting you to make progress with your training. Your engagement demonstrates a professional commitment to your practice. If you don’t engage, you may miss out on valuable opportunities. the PSU team will then obliged to inform the referrer.
How do I find time to attend this meeting?
This meeting is about supporting you and helping you progress with your training. As engagement with the PSU may form part of your professional development, it is usually expected that you attend during working hours, and given sufficient notice, your department will make arrangements for you to attend.
What type of support is available?
An individual support plan will be agreed between you and your case manager. Not every person seen requires additional support, but possible options include:
Communication skills support
Independent high level occupational health advice
Exam Support Workshop's
1:1 Exam Skills coaching
Are the meetings confidential?
Anything discussed with the PSU will be treated in the strictest confidence, and will only be shared outside of the PSU with the consent of the trainee. However this is subject to the professional, ethical guidelines of the GMC/GDC and the need to protect patients, self and the public from harm and abide by the law. If the Professional Support Unit "PSU" believes that professional, ethical principles or laws are being broken by the individual, the trainee will be advised of this and the contents of the meeting will be shared with the Postgraduate Dean or nominated representative to determine appropriate action including GMC referral.
Are all details held confidentially by the Professional Support Unit?
Records of discussions with your case manager are stored separately from your main training file and only staff members of the PSU can access them.
Who might information be shared with?
The agreed action points or outcomes and of any discussion along with your level of engagement will be shared with key individuals to support you and your training. These would usually include the referrer, and/or programme director. You will have an opportunity to discuss and check this information first.
How long can I have case manager support?
The PSU aims to support trainees throughout the whole of their training should the need arise however, trainees often do not need such continuous, high level support after initial support is identified and put in place.
Does the PSU follow any principal guidelines?
You and your case manager are bound by the requirements of the GMC “Good Medical Practice” guidelines and all postgraduate specialty training is referenced by “The Gold Guide” (see links).
Can I refer myself?
Our framework relies on most training concerns being addressed at a local level first thus, we feel a referral is better received from an educator on your behalf as this provides a better structure for support enabling us to work more collaboratively to explore and access additional support.
However, for trainees having experienced continual exam failure (2 or more attempts) a self referral "Form E" can be completed. TPD's should still be made aware of any trainee requesting additional support so that they can provide local support in addition to the support accessed via the PSU.
Please Note: The Exam Support put in place is typically across 8 sessions on a 1:1 basis and therefore a minimum of 12 weeks notice (prior to exam sitting) is required to ensure adequate support is provided.
What is the Professional Support Unit?
The Professional Support Unit (PSU) exists to help get doctors in training back on track with their training. Support may include the dedicated time of Case Managers for 1:1 assessment and support, and, when needed, access to problem specific expertise or supernumerary placement funding.
What is the role of a Case Manager?
Their role is to assess and manage doctors in training referred to the PSU, by carrying out an objective assessment, based on available information and their own findings. They identify what further action is required and access the relevant support. They then continue to support the doctor in training and monitor their progress, reviewing the situation until problems are resolved. A Case Manager will communicate with relevant parties and document their assessments and actions taken.
What are the possible signs of a doctor in training who needs referral?
The ‘Disappearing Act’: - not answering bleeps; disappearing between clinic and ward; lateness; frequent sick leave.
Low work rate: - slowness in doing procedures, clerking patients, dictating letters, making decisions; arriving early, leaving late and still not achieving a reasonable workload.
‘Ward Rage': - bursts of temper; shouting matches; real or imagined slights.
Rigidity: - poor tolerance of ambiguity; inability to compromise; difficulty prioritising; inappropriate ‘whistle blowing’.
‘Bypass Syndrome’: - junior colleagues or nurses find ways to avoid seeking the doctor’s opinion or help.
Career problems: - difficulty with exams; uncertainty about career choice; disillusionment with medicine.
Insight failure: - rejection of constructive criticism; defensiveness; counter-challenge.
Paice, E (2006)
What are the different levels of concern and how are they dealt with?
Level 1: Low Level Concerns - Trust/Specialty
Level 2: Intermediate level Concerns - Trust or Specialty/HEEoE
Level 3: High Level Concerns - HEEoE with access to Remedial training.
What form do PSU ‘level 3’ concerns generally take?
Serious untoward incidents
Serious and/or repetitious performance problems (health, conduct or capability)
Complaints from patients, relatives or healthcare professionals
Poor performance in the workplace clinically, managerially or inter-personally
No or limited insight into difficulties
High level risk to patients and others
Failure to engage in the educational process
Erratic behaviour or issues around bullying or harassment
How do I make a referral to the PSU?
Level 1 Concerns
Where concerns are of a low level nature, the Educational and Clinical Supervisor, or for GPST in conjunction with the TPD, should discuss these with the trainee and document the discussion by completing the Professional Support Framework (FORM 2). Information regarding the concern and resolution must be recorded in the Educational Supervisor’s report.
With early intervention, low level concerns will be resolved without further escalation. Where appropriate, careers support and/or input from Occupational Health may be of benefit. However any concerns, even if resolved, should be documented and communicated through the Educational Supervisor’s report and e-portfolio for consideration by the trainee’s next ARCP panel.
Level 2/Level 3 Concerns
Where concerns are of an intermediate or serious nature, there should be an escalation of approach within both the Trust and the appropriate Postgraduate School (Foundation or Specialty). The Professional Support Framework (FORM 2) can be used to guide review and discussion with the trainee.
In addition, the Professional Support Unit should be notified using a PSU Referral Form (FORM 1). This will normally be undertaken by a TPD or HOS, but may also be an Educational Supervisor. The trainee must be notified that the referral is being undertaken.
What happens after I submit the referral forms?
Referrals are screened and triaged by the PSU Team, then allocated to an appropriate case manager. The trainee will then be either;
- invited to a face to face meeting,
- invited to undertake a telephone conversation,
- emailed with next steps.
When should a referral be made to Occupational Health?
The Occupational Health service can advise on the impact of work on health and of health on work. It is important to take advice when a doctor’s health is considered to have the potential to impact the safe care of patients and, in order to help decide on the appropriateness and manner of a return to work after sickness absence.
Would I ever have to consider informing the next LETB if a doctor in training who has had issues is moving on?
Yes. There is a professional obligation to inform the next LETB if a doctor in training has unresolved issues or ones that could re-emerge and might have an influence on their practice and/or training. This should be done with the doctor’s involvement and ideally also their consent. The most appropriate people to inform would be the DME and Dean.