Career Focus

Flexible training is possible as a senior house officer

BMJ 1998; 316 doi: (Published 31 January 1998) Cite this as: BMJ 1998;316:S2-7128
  1. Patsy Scriven, associate postgraduate dean
  1. University of Birmingham

    BMJ 7128 Volume 316: Saturday 31 January 1998Career focus Flexible training is possible as a senior house officer

    Nancy Redfern and Patricia Scriven, who are both associate postgraduate deans, explain how SHOs can take advantage of flexible training

    Flexible training is available for all doctors in training grades who have, well founded individual reasons, which prevent them working full time. This option is becoming increasingly popular

    Most postgraduate deans have an associate dean to manage the flexible training scheme in their area, and with these appointments more energy has gone into publicity and recruitment. A national scheme exists for specialist registrars, described in the Guide to Specialist Registrar Training. No national scheme exists for senior house officers (SHOs), and posts are made available by the local postgraduate dean. Numbers vary according to region (fig 2).

    Obtaining a flexible SHO post involves several steps. The candidate must be eligible to work flexibly and be of the same calibre as full time trainees; funding must be available; and the post must have royal college educational approval.

    Information Information about flexible training is available from the local postgraduate dean's office where an associate dean may be responsible for flexible training in the region. The BMJ contains information about flexible training in this section. Undergraduate courses at British medical schools include advice on careers and full time and flexible postgraduate training. Many royal colleges have an adviser with responsibility for flexible trainees. At a more local level, college or district tutors, clinical and postgraduate tutors, and educational supervisors may be aware of flexible training, and its existence may be mentioned on induction courses. Despite all this information, some doctors in training grades are not aware that flexible training exists. Awareness that flexible training is possible seems to be lowest among overseas doctors and in specialties with fewer women trainees. The major influence on awareness is the presence of flexible trainees in a hospital.

    Eligibility For hospital posts, flexible (part time) training is available to all grades of doctors in training, when training on a full time basis would not be practicable for well founded individual reasons. Usual reasons include pregnancy, the need to care for young children, ill or disabled dependants, or the doctor's own ill health or disability. Other reasons, however, may well be accepted. Both men and women are eligible. Doctors wishing to train flexibly should make an appointment to see the local postgraduate dean or associate dean, who will decide whether the applicant is eligible, and can use their discretion as to what is well founded. This discussion will be confidential. Some argue that any doctor who wishes to train flexibly (part time) should be eligible as they must have good personal reasons for accepting a drop in salary. At present, however, budgets for hospital posts are limited, and priority is given to those with the most pressing needs.

    Trainees in general practice do not have the constraints of eligibility a well founded personal reason is not needed and anyone wishing to train flexibly can do so. Hours of work All flexible trainees have to work a minimum of 50% of a full time post that is, 20 standard hours a week. To comply with European Union rules, doctors on vocational training schemes must work for a minimum of six sessions a week (24 standard hours) and do one week's full time training during both a hospital SHO post and a GP trainee post. In some regions all flexible trainees must work for a minimum of six sessions. Most regions have a maximum of 28 to 32 standard hours a week; a doctor able to work more than this could probably work full time.

    Additional duty hours (ADHs) may be the minimum necessary to satisfy the relevant college's educational requirements. Usually, this is calculated pro rata that is, half a full timer's ADHs for someone working 50% of full time standard hours.

    Arrangements for out of hours work for GP registrars vary between practices. Some require 100 patient contacts, out of hours, during the 20 months training; some that the trainer is satisfied that the trainee has sufficient experience; and others require six hours a week of out of hours duty. Women doctors are increasingly concerned about personal safety; the majority of GP registrars work in cooperatives, with drivers, so it is uncommon for the trainee to be driving round alone at night.

    Study leave Many postgraduate deans allow the same study leave entitlement as for full timers you cannot go on half a course. This may be spread over the time taken for the flexible trainee to reach an equivalent stage of training. Some will also allow extra personal expenses such as childcare for course days when the flexible trainee is not normally at work. Funding In England and Wales, funding for supernumerary flexible SHO posts is usually arranged by the associate postgraduate dean and funded for the standard hours component that is, the part time equivalent of the first 40 hours of a full timer's contract. In Scotland, the postgraduate dean or associate dean applies directly to the director of the Scottish Council for Postgraduate Medical and Dental Education to obtain funding for a supernumerary flexible SHO post, making a case on an individual basis. Funding for GP registrars comes from a national budget via the family health services authority, and is usually arranged via the local vocational training scheme organiser.

