NW SuppoRTT Pre-Absence Form

This form should be completed by the trainee and their supervisor* during the pre-absence meeting 8-12 weeks prior to commencement of the period of time out of training. This meeting is an opportunity to discuss concerns / learning & training needs / CPD or work that may be done during absence etc.

*This will usually be the trainee's ES however this can also be another appropriate educator / supervisor as identified by the trainee's TPD.

The NW SuppoRTT Guidance document can be found on the HEE NW website (https://www.nwpgmd.nhs.uk/supportt-process) or by clicking here.

On completion this form will come directly to the HEE NW SuppoRTT Team. It is the trainee's responsibility to download the form on completion and upload to their e-Portfolio and send to their:

F/TPD
School SuppoRTT Champion
Trust SuppoRTT Champion (where trainee is leaving a Trust).

Details of the North West SuppoRTT Champions can be found on the HEE NW website (https://www.nwpgmd.nhs.uk/supportt-contacts) or by clicking here.

The information collected in this form will be securely held by HEE and will only be accessible to those directly involved in the Supported Return to Training programme including the trainee's Head of School, Training Programme Director and HEE School Team. Information may also be shared with the Lead Employer and host organisation. Data will not be shared wider without your consent.

HEE's Privacy Notice can be found here.

Section A

1.1. Date of Meeting Required

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

2.2. Trainee First Name Required

3.3. Trainee Surname Required

4.4. Professional Registration Number (GDC / GMC / PH) Required

Your answer should be no more than 7 characters long.

5.5. School Required

a.5.a. ACCS Specialty

b.5.b. Dental Specialty

i.5.b.i. Please specify:

c.5.c. Medical Specialty

i.5.c.i. Please specify:

d.5.d. Pathology Specialty

i.5.d.i. Please specify:

e.5.e. Psychiatry Specialty

i.5.e.i. Please specify:

f.5.f. Surgical Specialty

6.6. Training Grade Required

a.6.a. If you selected Other, please specify:

7.7. FPD/TPD Name Required

a.7.a. Email Address Required

Please enter a valid email address.

8.8. ES Name Required

a.8.a. Email Address Required

Please enter a valid email address.

9.9. Host organisation pre-absence: The following list includes NHS Trusts rather than individual hospitals; if you are in a hospital placement please choose the Trust that hospital sits within. There is also the option to choose community, dental, GP and public health settings which if chosen will provide a box to write the specific site. Required

a.9.a. If you selected Other, please specify:

b.9.b. Please specify:

10.10. Host organisation on return (please select 'Unknown' if you do not yet have this information): The following list includes NHS Trusts rather than individual hospitals; if you are returning to a hospital placement please choose the Trust that hospital sits within. There is also the option to choose community, dental, GP and public health settings which if chosen will provide a box to write the specific site. Required

a.10.a. If you selected Other, please specify:

b.10.b. Please specify:

11.11. Anticipated Absence Start Date Required

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

12.12. Predicted Return Date Required

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

A pre-return meeting is recommended 8-12 weeks before the trainee's time out of training comes to an end to assist in planning their return to training. We strongly recommend meeting this early so that an enhanced supervision period can be arranged which requires liaison with the School and returning host-organisation (including the department's rota master).

For trainees on Parental Leave it is also important to plan and apply for SRTT days as soon as possible so that any additional annual leave can be included at the end of the accrued annual leave period. Further information about Return to Training Activities (RTT-A), including reimbursement of time and expenses can be found on our website here: https://nwpgmd.nhs.uk/supportt-activities.

13.13. Reason for absence (Please note: Parental Leave includes adoption, maternity, paternity and shared parental leave) Required

OOPC

OOPE

OOPP

OOPR

OOPT

Long-Term Sick

Parental Leave

Suspension

Other

a.13.a. If you selected Other, please specify:

14.14. Are you happy to be contacted by HEE during your time out of training? Required

Yes

a.14.a. Preferred Email Address

Please enter a valid email address.

b.14.b. Preferred Phone Number

Section B

Please review the AoMRC's recommended Questions and Actions for planning an absence from training which can be found here.

15.15. Please detail any concerns the trainee has about taking time out of training

16.16. Please provide details of any learning / training needs that have been identified

17.17. What activity is planned during the time out of training to address learning needs or keep up to date (please choose all that apply)? Please note: Retun to Training Activities can include using KIT / SPLIT and SRTT days to undertake courses, conferences, webinars, e-learning, regional teaching, induction, simulation etc.

CPD

Clinical work

Mentoring

Return To Training Activities (RTT-A)

Other

a.17.a. If you selected Other, please specify:

b.17.b. Please provide further details:

For information about Return to Training Activities (RTT-A) and how to apply for funding and the time to undertake the activity (i.e. KIT / SRTT day etc.) please visit https://www.nwpgmd.nhs.uk/supportt-activities.

18.18. Please use the following space to record anything else the School, supervisor or trainee requires in terms of this period of time out of training:

19.19. Name of person completing form with the trainee Required

a.19.a. Role in relation to trainee (i.e. Educational Supervisor)

If you submit your answers you will not be able to return to this page.