Acting up into a Consultant Post during higher training in psychiatry
For all relevant forms please (Acting Up as Consultant Policy).
This document has been written to address frequent questions and concerns that arise when advanced trainees and their trainers are considering the suitability of an acting consultant role. These roles are frequently highly beneficial to trainees preparing for consultant practice but can, if not well managed, risk exposing the pre-CCT trainee to responsibilities for which they are not ready.
1. When are trainees eligible to ‘act up’ and for how long?
Trainees can act up when they are ST6. Trainees can act up for three months, pro-rata for LTFT trainees (i.e. for the duration that provides the equivalent of three months FT experience).
2. What kind of consultant post is suitable for an acting up trainee?
The Consultant post must be an established, College Approved consultant post relating to the trainees CCT. If the post does not currently have college approval then details of the post must be included with the application (see information on application process below). The post would typically be in the same geographical region as the training programme. It is possible to act up in a post outside of Severn provided the other criteria specified here are met. The post must be in a manageable and appropriate setting with good managerial and clinical support.
In order to prevent posts from becoming long term locum posts, acting up posts cannot have consecutive trainees.
3. What support is needed for the trainee who is acting up?
The acting up trainee must have a named supervisor in the locality where the acting up is taking place. One hour weekly supervision must continue throughout the acting up period. Within working hours the trainee must have access to consultant colleagues for advice and support on clinical/legal matters.
The trainee’s TPD will monitor the progress of the acting up at least monthly and must be notified immediately if any difficulties arise. If difficulties cannot be resolved, the TPD can discontinue the acting up period.
4. Will acting consultant time count towards award of CCT?
During the acting up period the trainee remains ‘in programme’ and the time therefore counts towards award of the CCT. GMC approval will not be required unless the site does not already form part of the training programme In this situation GMC site approval will be needed before the trainee can start the acting up post.
5. Do the hours of the trainee and post need to match?
This is an area that may change so seek advice early from the TPD. Current advice is that Full time (FT) trainees can only act up into a full time consultant post. If a FT trainee wanted to undertake a less than full time consultant post, they would first need to apply to train LTFT, which would delay the CCT date.
Less than full time trainees (LTFT) can act up into less than full time consultant posts. All working sessions must be used for the consultant post (so a trainee working 0.8 WTE cannot act up into an 0.6 WTE consultant post). We would not approve a LTFT trainee acting up into a full-time consultant post (unless they first applied to return to full time training).
6. What does the trainee need to do while in the acting post?
The trainee remains in training through out the acting post. This means that they must continue to undertake WPBA through out. They must keep a reflective log which must be discussed in supervision during and after the acting position. This log must be included in the e-Portfolio as part of the evidence for ARCP. The supervisor should comment on any areas of competency development identified during the acting post.
The trainee will continue to have one day (2 PA’s) for clinical/non-clinical special interests while in the acting post. These will be included in the SPA time for the consultant job plan, not extra. The trainee must have at least this amount of SPA time in the proposed job plan, not less. This applies to both full time and less than full time posts.
If the trainee has an on-going non-clinical commitment (e.g. to a research project) they should discuss in advance whether it will be possible to continue with this during the acting post.
7. What about out of hours/on call work?
The trainee is pre-CCT so must remain on the trainee rota while in the acting post. If the trainee is working at a distance from their training post, they could transfer to an appropriate trainee rota in the locality where they will be working. This must be negotiated and agreed in advance of starting the post.
8. What about annual and study leave? Who is responsible for what?
During the acting consultant post the trainee will be entitled to annual and study leave as per the Terms and Conditions of the Consultant Contract and through the Trust they are working for as an acting Consultant. This will be accessed via the local application and approval process, with consultant colleague cover arranged.
9. What about trainees in their ‘grace period’?
If the trainee is in their grace period when a suitable post becomes available, it would generally be more appropriate for the trainee to resign from their training scheme and undertake the post as a locum. If the acting consultant post extends into the grace period, other than for a very short period of time, the trainee should resign their training post and continue as a locum.
A flexible approach is possible for very short acting consultant posts (no more than four weeks) or two posts of no more than six weeks combined, when the trainee will be able to remain in their grace period after the acting post has finished.
The trainee should be paid at the consultant rate for the sessions they work as a consultant. Out of hours work should continue to be paid at the trainee pay rate. Agreement about remuneration should be achieved between the trainee and the HR department of the employing Trust before the trainee commences the acting post.
11. A/C Status for acting consultants?
Trainees should aim to have undertaken their A/C training and completed their A/C application before applying to be an acting consultant. Details of how to apply are available here http://winterhead.co.uk/ac-approval. Various documentary evidence and references are required, in addition to evidence of attendance at the relevant training course. Trainees should be aware that the approval process can take some time so this process would best be started as soon as an acting post is being considered.
Trainees are able to act up into a consultant role without A/C approval provided another consultant who has A/C status is available to fulfil the responsibilities of the A/C under the MHA.
12. What will be the trainees ‘role’ in the acting post?
The trainee will be an acting consultant. They are not a locum consultant and should not be referred to as such. Trainees should sign themselves in notes and on letters as ‘Dr XXXXX, ST6, Acting consultant’.
13. Planning an acting post
There must be proper and adequate planning of any acting consultant post. The following points should be considered:
Is this post suitable for this trainee (hours, type of role, support available)
How much time is needed to plan the move from the current post to the acting post (at least two months, the usual notice period, is expected)
Who will be the named supervisor
Will the time in the acting post affect any endorsement the trainee is seeking
Is there a suitable trainee OOH rota
Is there Trust management/HR agreement about pay, annual leave, study leave, SPA time
What about A/C status
14. How do trainees apply?
As in all aspects of their training, the trainee must take a lead in this process. They should discuss all of the above and any other concerns or issues with their current educational supervisor and their TPD.
The application form is available to be downloaded from the Severn Deanery Website. It is advisable to plan such posts well in advance and there is an expectation that the application form is submitted at least six weeks in advanced of the proposed start date. Occasionally opportunities become available at short notice; in this situation approval may still be possible.
All sections of the form need to be completed providing as much detail about the post as possible. As this is a generic Deanery form (used for all specialties) no mention is made of A/C status which is obviously an important aspect of many consultant roles. Trainees should discuss the need for A/C approval with their educational supervisor and/or their TPD.
The trainee needs to sign the form and then pass it to their TPD.
The TPD needs to sign the form to show their agreement with the acting up application. They should ensure they have agreement in writing (by email) from the relevant medical manager (medical or clinical director) that they are aware of and approve both the acting post and the trainee it is proposed to place in the post. The TPD must confirm details of the out of hours arrangements and arrangements for the A/C role must be clear. The Head of School and Regional Advisor are no longer required to endorse these applications.
Once the TPD has signed the form it should be forwarded to the Programme Support Manager at the Deanery who will pass it the Postgraduate Dean (or their deputy) for approval.