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Guidance for hospitals when an issue arises

The RCOG strives to ensure that all MTI placements are a success and provide a rewarding, positive experience for MTI doctors and UK hospitals alike. However, there are occasions where issues may arise with the placement.

Not uncommonly, there can be initial difficulties in the adjustment to life in the UK and working in the NHS. The RCOG provides clear, comprehensive guidance to doctors and guidance to hospitals to manage problems where they occur.

If however, despite the support and supervision provided, significant issues remain, we advise that hospitals follow these steps in an effort to resolve the situation.

Step 1

Please ensure that the doctor is well informed about the issue and understands the nature of the problem. We suggest that the College Tutor also informs the doctor that the RCOG will be contacted about the issues.

Step 2

Any concerns or issues must be reported in writing to the RCOG MTI Officer (address at the bottom of this page) as soon as they arise.

The letter should contain:

  • A detailed explanation of the issue/concern
  • An explanation of the steps taken so far to try to improve the situation
  • A proposed plan for future action if required

Step 3

The RCOG MTI Officer and MTI Lead will be available to discuss and suggest possible options with the Educational Supervisor and College Tutor.

The RCOG may suggest that:

  • An outline of how to provide the MTI doctor with a targeted training programme with focused supervision and support.
  • The College Tutor should be available to the MTI doctor for direct advice.
  • The Educational Supervisor should try to arrange regular meetings with the MTI doctor to identify areas that need improvement and offer the doctor guidance.
  • If there are continuous concerns about a doctor’s communication skills, for example, it may be useful to direct doctors to the GMC’s Welcome to UK Practice communication tools or encourage them to join a communication skills courses at the hospital.

Step 4

Depending on the nature of the issue and the plan proposed by the hospital, the RCOG shall arrange a face-to-face meeting or write to the doctor directly to gain insight into their interpretation of the issue.

Step 5

After the plan is in place, the MTI Officer will expect an update report on progress once a month via email to MTI@rcog.org.uk.

Step 6

After a reasonable amount of time, the MTI Officer will assess the situation, hearing from all parties involved and suggest next steps.

If there is no improvement in the situation despite efforts to resolve the issue

  • Where an MTI doctor persistently fails to make progress from ST2 to ST3 and is deemed unsuitable to work on the on-call rota after adequate opportunities for training, the situation should be made clear through written communication to the MTI Officer at the address below.
  • In some cases, it might be appropriate and feasible to consider transferring the doctor to another hospital which can offer a different post or environment. Some doctors benefit from such transfers and manage to meet the NHS standards. In such case, the RCOG will try to facilitate the transfer, although this cannot be guaranteed as it depends on availability of placements. This should always be discussed with the MTI Officer in advance.
  • At a very last resort, it may be necessary to consider terminating the doctor’s placement. This should be discussed with the MTI Officer well in advance and the hospital should be able to demonstrate that all other avenues to improve the situation were taken prior to this decision.
  • In the case of termination of the contract, the End of Placement Form / Exception Report must be completed by the hospital and sent to mti@rcog.org.uk as a matter of urgency.
  • Doctors on the MTI scheme are subject to dismissal under circumstances which would normally lead to termination of a contract within the NHS such as: resignation, prolonged absence, moving to another hospital, breach of the terms and conditions of working and leave, engagement in criminal activity etc.
  • All of such incidents must be reported to the RCOG MTI Officer via mti@rcog.org.uk or in writing to the address below.

Important information

The RCOG has the duty to provide MTI doctors with pastoral support but cannot be involved in any communication between a doctor and a hospital regarding any contractual and/or legal aspects of the MTI doctor’s placement. This must be between the hospital and the doctor as the employer and employee and does not come under the responsibility or capacity of the RCOG.