• Positive - parental leave (majority), OOP(C), OOP(E), OOP(P), OOP(R) 
• Negative - bereavement, long term sickness, discipline, investigation 
• Planned - surgery, parental leave, OOP(C), OOP(E), OOP(P), OOP(R) 
• Unplanned - long term sickness, carers leave, GMC issue, discipline 

See https://www.nwpgmd.nhs.uk/time-out-programme for explanation of the above categories.

• The forms guide / prompt discussion. 
• Standardise as far as possible / fairness. 
• Not specialty specific. 
• Form completion / process undertaking informs the SuppoRTT team. 
• We are not always aware of absences! 
• May raise funding awareness! 

• Any GPST who has been OOP for 3/12 or more. 
• Evidence shows that the reason for OOP is NOT protective and there is robust evidence that time out of training affects technical skills, competence, and confidence. 
• Patient safety and GPST safety are paramount. 

• The potential impact of OOP on knowledge, skills and confidence applies to any trainee irrespective of whether standard or academic. 
• Any trainee who has been OOP for 3/12 or more should undertake the RTT process. 
• Evidence shows that the reason for OOP is NOT protective.

9. What about GPSTs who are LTFT (less than full-time)?

• LTFT trainees should have the equivalent level of SuppoRTT as full-time trainees.

For example, a full-time trainee, who has been OOP for 12/12, would generally have 4/52 of individualised SuppoRTTed training.

An LTFT trainee working at 50% would, therefore, require 8/52 of a tailored SuppoRTT plan.

• Once an IMG has received their NTN the same RTT principles apply. 
• Currently, the process for recruiting IMGs who are OOP for GPST training and how the principles of RTT should apply are being addressed at a National and Deanery level. Updates shall be provided once the situation is elucidated. 

11. How useful is SuppoRTT?

• This is evidence-based on the priorities identified by trainees and trainers.
• We have robust evidence from the GMC that TOOT affects technical skills, competence and confidence and that targeted support helps.
• By  By April 2022, we aim to upload a video of current GPSTs giving first-hand accounts of their experiences of the SuppoRTT programme.

• Pre- Absence: 

This should take place 8-12 weeks prior to your exit from the training programme whenever possible. 

This should lay out plans for your return and set a tentative return date. 

Share information about courses and ways of keeping up to date while away 

Help to understand KIT/SPLIT/RTT days. 

Ensure up-to-date contact details are available to keep in touch with you while you’re away from your usual workplace. 

• Pre- Return: 

This should take place 8-12 weeks prior to your return into training. 

This should include an up-to-date health assessment (if required). 

This should include agreement on the anticipated period of return and/or enhanced supervision (anticipated as usually 1 week per every 3 months off; usual max 4/52 unless exceptional circumstances when 6/52). 

Confirmation of LTFT or FT status planned on return to training (RTT). 

Should list mandatory requirements e.g. resuscitation and safeguarding. 

The clinical activities of the enhanced supervision period (e.g. ward work, surgery/outpatient work, home visits, emergency work, out of hours work etc.) 

The assessment methods for the enhanced supervision period (e.g. supervised learning events (SLEs), direct observations, CBD/COTs, simulation scenarios, senior team feedback, peer feedback etc.) 

• Post- Return: 

This should take place 2 weeks after your return to training or at the end of your agreed period of Enhanced Supervision, if longer. 

Mutual agreement about whether you are ready to “restart the clock” on training and commence usual duties. 

Discuss any ongoing learning needs you might have. 

• This varies from patch to patch in the North West. 
• We recommend that training programme directors (TPDs) meet with GPSTs as they are likely to know them/be more experienced/familiar with the process/have more contact/relationships with secondary care clinical supervisors and Trust SuppoRTT Champions. 
• Education supervisors (ES) can undertake these meetings for the GPSTs they supervise as they should know them well. However, an ES is likely to undertake such meetings infrequently, and, consequently, may be less experienced/skilled in making appropriate recommendations.

• A phased return is one where the GPST gradually increases their training/work commitment. 
• For example, they may return one day a week for one week, two days for the second week, three days for the third until they reach their LTFT working week of 60%. 
• A supported return is a period (usually 1/52 per 3/12 OOP) where a plan of support is put into place that allows the GPST to safely / confidently return to training. 
• A phased return can be part of a supported return, but this usually involves the GPST in using annual leave to “pay back” for the days when not training/working.

• Depends on knowledge / skills / confidence level of the GPST. 
• Previous experience and in which posts. 
• Post being returned to +/- any previous experience in this speciality. 
• Courses that may address gaps in knowledge / skills / confidence levels. 

