Deferred Entry to GP Training - Policy

STEP ON STEP OFF TRAINING (SST) FOR GP SPECIALTY TRAINING (GPST); DEFERRED ENTRY AND WIDENING OUT OF PROGRAMME (OOP).

POLICY FOR HEE, NHSEDUCATION AND HEIW

1.         Rational for the proposal

1.1       The options for Step on Step off training (SST), deferred entry to GP Specialty Training (GPST) and widening of OOP opportunities have been proposed in order to increase flexibility and maximise recruitment into GP training. The rationale is that allowing greater flexibility in GP programmes which are currently restricted because of the shorter duration of the programme (three years’ whole time equivalent) compared to other specialties with longer training programmes of five to seven years; might make GP training more attractive to potential applicants and act as a positive incentive for recruitment.

2.         Scope of policy

2.1       This policy sets out the framework for Step on Step off Training (SST) for GP Specialty Training programmes. SST will have specific rules relating to deferment and time out of programme which differ from those stated in the main body of the Gold Guide.

2.2       This policy on SST applies to doctors appointed to GPST in England, Scotland and Wales from August 2019.  

3.         Background to the development of the proposal

3.1       These two groups of options for Step on Step off training (SST) have been considered together as the regulatory framework covers similar elements and the generic principles are considered as a whole.

3.2       Step on Step off training (SST) should be differentiated from multiple entry points. From August 2019, SST will give GP specialty trainees the option of “stepping off” to benefit from a range of opportunities such as clinical fellowships and academic opportunities secure in the knowledge they can return to the programme at the stage of training at which they left.

3.3       Currently the option for deferment to allow for a “time out” does not exist as the Gold Guide only allows deferments to specialty and core training on statutory grounds (e.g. maternity/adoption leave or ill health) with the exception of Defence Medical Services (DMS) only, where training may be deferred for DMS operational reasons.  The “time out” refers to opportunities such as a year out for overseas travel to capture trainees wanting to go off to Australia and alike for a period of time.

3.4       The changes outlined to enable SST are recognised to be inconsistent with the Gold Guide but have been implemented for the reasons defined in paragraph 1.

3.5       SST is designed to give GP specialty trainees more flexibility to defer the start of or to take time out from their training. Other than the changes relating to availability of deferment and time out of programme delineated in this policy and any published guidance, the general rules, restrictions and criteria for time out of programme (OOP) as detailed in the latest edition of the Gold Guide will still apply.

3.6       The eligibility criteria for out of programme option (OOP) are set out in the Gold Guide which include all four categories, OOP Training (OOPT); OOP Experience (OOPE); OOP Research (OOPR) and OOP Career break (OOPC). The facility is currently under used by GPSTs and those that do use it (small numbers) are for OOPC many of which relate to child care or health issues.

4.         Step on Step off Training opportunities in GPST

4.1       SST options may only be used once in the course of a GP specialty training programme. For example, if the option to defer the start of training (other than for statutory reasons) is used then further SST options would not normally be available later in training.

4.2       SST Option 1- For deferred start – Deferments give successful applicants the opportunity to defer GP training (for a maximum of 12 months) before the GP training programme starts. This is to facilitate early options for SST, subject to approval by the Postgraduate Dean. All applicants applying for non-statutory deferral must indicate they are interested in deferment at time of application by saying “Yes” to the question on the Oriel application form “Do you wish to apply for a deferred start date?” Failure to do so will make the applicant ineligible.

If successful in recruitment a formal application for deferment must be made to the Local Office/Deanery within two weeks of acceptance of the GPST programme offer.

4.3       Criteria for option 1:

• Successful at GP recruitment and be appointable with all competences demonstrated.
• Applicants must indicate their intention to defer in their Oriel application. Failure to do so will render them ineligible.
• Limited to a maximum of one calendar year and would normally be for a minimum of six months unless the posts in the programme are 4 month duration – then 4, 8 or 12 months are acceptable.
• Applicants once accepted cannot extend the period of deferral.
• Applicants who accept a post and defer and reapply to a subsequent recruitment round in the same year will not be eligible for a second deferral.
• Allocation to a Local Office/Deanery and programme is dependent on the ranked score at the time of recruitment with an obligation to return to the programme offer accepted on return. Failure to do so means that applicants relinquish their entitlement to the programme and would have to reapply for GPST.

4.4       Trainees are required to confirm a date for the start of the deferred programme at least six months before the planned start date; or a minimum of four months’ notice where the duration of the period out of programme is less than six months.

4.5       SST Option 2 - Out of programme applications for time out during programme

SST will enable doctors on GPST to take time out of programme part way in ST1 or between

ST1 and ST2 for a range of opportunities as detailed below (paragraph 5). Applicants wanting to take time out before the programme starts should consider options set out above: SST Option 1- For deferred start.

4.6       The start date for a period of time out of training (OOP for SST) would not normally be agreed until a trainee has been in a training programme for at least six months (whole time equivalent) of the first year of training (ST1).

4.7       The criteria set out in the Gold Guide for aligning with post and programme end

dates will apply.  The trainee must also give the usual minimum three month period of notice to the Postgraduate Dean and their employer prior to commencing OOP for SST as currently set out in the current Gold Guide. Continued approval for OOP for SST is conditional upon the following criteria being met:

4.8       Criteria for option 2:

• Satisfactory completion of ST1
• ARCP Outcome 1 at end of ST1
  • Or if applying for OOP part way in ST1 MUST have as a minimum satisfactory progress at interim educational supervisor’s review.
  • Timing of OOP to be aligned to start dates for placements in programmes and should NOT affect service delivery.

• Trainees are required to confirm a return to programme at least six months before the planned return date (or three months where the period off programme is less than six months).

4.9       All OOP opportunities beyond the end of ST1 are facilitated according to the guidance delineated within the Gold Guide

5         Opportunities available under SST

Opportunities that might be used for Step on Step off/OOP must meet the eligibility criteria set out in this document and associated guidance and include.

• Clinical Fellowships and standalone academic opportunities – OOPE/OOPT /OOPR (OOPT, and also OOPR if it is to count towards training, require prospective approval from GMC & RCGP)
• Clinical experience in other specialties - OOPE
• Clinical SST options related to GPST could be OOPT * requires prospective approval from GMC & RCGP for OOPT
• Non-clinical SST options – OOPC (as currently detailed in the Gold Guide 6.75)

6         Periods out of programme (OOP) for whatever reason are likely to delay the CCT date which will be recalculated at the next scheduled ARCP.