Support
​Updated 16 December 2024
Paediatrics is a long training programme, and many trainees are less than full time (LTFT), and spend a significant time in the East Midlands training, often over ten years. Over such a long period it is very normal to experience life events that affect your ability to work or train effectively. The deanery has developed a number of processes and support systems to make this easier for trainees. There are other supporting agencies available, and what is listed below will never be a comprehensive list of everything you could access.
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We have listed some common scenarios and what is available to help, as well as some general advice and resources.
General advice
We all have an obligation to look after our health under GMC guidance, and in addition, we want to create an environment where we can enjoy giving great care to young people and their families, developing useful and rewarding careers here in the Midlands. Somethings affect everybody, some are unique to a phase in life and some are unique to individuals.
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Things applicable to everyone:
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GP – everyone should be registered with a GP in their local area in order to access health care. If you are less familiar with the UK system, or normally well, you might think this is unnecessary, but again this will be expected by your employer, and at some point you will need it.
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Eating and sleeping well are essential to the job. All hospitals in the East Midlands have signed up to the trainee charter so rest and eating facilities should be available. Please do let the team know if you are experiencing significant issues with either of these.
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Nights – these are more of a struggle for everyone than day shifts, and the long-term effects are well-documented. It is worth optimising your sleeping environment before it becomes a problem, as trying to sleep when you are over tired is harder.
Supported Return to Training (SuppoRTT)
It is both normal and expected for trainees to take time out of programme at some point during their training for a number of reasons. This may be in the form of formal periods of out of programme or may occur unexpectedly as a result of illness.
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If it is a planned absence it is worthwhile taking advantage of the supported return to training programme. This is available to all trainees who are absent for at least three months, regardless of the reason. The support provided is offered before, during and after the period of time out of training. The paediatric SuppoRTT champion is Dr Maria Moran. Ideally you start the process 3-6 months before you come out of programme to make a plan for your return, and contact your supervisor 3- 6 months before your return to ensure things are in place. Things that are provided by this NHS wide HR agreement include enhanced supervision, a phased return including buddying on the rota, and reduced OOH working for 4 weeks or full-time equivalent, plus things like coaching and mentoring and Keeping in Touch (KIT) days, although most people will not require all of these. There are a set of forms on the NHSE website to guide you and your ES through this.
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For more information please go to https://www.eastmidlandsdeanery.nhs.uk/trainee/supportt.
Professional Support and Wellbeing (PSW)
The team at the Professional Support and Wellbeing (PSW) service are available to provide additional support for a variety of situations such as health issues, challenges with passing exams, significant life events, and concerns regarding training progression. They provide a holistic and collaborative approach to supporting you, and your discussions with them are confidential unless there is a risk to yourself or patients.
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You can self-refer or be referred by your ES, via the same form. If you are planning to self-refer it is wise to let your ES know, as if you are struggling with training, understanding this is helpful. It is also reassuring to know that trainees are seeking to deal with their problems.
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You are not obligated to take anything that they offer you, but we are all obligated to deal with issues in our practice, so if you decline help, you should have an agreed alternative plan to deal with that issue. The PSW are highly experienced in dealing with doctors in training. They understand the effects training can have on doctors, and the effect life-events can have on training. They are also confidential. They will not be revealing details of any sessions you partake in, but they will send your ES an email saying what they have offered, and a short report saying what you have taken up. The service they offer is not available on the NHS, and would be prohibitively expensive privately.
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For more information please go to https://www.eastmidlandsdeanery.nhs.uk/trainee/psw.
Less than full time (LTFT)
All doctors are able to apply for less than full time (LTFT) working. If you are considering doing so it is important to discuss this with your educational supervisor so that you are aware of its implications, as well as your TPD so that they can take this into account for your future rotations. Unless there are exceptional circumstances, you need to give 6 months notice. This notice can start during maternity or sick leave. Going LTFT will affect both training time and pay, so please do take both of these things into consideration when making your decision to apply. More information can be found at https://www.rcpch.ac.uk/resources/less-full-time-training-ltft-guidance.
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In order to apply please go to https://www.eastmidlandsdeanery.nhs.uk/policies/ltft and complete the application form.