    ADHs have to be funded by the employing trust. This has caused problems where trusts are in financial difficulties. When a flexible trainee joins a department in which full time trainees are part way through their posts, adjustments cannot be made to the full timers salaries. Thus the flexible trainee's ADHs are an extra cost to the trust, and trusts have refused to accept flexible trainees because they will not pay the relatively small extra cost of the ADHs. This problem may be overcome if a flexible trainee gives enough notice of an intention to train flexibly. ADHs in full time contracts can then be reduced before appointment, to the hours actually worked, allowing the flexible trainee's ADHs to be funded at no extra cost.

    Educational approval Obtaining educational approval for a flexible post may appear to be more complicated than for a full time post. To count towards accreditation, SHO experience must be obtained in posts approved by colleges, and some college examinations can be taken only if the candidates work in approved posts. Departments and training programmes are inspected at regular intervals by colleges, who grant educational approval for several full time posts. A full time trainee applies for a programme which already has approval. A parallel system exists for flexible posts. In some deaneries, flexible posts with college educational approval have been created. In others, educational approval of a training programme must be sought individually from the relevant college, usually via the regional adviser. This training programme must meet the individual's training needs and personal domestic or health needs. It is therefore important that the flexible trainee discusses his or her training and other needs with the consultant or GP supervisor before the programme is submitted for approval.

    In the general practice vocational training scheme (VTS), educational approval for flexible GP registrars is sought by the organiser of the local VTS from the Royal College of General Practitioners and the Joint Committee on Postgraduate Training for General Practice. In some areas, there are formal training programmes for flexible trainees on VTSs, and the local postgraduate dean or associate dean may have close ties with scheme organisers. Hospital posts for trainees must be accredited by the appropriate royal college. Vocational trainees must complete their training in a 10 year period.

    Appointment process Some postgraduate departments place advertisements for flexible SHO posts in the part time section of the BMJ. If a doctor wishing to train flexibly is already working full time in the same grade and in the same specialty then an interview is not required. References are always taken up, and a medical is usually required if the trainee moves to a new employer. A flexible trainee who changes grade or specialty will need to be shortlisted and interviewed, to ensure that he or she is of the same calibre as their full time colleagues. Contracts are issued by the trust, and apart from the hours worked, the terms and conditions of employment should be the same as for a full timer. Flexible VTS trainees are interviewed either by local scheme organisers or by the trainer, if on their own scheme.

    Job sharing If two doctors wish to split a full time post into two equal halves that is, job share no special funding is needed and they do not need to satisfy any eligibility criteria. Most regions encourage job sharing wherever possible as this is more effective. Pros and cons Many flexible trainees find themselves breaking new ground as the first flexible trainee to work in a department, general practice, or on a particular consultant's firm. Openness and understanding are required from both sides. Returning to work can be a particularly stressful time, and the situation is greatly helped if peers and senior colleagues treat the flexible trainee with sensitivity as he or she attempts to achieve a sensible balance between a career and other responsibilities. Studies of both hospital doctors and GPs show that part timers are happier and more enthusiastic than their full time colleagues. Flexible work patterns allow doctors to continue training. Many change back to full time at a later stage.

    Nancy Redfern, associate postgraduate dean, University of Newcastle, Patsy Scriven, associate postgraduate dean, University of Birmingham

    Briefing The medical royal colleges want doctors to learn more about management so that they can contribute more effectively to the NHS. They have endorsed a proposal from the Scottish colleges that management training should be an integral part of undergraduate and postgraduate training. The colleges believe that all doctors must understand the organisational context in which they work and possess a range of management skills. The core curriculum includes interpersonal and team skills; functional and operational skills and knowledge; strategic skills; and self management. The president of the Royal College of Physicians of Edinburgh, Professor John Cash, said that the proposal was not about turning doctors into the health service managers of the future. It will now be up to the individual colleges and postgraduate deans to carry the proposals forward. The UK health secretary plans to involve NHS front line staff to improve efficiency and working practices in the NHS. A task force, of about 10 people, will include non-professional staff, such as porters, maintenance workers, and cooks as well as doctors, nurses, and managers. The task force will advise ministers on how the NHS can involve staff more effectively and make the best use of their unique knowledge. Its chief role will be to spread successful practices between NHS organisations. The health minister has assured the BMA that reducing junior doctors hours is one of the government's key concerns. He said that each trust should have an implementation plan and that the government would fund regional task forces for at least another year. Furthermore, he has made improvements on on call accommodation and catering one of his five central human resource targets.

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