Advice and requirements for trainees ‘acting up’ in programme into consultant posts as part of higher training (Version 7, in place from July 2016)
For the Acting Up Application Form, Reflective Log During Post and Out of Programme Experience Form, please click here.
This document has been developed to address common queries and concerns that have arisen in relation to higher psychiatric trainees undertaking a period of acting up into vacant consultant posts.
It is intended to be of support to both trainees and employing trusts in clarifying expectations and requirements for trainees to be able to act up into a consultant post whilst ensuring appropriate supervision to support the pre-CCT trainee in this role, ensure that they gain maximum educational value from the experience, and to ensure that the trainee is not inappropriately exposed to responsibilities that they are not yet in a position to undertake without the availability of post-CCT consultant supervision.
A trainee may ‘act up’ in a substantive consultant post for a maximum of three calendar months during the last twelve months of single CCT training or the last two years of dual training (this three months time limit applies for flexible trainees also, in line with the Gold Guide), as a part of their training programme. The acting up post must be appropriate to enable the trainee to develop experience of greater autonomous working in a manageable, approved clinical setting with good managerial & peer support. As it is in programme, the ‘acting up’ period counts towards the CCT date.
For ‘acting up’ appointments, the following conditions apply:
The appointment needs to be discussed and agreed with the Training Programme Director. This discussion needs to consider the time needed to transition effectively to the acting up post from the existing training post and to ensure that existing responsibilities are addressed and that continuity of patient care is not compromised. This would normally equate to the standard notice period of 2 months.
The standard ‘Acting Up’ application form (available on the School of Psychiatry website) must be completed, signed by the TPD and School Quality lead Dr M Merricks and returned to the Head of School for completion.
An Out of Programme form (available on PGME website) is completed, and returned to the Out of Programme Administrator at Severn PGME.
Important points to note:
- ‘Acting up’ must be within the UK, in an established, consultant post approved by the Royal College, relating to the trainee’s CCT.
- A trainee must have a named supervisor in the locality where the ‘acting up’ is taking place. Weekly 1 hour supervision should continue for the duration of the ‘acting up’.
- As the period of ‘acting up’ will count towards the trainee’s CCT, and it is deemed to be a normal part of the CCT-approved specialty training programme, GMC approval will not need to be sought as in effect this is an already approved element of the training programme. This will normally be the case if, for example, the acting up is within the Severn area and in the psychiatric specialism of the trainee. It is possible for a trainee to have an acting up post in another (outside Severn) area, providing the criteria set out in this policy are all met.
- In order to ensure the posts available to trainees acting up do not become long term locum posts, and to try to ensure appropriate continuity of consultant level care, acting up posts must not have consecutive trainees appointed to them.
- Acting up experience can only be undertaken in the final year of training for single CCT trainees, but in the last 2 years for dual CCT trainees.
- Proper planning of the acting up period needs to include attention to issues including on call, remuneration, AC status, supervision, effect on endorsements and continuity of special interest responsibilities and roles.
Guidance on Acting Up
- Part time trainees:
Special consideration needs to be taken for part time trainees and part time acting up consultant vacancies. This is to ensure that trainees do not take on posts which have excessive workloads, or provide inadequate experience. The hours available for the trainee acting up are normally expected to match their current hours, i.e. f/t trainees should be applying for f/t posts, p/t trainees for p/t posts. Where a trainee wishes to propose an alternative arrangement they will have to provide evidence that contractual, on call, AC status and effect on endorsements have all been considered and dealt with. The duration of time acting up counts towards higher training is for a maximum of 3 calendar months and is not pro rata for flexible trainees.
- Acting up and the grace period:
If the trainee is in their grace period at the time of a consultant locum post becoming available, it is generally more appropriate for the trainee to resign their post in the training scheme so as to undertake a full consultant locum post, which may continue after the grace period. Where a trainee’s acting up post continues into the six months period of grace, if the locum is for a lengthy period it will again generally be appropriate to resign from the scheme.
A flexible approach will be taken for single short locum posts of up to 4 weeks or two short posts totalling no more than 6 weeks when the trainee will be allowed to return to the training scheme to complete their grace period. In all cases, the final decision about supporting an application for an acting up or locum application will rest with the School of Psychiatry, and Severn PGME staff.
- Acting up and locum posts:
An acting up post is not a locum consultant post - the latter has historically been used as a shorthand for the former but it causes confusion with doctors who are post CCT and on the specialist register and thus able to work fully as consultants without ongoing formal educational or clinical supervision. The term ‘locum consultant’ should not be used in relation to acting up experience. Trainees are not generally encouraged to undertake locum posts while they are in a training programme.
- A trainee who is acting up should be referred to (and should sign medical notes, letters etc) as ‘Dr Xxxxxxxxx, ST6, Acting Consultant.’ They should not use the term ‘locum consultant’
- 'Acting up’ must be within the UK, in an established, consultant post approved by the Royal College , relating to the trainee’s CCT. Where the post has been approved by the Royal College in the last year, it is sufficient to include the college reference number (RCPsychSWSXX.xxx) and date of approval. For all jobs not approved or approved more than one year ago, a brief JD including timetable, secretarial support and indicative activity data (e.g. numbers of new referrals, caseload for the postholder and for the team) should be included in the application.