Maternity leave
You are legally allowed to take time off for all maternity related appointments as a pregnant woman. In reality these don’t all fall within working hours, so do try to be respectful of how you do this. Please let your team and rota co-ordinator know when you have appointments as soon as you know. It is good practice to let the other parent attend if at all possible but this will be at the discretion of their team.
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Rota adjustments can be made at managers discretion, so please discuss with your ES earlier and your rota co-ordinator. If you or your ES feel that adjustments are such that they could affect training, please discuss with the relevant TPD, but it is unlikely that 1-2 months in the scale of things will make a huge difference. If you, your doctor's or your ES feel that there needs to be significant adjustments such as non-clinical time this may warrant an occupational health (OH) assessment. Again letting people know early does makes this easier, no appointments happen immediately. If you already know your pregnancy will be complicated, you could consider self-referring early, even before you inform your ES, especially if you don’t want to discuss your condition with whilst it is still precarious. Please do let the JDA team know early too, and document all discussions in case of debate later on. You might let your line manager know by 28 weeks to receive maternity pay.
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Joint paternity/maternity leave is also possible, but it is complicated, so please be patient with people processing your requests.
You are entitled to leave following adoption, but not for fostering. Please do look at your local policy, and inform your local team and TPD if you are seeking approval for adoption, as requests to take children can develop quickly.
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NHS employers maternity guidance handbook provides a huge amount of useful information https://www.nhsemployers.org/system/files/2023-08/Maternity-guidance-2022.pdf
Burn out and stress
The first thing to do is talk to someone about it – sometimes just chatting with your ES will be enough, but sometimes you will need more help. Sometimes coaching is useful, sometimes formal counselling, or sometimes someone just to guide through a difficult process in your career, such as going to coroner’s court or involvement in a serious incident. This is all available through the professional support and wellbeing unit (see earlier). All trusts have a legal obligation to prevent psychological injury to all staff, and so they will all offer counselling services. Sometimes these are subcontracted out, and sometimes they are in-house. You are welcome to use these, but they won’t be able to address any issues specific to training. The BMA also offers counselling to its members, up to 6 free sessions
I am unwell
There are two aspects to this – the human resources aspect and the training aspect. From a HR perspective you are entitled to up to six months leave at full pay and more time off with reduced pay. You are entitled to reasonable adjustments for any long term disabilities. The process for this is to see an occupational health professional who will suggest adjustments to enable you to do your job and/or train, and then your line manager will decide if they are reasonable. The aim of these adjustments is to enable you to do your job properly. From a legal perspective they are employer specific. If you believe you are going to need long-term practical adjustments in order to work, please do let your ES and TPD know.
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None of these adjustments are necessarily permanent; they allow you to continue training. It is worth considering with your ES how these adjustments might work as consultant as you progress through training.
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It may be that you are well enough to work, but not well enough to train, and this may require a period outside of training. You ES will speak to you if they believe this may be the case, and you should speak to them if you believe this to be the case.
Many people do need some time out of training due to ill-health. This is ok, and many trainees, and consultants, continue to work with long-term health conditions. However any time you have off won’t count as training time, and there is a limit as to how much extra training time is available. If you are worried about this, please do ask your TPD.
I am okay, but I struggle a bit with things like sleep and anxiety
There are a number of online resources available
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Headspace is currently free to all NHS workers until March 2025
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Silver cloud is an evidenced based online cognitive behavioural platform that many trusts have signed up to.
Other things that could be useful:
Remember while you work at a trust you are entitled to everything else the trust has to offer so it is worth taking a look. Many trusts will offer staff free physiotherapy sessions to help with things like back pain, and most will offer some kind of physical exercise classes.
There will be things like salary sacrifice schemes to enable you to buy a car earlier on in your career – these do have pension implications, so be aware of that. Most trusts will have cycle to work schemes, and some will offer free bike servicing. Look out for free places to lock up your bike safely.
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You may not yet consider your pension as a well-being benefit, but there isn’t a financial advisor out there who will advise you not to take it. Many trusts will offer sessions on money management, how to work out your payslip and pensions advice. The BMA offer this too if you are a member, or if your spouse is.