4. Time out of training

4.1. The GMC’s Time out of Training Position Statement says that absence of GP registrars should be monitored by Deaneries through the ARCP process. Absence of 14 working days or more in one training phase should trigger a review of whether the end of training date needs to be extended and is dependent on their acquisition of competence. (Gold Guide 10 3.183)

4.2. The following principles provide a framework which is underpinned by GMC and Gold Guide positions and the need for GP registrars to have acquired the GP Curriculum capabilities required to make them safe and competent practitioners. It is up to the Deanery to apply these as they feel is appropriate.

• Training should be referred to in terms of phases rather than ST years.
• The indicative time which should be spent in the training programme is 36 months (1095 days) wte and the GMC approved GP training curriculum is designed to be delivered over this period.
• The expectation is that all GP registrars should aim to complete all of this time in training.
• Time away from training does not automatically result in an extension. Equally, not having to make up missed time is not an entitlement.
• The determination on training phase progression, final CCT dates and whether absence should be made up is by the ARCP panel.

4.3. The GMC monitors the quality and consistency of recommendations made for CCT by each College and Faculty and expects to see that its guidance on training time has been followed, including:

• The duration of a GP registrar’s posts all add up to the appropriate duration for the programme with any gaps appropriately accounted for.
• Any changes to the expected completion of training date have been accounted for and explained (due to sickness, maternity/paternity leave, part time working, periods OOP or gaining competencies at a faster rate than expected).

4.4. Types of absence considered time out of training which should be declared, include:

• Sickness absence (including for COVID)
• Maternity leave
• Paternity leave
• Compassionate leave
• Parental leave
• Carer leave
• Sabbaticals
• Jury service
• Industrial action strike
• MoD responsibilities
• Professional leave (work outside the requirements of the curriculum)
• Shielding or self-isolation due to a pandemic (where remote training is not possible)
• Annual leave accrued during times out of training as above.

4.5. The following types of leave are managed by the Deanery as they are either linked to training or are employment related. These types of leave do not count as time off from training and therefore do not need to be recorded:

• Annual leave accrued from time in training
• Study leave
• Representation at relevant educational or trade union meetings (up to five days per phase of training of pre-approved leave for non-clinical roles linked to GP training).

4.6. Whilst on parental leave, a GP registrar may work for up to a maximum of 10 keeping in touch (KIT) days which do not have to be consecutive.

• They are considered employed days where a GP registrar is paid to be in training.
• KIT days would not normally count towards training, however if there is evidence of education attained on a KIT Day, this should contribute to the overall assessment of training.
• It should be noted that the acquisition of evidence is not the primary intended purpose of KIT days.
• A GP registrar may choose to take an exam on a KIT Day if supported by the Deanery.

4.7. It is important that absence is recorded accurately to:

• Ensure a standard and consistent approach and fairness to all GP registrars.
• Make absence evident to Deaneries.
• Ensure an accurate record of training.

4.8. The Gold Guide and the GMC Time Out of Training statement outline that it is the responsibility of the GP registrar to report absences to the Deanery, and the responsibility of the Deanery to administrate and record these absences. ARCP panels must take all absence into consideration and record their decision-making clearly.

4.9. GP registrars must record all absence contemporaneously and in calendar days. This should be done upon return to work and added to the absence recording tool in the Training Portfolio. In addition, GP registrars must declare all absence on their Form R / SOAR, or via the agreed Deanery process before each ARCP panel. This is all in addition to reporting absence to an employer.

4.10. The total number of days absent since the last review must be added to the box on the ARCP form by the panel stating the cumulative total of all periods of absence in this review period.

• If absence is declared after the ARCP panel, this should be added to the total on the next ARCP form.

4.11. Absences of 30 consecutive days or more should be recorded on the Training Portfolio as a stage of training, including if that absence has prior approval or is for statutory reasons.

• If the absence is taken during a post that the doctor then returns to it should be documented in date order.
• All entries should run chronologically and concurrently with no overlapping dates.

4.12. The Deanery should be aware of GP registrars who may have planned leave (such as parental or planned sick leave) beginning close to their CCT date and should try to monitor them closely to ensure that the Deanery is aware of any changes to training as early as possible. In principle, a plan should be developed for each of these GP registrars, and they should be managed individually and in line with the current Gold Guide.

4.13. If a GP registrar’s absence coincides with the end of training, and they will have completed the requirements for CCT by their planned end of training date, there is no need for them to return.

• An ARCP panel is held as normal in the two months before planned completion.
• Ideally, the final ESR should be done as close to the final panel as possible so that in the event of unplanned absence when a return to training is required, it will still be in date and will not need to be redone.
• If an Outcome 6 is issued, the GP registrar applies for CCT.

4.14. If a GP registrar is required to return to training for any length of time, an Outcome 6 should not be issued prior to their absence to allow them to retain their NTN.

• A doctor cannot return to training once they have been added to the GP register.
• An ARCP panel held prior to the absence should award an Outcome 1 if progress is satisfactory.
• A further review should be held after return to training within two calendar months of the CCT date to confirm if an Outcome 6 can be issued.
• A new Form R / SOAR or equivalent, must be completed when the GP registrar returns to training with any new health issues or significant events declared.
• A new ESR is only required if the one completed prior to the period of absence is out of date (more than two months of training time between ESR and panel) or the time away from clinical training is more than 12 months.

4.15. If unplanned absence is taken after an Outcome 6 has been issued, it is the GP registrar’s responsibility to notify the Deanery and their employer.

• There is no requirement for the CCT date to change, or a recommendation for CCT withdrawn. Changes to the CCT date after an Outcome 6 has been issued can only be made in exceptional circumstances and with agreement from the GMC.
• The Outcome 6 will stand as a robust record that all mandatory requirements for CCT have already been met.

4.16. If a period of continuous absence from clinical training of 12 months or more (including any accrued annual leave) occurs, the GP registrar should return to training for sufficient time to allow a new ESR to be completed and maintenance of capabilities to be assessed before CCT (up to 3 calendar months may be required for this).

• An ARCP panel will be held when the GP registrar is approaching completion of training.
• A new ESR and contemporaneous evidence of learning should be presented to the ARCP panel - this might include log entries and WPBAs.
• If less than three calendar months are completed on their return to training, the ARCP form must include a statement confirming that the panel is satisfied the GP registrar has maintained the capabilities for general practice.

4.17. For continuous periods of absence more than six months but less than 12 months, the ARCP panel must be satisfied that the GP registrar has not lost their skills.

• A new ESR is only required if the one completed prior to the period of absence is out of date (more than two months of training time between ESR and ARCP panel).
• Contemporaneous evidence of learning should be presented to the panel even if there is no need for a new ESR - this might include log entries, WPBAs and an Educator note confirming that the GP registrar has maintained their capabilities.
• The first ARCP form on return to training must review capabilities and contain a statement confirming that the GP registrar has maintained the capabilities for general practice.
• If there is no sufficient evidence to support maintenance of capabilities the ARCP panel may award an extension to training.
• Where a GP registrar returns to training for less than two weeks before their CCT date there may not be any new evidence for a new ARCP panel to review. If an ARCP panel was held and an Outcome 1 issued confirming all requirements for CCT were met prior to the leave and a new ESR is not required, the final ARCP form should include the following statement: ‘The GP registrar gained all the capabilities for completion of training before the period of absence commenced however, we were unable to recommend Outcome 6 at this point in training as it was more than two months before the completion of training date.'