We have received several enquiries from senior trainees and Schools about the correct process for arranging 'acting up' and formal 'locum' consultant posts near the end of specialty training. There are important differences which really depend on whether a trainee is 'pre-CCT' or 'post-CCT'. Previous advice has been revised based on new regulations in the 2008 version of the Gold Guide and in direct discussion with GMC (see appendix).
Pre-CCT, a trainee can only consider an 'Acting up' post and the norm is for time to count towards CCT. In this situation, the most important change is that prospective GMC approval is now required. Therefore, trainees must plan at least 3 months ahead, even for short-term acting up posts. It is also important that the trainee seeks formal support from the Postgraduate Dean at an early stage and clarifies the maximum time that will be supported as OOPT in an acting up post.
Pre-CCT
- The correct term for experience of consultant duties prior to gaining CCT is Acting up (the term Locum consultant is not appropriate prior to CCT)
- Acting up should only be considered in the last 6 months of training (preferably as close to CCT as possible) and will usually be a short-term post (2-3 months)
- Acting up must only be offered to a trainee who is making satisfactory progress with NO significant requirements or competences to be signed off/completed for CCT purposes (confirmed by TPD or HOS)
- Please note - the trainee must have supervisory mechanisms in place during the Acting up post, comparable to any other trainee at the same level of training (see appendix – Gold Guide para 6.74)
- OOPT is the correct and usual route and will require prospective GMC approval – 100% can count towards CCT. The Postgraduate Deans support is required. RCOG support for time counting towards CCT will also be required (contact Tania Chambers at tchambers@rcog.org.uk
- The same advice pertains to Acting up posts undertaken during the last 6 months of subspecialty training. Individual cases should be discussed with the Chair of the Subspecialty Committee (contact Bettina Muller at bmuller@rcog.org.uk ). Support and individual, prospective GMC approval must be obtained via the Deanery (HOS and PG Dean).
- In rare circumstances, OOPE may be considered (para 6.78). This will be at the discretion of the Postgraduate dean and HOS. It would be unusual to support that route as it would require the CCT date to be moved backwards. GMC approval is not required for OOPE.
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Post-CCT
- After CCT a trainee may take up a Locum consultant post without informing GMC
- The Deanery must be informed, as a formal 3 month period of notice can be required (entirely dependent on the circumstance of the locum)
- Undertaking a Locum consultant post during the period of grace (POG) does not require resignation of an NTN, unless the locum period equals or exceeds the end of 6 month POG. The post would then be viewed as 'substantive' non-training employment outside the provisions of POG.
I hope this advice helps clarify the situation and in particular the subtle but important differences between pre-CCT Acting up and post-CCT Locum consultant posts.
Kim Hinshaw
Chair, Specialty Education Advisory Committee
November 2009
Appendix
Excerpts taken from Gold Guide 2008.
The relevant paragraphs are:
OOPT (this would be the usual route pre-CCT as it does not affect the CCT date)
Para 6.74 - Trainees will also be able to take time out of programme and credit time towards training as an “acting up” consultant if this has been prospectively approved by GMC. Trainees acting up as consultants will need to have appropriate supervision in place and approval will only be considered if the acting up placement is relevant to gaining the competences, knowledge, skills and behaviours required by the curriculum
OOPE (this route could only be used at the discretion of the Postgraduate Dean in discussion with the Head of School. It does not require GMC approval, but as time would not count towards training, the CCT date would need to be moved backwards)
Para 6.78 - Trainees may seek agreement for out of programme time to undertake clinical experience which has not been approved by GMC and which will not contribute to award of a CCT. The purpose of this could be to: take time out of programme to gain experience as a locum consultant which cannot be credited towards training.