- Before endorsing the acting up applicationthe TPD must receive written/email confirmation from the relevant medical manager (i.e. medical (including associate/assistant) director or clinical director) that they are aware of and approve both the acting up period within the vacant post and the trainee it is proposed to place in the post. The TPD should make reference to this confirmation in completing the TPD’s section of the School acting up application form available from the School website.
- The trainee must continue to have weekly educational supervision as normal during the acting up period (in fact being able to reflect on progress is invaluable in terms of learning) which could be with the pre-existing supervisor or, for the acting up period this might appropriately be transferred to another SpR ST4-6 supervisor on the scheme who is more local to the post. This needs to be specified in advance and agreed with both the supervisor(s) and the TPD.
- Where a trainee is in a post which has an endorsement, the acting up period must not lead to a loss of training time which would result in the failure to achieve the endorsement.
- The trainee is expected to keep a reflective log during the acting-up post. This should be discussed with the supervisor who will, at the end of the acting-up period, countersign it and comment on the trainee’s experience/performance/any areas for further development that have become apparent during the post. This will be included in the trainee’s portfolio as a record of experience gained whilst acting up (suggested format appended).
- The trainee is still in training & will be expected to continue to undertake workplace based assessments at a rate of at least 1/month during acting up. The application needs to specify how the acting up period will help meet competences as set out in the college curriculum.
- It would normally be expected that the trainee would continue to have one day (two PAs) in total per week clinical/non-clinical special interest time continuing through the acting up period. These would be included within the SPA allocation in the job plan for the consultant post and would not be in addition to normal consultant SPA allocation. It is recognised that in some circumstances this may not be possible due to constraints of timetables/geography and that an aspect of the acting up period itself may form a special interest for that time. If ongoing research/special interest cannot be accommodated in the acting up period the prospective acting-up trainee must be made aware of this and will need to discuss with special interest/research supervisors to inform their decision as to whether or not to take up the acting-up experience.
- The trainee’s on-call should remain on the advanced trainee on-call rota. They must not join the consultant on-call rota for the post into which they are acting up (as this would leave them exposed as a pre-CCT doctor with no access to more senior support out of hours). Where the trainee is working at a distance from their training post, it may be appropriate to transfer to the advanced trainee on call rota which links with the acting up post. These matters must be organised in advance, as a part of the plans for establishing the acting up post. The arrangements for on call must be described in the application form.
- In working hours the trainee must have access to consultant colleagues for advice / support on clinical & legal matters as needed.
- Pay & study/annual leave issues: In an acting-up post the trainee continues to receive their salary for both in-hours acting consultant work and SpR/ST4-6 on-call work via the LEP (with any appropriate recharging arrangements being set up between LEPs). These arrangements need to be established in advance and confirmation written in the application that this has occurred. The acting up trainee will access study and annual leave while in this post according to the Terms and Conditions of the Consultant contract and through the Trust they are acting up into. This would be accessed through standard annual/study leave request processes, with cover from consultant peers.
- The trainee and trust HR department must confirm the trainee’s position regarding Approved Clinician (AC) status. This has obvious implications with regard to whether the acting-up trainee is able to legally take on AC functions his/herself or whether they will need access to consultant colleagues to undertake this for the patients under the acting-up trainee’s care. The trainee should contact the South West Registrations Approval Panel to establish whether they are on the AC register or not. PLEASE NOTE: having done the AC course does NOT mean that a trainee is approved. An application for approval must be made to the AC panel which requires further forms to be completed, endorsement by the TPD and potentially submission to the panel of additional evidence to establish that the competences required for AC registration have been achieved. The panel will confirm approval and its date etc once this is completed. Not having AC approval does not prevent a trainee from acting up, but would mean that they would need consultant (i.e. a consultant with AC status) support for AC functions - as is the case for a senior trainee in dealing with MHA work throughout the other stages of their higher training. The trust would need to make sure that this support was available for a trainee acting up without AC status. The requirement for educational supervision as defined above will ensure that a trainee who has AC status and is undertaking this role for the first time has the opportunity to discuss and reflect on the role and its implications as part of the training they gain from the acting up period.
- During acting up, the TPD will continue to monitor the progress of the acting up post at least monthly, through a review meeting or a correspondence. If any difficulties occur during acting up the TPD should be notified immediately and the acting up post may be discontinued if supervision arrangements or other aspects of support for the acting up trainee are not in place.
Dr Rob Macpherson, Acting Head of School of Psychiatry, Severn PGME
Dr Guy Undrill, Regional Advisor, Royal College of Psychiatrists
Dr Melanie Merricks, School Quality Lead
Dr Geoffrey Wright, Associate Postgraduate Dean, Severn PGME
Last updated: July 2016