The traditional route of full-time clinical training with direct progression to a full-time consultant post may not work for everyone. Top tips for physicians at different stages of their career and advice on discussing flexible working with their employers are provided below.
- Expect the expected. We will all get older, we and our families will have variable health and likely a long-term condition by the time we retire. We will need variety to keep us interested. Think about how flexible working could revitalise your career. Health passports are beginning to be used in trusts for staff and are a useful summary to show new work places:
- Don’t forget the invisible impacts of long-term health conditions such as fluctuation and fatigue.
- Use your occupational health department.
- Find out who your local champion of flexible working is: www.nhsemployers.org/pay-pensions-and-reward/medical-staff/ doctors-and-dentists-in-training/terms-and-conditions-contracts/champions-of-flexible-training-guidance
- Know what job opportunities are out there: www.rcplondon.ac.uk/medicine-jobs
- Contact your training programme director as soon as you know who they are and discuss flexible options.
- Inform yourself of the process: www.healthcareers.nhs.uk/explore-roles/doctors/career-opportunities-doctors/less-full-time-training-doctors
- If you want LTFT training apply as soon as possible, as you will need signatures.
- Be aware of portfolio opportunities such as:
– Academic foundation posts
– Flexible training portfolio
– SAS specialist associate and specialty doctor posts
– Chief registrar scheme
- You are entitled to your full-time equivalent study leave, as you have to meet the same standards.
When negotiating job plans with organisations:
- ensure a minimum of 25% (England and Northern Ireland) and 30% (Wales) SPAs for a typical full-time post
- use 6-month trials of new work patterns
- use e-job planning
- Drive change by role modelling flexible working and supporting clear lines of responsibility, good handover practice, leaving on time.
- Support portfolio careers. The RCP Medicine Jobs website has clinical and other opportunities for physicians.
For those considering retirement
Have a discussion at the age of 55 to: plan the next 10 years, use departmental job planning, look at complementary roles. Succession planning and appointment of a successor will take longer than expected.
- Make mentoring part of your job plan and succession plan.
- Employ an opt-in approach to on calls for those ≥60 years old. 
- Consider job sharing.
- Look at where you stand with your pension
For those who have left
- If you are working, but have no designated body or suitable person to revalidate with, you can complete an annual return without a connection and remain on the GMC register with a licence to practise: www.gmc-uk.org/-/media/documents/revalidation-guidance -for-doctors_pdf- 54232703.pdf It takes 2 weeks to restore your licence after it is relinquished if you have evidence of good standing from your most recent employer.
- An ID check is needed as well if you give up registration and re-register: www.gmc-uk.org/registration-and-licensing/managing-your-registration/changing-your-status-on-the-register/restoration-to-the-registerice/employment/pensions/annual-allowance
Suggestions for discussions with your employer
1. Reinforce that your champion of flexible working should have protected time to fulfil the role and should:
- have a presence at inductions
- email all, not just those working LTFT, to introduce themselves
- have a good working relationship with Human Resources, the directors of medical education and the guardian of safe working.
2. Refer them to NHS Employers resources on flexible working
3. Ask whether they will offer pre-earned ‘sabbatical’ leave. For example: 1 extra DDC, per month, for 5 years resulting in an 8-week period of extra paid leave.
4. Ask if they will support career exchanges: The RCP offers the opportunity to spend some time with another RCP fellow in a different trust or other part of the worldwide network of RCP fellows; suggestion is to use 2 weeks of study leave.
5. Suggest they could support portfolio careers by setting up a jobs board with opportunities for healthcare professionals outside of the trust.
6. Ask if they will ‘keep the door open’. NHS employees can have an unpaid employment break for 3 months every 5 years. Your employer should be supportive and aim to retain employees who would otherwise leave permanently.
7. Encourage support and creativity in the adjustments, or redeployment, options for doctors with changes in their health to retain their skills.
8. Ask if they will support flexible retirement options
Suggestions for discussing flexible working at appraisal
- Trusts’ needs should be ignored for the first 30 minutes and you (the appraisee) should be allowed to guide conversation.
- Discuss your personal and professional objectives over the next year.
- Think about how your talents can be used best within your organisation.
- Discuss how the service can be improved and what is done well and badly.
- One size does not fit all; the take it or leave it policy from employers does not work.
- Shared parental leave should be available for all, including SAS doctors.
- Employers should support initiatives to prevent burnout, such as pre-earned leave and career exchanges with international colleagues.
- Suggest step-on, step-off training routes.
- Employers should support doctors with ill health through creating ‘ill health retirement’ policy that supports doctors who could later return to work and that does not penalise them.
Ensure that your work schedule enables you to be: well; healthy; effective in your work and able to sustain your contribution to high-quality patient care.
- Royal College of Physicians. Later careers: Stemming the drain of expertise and skills from the profession. London: RCP, 2018. www.rcplondon.ac.uk/projects/outputs/later-careers-stemming-drain-expert... (Accessed December 2019)
- General Medical Council. Caring for doctors, caring for patients. How to transform UK healthcare environments to support doctors and medical students to care for patients. https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-p... (Accessed 23 January 2020)