Enhanced Supervision

An enhanced supervision period is typically described as:

a short, intensive period of enhanced supervised practice, focused learning activities and direct observation of clinical activities with the aim of enabling trainees to return to normal duties safely and confidently. It is expected that during this time trainees may not be required to undertake any out of hours arrangements if adequate supervision isn’t available.

In order to rapidly regain clinical knowledge and confidence, doctors returning to training following a sustained period of absence are strongly encouraged to participate in a period of enhanced supervision for at least 10 working days on their return to work.

During this period;

• You will participate in closely supervised work and by the end of the period you should be working at a level commensurate with re-entry into the training programme.
• You will be paid for this period at your usual rate via payroll, as if you had returned to your usual working pattern.

What if I don’t want to have Enhanced Supervision?

If you feel enhanced supervision is unnecessary, you should discuss this with your FPD/TPD/Supervisor during your Pre-Return meeting in advance of your anticipated return date. Your intention to opt out of enhanced supervision must be clearly indicated on the Pre-Return Form.

We strongly recommend even the most senior trainees undergo Enhanced Supervision. Senior trainees often experience a degree of non-technical skills attrition during time away from training, so a period of additional supervision can be extremely helpful, regardless of clinical experience and knowledge.

How do I arrange enhanced supervision?

After discussion with your supervisor during the Pre-Return meeting, your Supervisor should disseminate your SuppoRTT plan to colleagues who will be working with you and any rota coordinators.

It is strongly advised that you also contact your Trust’s SuppoRTT Champion. They can liaise with medical staffing and rota coordinators to ensure your SuppoRTT period is protected and your period of Enhanced Supervision is being arranged appropriately.

Can I work out of hours/on call during the enhanced supervision period?

You can volunteer to work out of hours/on-call during the enhanced supervision period providing a senior or consultant colleague is identified to offer supervision.

If you wish to participate in OOH/on-call this should be discussed and agreed in advance with your TPD/FPD/Supervisor during your Pre-Return meeting.

Will the period of Enhanced Supervision count towards my CCT?

Usually, no. The “Training clock” restarts once you are signed-off to restart normal duties at your Post-Return meeting. If necessary, this can be reviewed with your TPD/FPD/Supervisor or at your next ARCP panel review, especially if you have a longer period of Enhanced Supervision and feel it should count towards training.

GP Trainees returning to Practice Placements

When returning to a general practice placement, for the first two weeks, the trainee 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 trainee’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.

What if I need more than the standard ten working days of Enhanced Supervision?

That’s fine. There are many reasons why you may feel you need a longer period of Enhanced Supervision. Some specialties suggest longer than 10 days as standard. You can discuss this during your Pre-Return meeting. 10 days is intended to be a rough guide and returning to usual working patterns should be a mutual agreement when you are ready.

What if I’m asked to work without adequate supervision during this period?

If you encounter any difficulties surrounding rota/clinical commitments during your period of enhanced supervision, you should contact your Trust SuppoRTT Champion who has the authority to enforce our recommendations. If this is not successful, please contact the NW SuppoRTT team at NHS England who will assist you further.