If returning to GP post, consider: 

• An annual GP Update 
• Hot Topics course 
• GP Urgent care course 
• Diabetes in primary care course 
• Teleconsulting course  
• Covid-19 update 

If returning to an O&G post, consider a Womens’ Health update course. 

If returning to Paediatrics, consider a GP focused paediatric update course. 

If returning to Psychiatry, consider a mental health update course.

17. Which courses can GPSTs undertake as part of the SuppoRTT process?

• Information about the different type of day is available here: https://nwpgmd.nhs.uk/supportt-days. 
• Trainees can apply for KIT / SPLIT and SRTT days and any associated expenses (e.g. course fee, travel and accommodation etc.) via the RTT-A (return to training activities) application form: https://nwpgmd.nhs.uk/supportt-activities. 
• The NW SuppoRTT team will manage the application process.  
• Salary and annual leave will be managed as normal by the Lead Employer.  
• RTT-A expenses will be paid directly to the trainee’s bank account.

• Depending on what is thought to need assessing, consider CBDs / CATS / COTS / mini-CEXs. Usually, only 2 formal assessments are required in a 4-week period of supported return. More can be undertaken if required. 
• The mix of assessments may vary and will also depend on the stage the GPST is at and whether returning to a secondary care department or to a GPST2 / 3 post. 
• Assessments do NOT count towards mandatory requirements and are undertaken to contribute to the evidence to assess progress during the return-to-training period. 
• An informal educator note by the clinical/educational supervisor can further inform progress.

• Pre-Absence: 

A copy of the form should be uploaded to the trainee’s portfolio and also shared with: 

The Educational Supervisor. 

The current Clinical Supervisor. 

Lead employer lead.employer@sthk.nhs.uk  

The TPD (if he/she is not undertaking the meeting) 

The local programme administrator 

The local Trust SuppoRTT Champion if secondary care 

The GP School SuppoRTT Champion  

The Head of School Robert.Stokes@hee.nhs.uk  

• Pre-Return: 

A copy of the form should be uploaded to the trainee’s portfolio and also shared with: 

The Educational Supervisor 

The Clinical Supervisor in the returning post 

Lead employer lead.employer@sthk.nhs.uk  

The TPD (if he/she is not undertaking the meeting) 

The local programme administrator 

The local Trust SuppoRTT champion if next post in secondary care 

The GP School SuppoRTT Champion  

The Head of School Robert.Stokes@hee.nhs.uk 

• Post- Return: 

A copy of the form should be uploaded to the trainee’s portfolio and also shared with: 

The Education supervisor 

The current clinical supervisor 

The GPST who should upload a copy onto their portfolio 

The TPD (if he/she is not undertaking the meeting) 

The local programme administrator 

The GP School SuppoRTT Champion  

The local Trust SuppoRTT champion if secondary care  

If there are any concerns these should be shared with: 

Lead Employer lead.employer@sthk.nhs.uk  

The Head of School Robert.Stokes@hee.nhs.uk

• As a record of their discussions and any agreed plans which can then be shared consistently to all parties involved in the SuppoRTT process. 
• To ensure trainees receive the bespoke support that they need for their return to training. 
• Inform them of activities at a time where it is relevant such RTT meetings.  
• Monitor how the SuppoRTT programme is performing generally. 
• As a record of engagement in the SuppoRTT programme.

https://nwpgmd.nhs.uk/supportt-educators 

https://portal.e-lfh.org.uk/Component/Details/604888 

https://nwpgmd.nhs.uk/sites/default/files/NW%20SuppoRTT%20Guidance%202020-21%20_0.pdf (detailed guidance) 

The AKT is a mandatory exam for MRCGP and it is a computer marked paper testing APPLICATION of knowledge in a general practice setting. 
The exam is 200 questions over 3 hours 10 minutes and is held at a Pearson Vue test centre. The pass mark is usually around 70% and just over two thirds of those sitting the paper pass at any one sitting.
80% of questions are clinical medicine, 10% are organizational and 10% are evidence interpretation (statistics)

Please see Preparing for the AKT for more information and tips on how pass the exam.

As part of her role as Associate Dean in Health Education North West, Dr Alison Caldwell looks after GP trainees who sit the AKT and those that may fail. In this episode she shares her pearls of wisdom for preparing and sitting the AKT.

It has lots of useful information for trainees and trainers including how to break down the curriculum and where to best focus learning as well as how to actually do that learning effectively. We also cover how to improve exam technique as well as useful resources and specific advice for those who have tried and failed the exam.
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast

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️Contact us
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