Enhanced Supervision
In order to rapidly regain clinical knowledge and confidence, the Postgraduate Doctors and Dentists will be strongly encouraged to participate in a period of ‘Enhanced Supervision’ for 2 weeks (up to 10 working days) prior to their return date.
During this period:
- Postgraduate Doctors and Dentists will participate in closely supervised work and by the end of the period Postgraduate Doctors, Dentists and Pharmacists should be working at a level commensurate with re-entry into the training programme.
- Postgraduate Doctors and Dentists will be surplus to the rota at their employing Trust and will not be used to fill rota gaps
- Postgraduate Doctors and Dentists are able to work a two-week period (10 working days) and this can be on a pro-rata basis for LTFT.
- The Postgraduate Doctors and Dentists’s employing Trust will pay the Postgraduate Doctor, Dentist or Pharmacist for this period via the usual pay mechanisms.
Ideally a period of Enhanced Supervision will be undertaken in the weeks immediately before your confirmed return to training date, however we understand that this is not always possible. In cases where this is not possible, you may arrange for a period of Enhanced Supervision to be complete from your confirmed return to training start date, and this time will be considered at your next ARCP and a decision made on whether this will count towards your training.
How to organise Enhanced Supervision
In order to arrange a period of Enhanced Supervision, this must be discussed and agreed with your Training Programme Director (TPD) and HR/Medical Staffing at your Trust. You must document your Enhanced Supervision plans on your SuppoRTT Pre-return form as this will inform HEE of any reimbursement required to be made to your Trust.
Please be aware that HEE is unable to confirm any Enhanced Supervision arrangements, as this is managed with your Trusts HR/Medical Staffing department and/or your Rota Coordinator.
GP Postgraduate Doctors returning to GP Practices
When returning to a general practice placement, for the first two weeks the Postgraduate Doctor's should be offered the usual GP Practice induction period. this should include the opportunity to sit-in with various members of the practice team and a general reorientation to practice systems and protocols. Joint surgeries and home visits should be considered and regular/daily debriefs should also take place. Tutorials during this induction period should focus on identifying individual learning needs and planning how to meet these, including refreshing the Postgraduate Doctor, Dentist or Pharmacist's clinical skills. They should have a meeting with their supervisor towards the end of this period to ascertain that they are confident to return to 'normal' consultations.
If, following discussion, the GP trainer feels that the GP Postgraduate Doctor needs more assistance than this, please discuss this with the appropriate TPD/AD. The possibility of an extended induction will the be considered, including a double trainers grant for up to one month.
Opting out
If you do not wish to undertake a period of Enhanced Supervision, please ensure this is clearly identified on your SuppoRTT Pre-return form.
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‘Enhanced supervision’ is the term used to describe a period of time where a doctor returns to their workplace to familiarise themselves with their new role and engage in specific return to workplace activities aimed to refresh their clinical skills, whilst receiving an appropriate level of supervision.
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Many different terms have been used to describe these days both in the EoE and in other SuppoRTT regions. To keep things simple, EoE have decided to use the term ‘enhanced supervision’ to describe the period/days where a doctor returns to work before officially starting their rotation and resuming their normal clinical duties. This term encompasses the varying levels of engagement and supervision doctors may choose which includes shadowing at one end of the spectrum.
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In the context of post graduate doctor, dentist, and pharmacists, it will also apply to the funding provided by SuppoRTT for this period, but the term can be used by non-trainees who are not currently eligible for this funding but are doing an equivalent workplace return period.
- Most people will feel anxious about returning to work and will naturally want to run in the opposite direction, but with some thoughtful planning, enhanced supervision can help make the transition easier. The purpose of this guide and the associated planning resources is to make sure enhanced supervision is definitely not just going back to work earlier (and for less money!).
- From our experience, we know that the vast majority of post graduate doctor, dentist and pharmacists returning to work are fully competent to deliver safe patient care and so enhanced supervision aims to provide an opportunity for post graduate Doctors and Dentists to regain confidence in their skills and acclimatise to their clinical environment.
- Post graduate Doctors and Dentists are not expected to prove their competence, therefore there are no mandatory requirements to complete ‘assessments’ or be ‘signed off’, instead we encourage post graduate Doctors and Dentists to choose the most effective way to appraise their progress and encourage supervisors to be present and responsive to each trainee’s needs.
- You should be supernumerary to the rota and not be used to fill rota gaps, sickness or other types of leave. To facilitate this, we ask that these days be undertaken prior to your original rotation start date, which will also give you the benefit of working with an experienced team. If you are returning outside of usual changeover times, this may not be as crucial. (NB. This is different from a ‘Supernumerary period’ which is used by HEE, EoE in special circumstances and is not funded through SuppoRTT.)
- During this time, we recommend you engage in a mixture of routine work to familarise yourself with the clinical environment and your different roles/responsibilities AND specific return to workplace activities (RTW-As) aimed to refresh your clinical skills. Please see the ‘RTW-As sheet’ for examples. Being supernumerary gives you the greatest opportunity to create a diverse schedule.
- The ‘Planning exercise’ will help you identify the skills you should focus on so you can get the most out of your enhanced supervision time.
These days can be used flexibly to fit in with your individual requirements:
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You can take less than 10 days, but not more than 10 full days
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The days can be taken consecutively or non-consecutively
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You can take them as full days, half days or a mixture
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There will be less flexibility if you cannot take enhanced supervision prior to your expected start date.
Please see the ‘Case studies’ for illustrations.
SuppoRTT funding is only for 10 days but you could utilise any remaining KIT/SPLIT or SRTT days for additional workplace days (if you are eligible AND the trust responsible for reimbursing these is in agreement - in the case of KIT/SPLIT days this may be different to the trust you are returning to). Please see the ‘Funding guidance’ for further details.
I’m not sure I will be able to return to normal clinical duties, even after taking all my enhanced supervision days, what should I do?
If you think you will require a longer period before you are able to return to normal clinical duties including out of hour shifts, please discuss this as early as possible with your TPD and SuppoRTT so an alternative package can be tailored for your needs.
This is not a problem and is best handled with good planning so you can receive the right level of supervision and support for as long as you need it and other funding options can be considered. Having a plan in place for extra support permits departments to arrange suitable cover whilst allowing you to go at your own pace without needless pressure.
Depending on what level of ongoing support you expect to need, you and your TPD could also consider the following:
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Choosing a training unit where there is good quality consultant/senior support (clinical and pastoral) available, including out of hours (resident consultants/two registrars/advanced practioners to train or provide cover)
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Allocating you to a department with a well-staffed rota to allow flexibility, if required
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A rotation with a balance between sufficient patient turnover for experience and a manageable workload.
Being in the right environment may avoid the need to utilise special ‘supernumerary periods’. This may need to supersede other requirements such as subspeciality exposure or location preferences, to prioritise your wellbeing and ensure patient care is not compromised.