A guide to re-entry to general practice

Formulating a plan for re-entry

Last revised: 19 May 2020

A plan for re-entry is more than a study or learning plan. It should encompass:

  • a learning plan
  • a schedule of activities
  • orientation to the practice
  • support
  • provision for performance review in-practice
  • ongoing evaluation of objectives and whether they are being achieved.

Each GP will have differing needs when re-entering practice that will reflect their experiences and circumstances, not simply the time out of practice. There are many factors that may have an impact on skills retention, the ability of the GP to update their knowledge and skills and be up to date with clinical guidelines and changes in practice. There may also be obstacles to overcome or restrictions to practice that will have to be adjusted to. Therefore, the following should be considered first when preparing a plan for re-entry:

  • Reasons for the absence
    • personal reasons (illness, disability)
    • family reasons (parental leave)
    • restrictions imposed by the Board (restrictions, suspension, deregistration)
    • return from overseas (extended travel and/or study)
    • a career break or career change, including study leave.
  • Length of time away. Shorter absences are less likely to cause significant problems; however, they still have the potential to affect confidence. The longer the period of absence, the more robust the approach should be in terms of problem definition, learning needs assessment and management.
  • The GP’s age. The older the GP, the more likely they will experience difficulties with re-entry and require a higher level of support.
  • Any disabilities that may have been incurred as a result of illness and their potential impact on performance.
  • The scope of practice to which the GP will be returning
    • if no change in scope, the GP will require refreshment and updating of skills
    • if modified or entirely new scope, the GP may require re-skilling, in addition to refreshment and updating of skills.
  • The need for a mentor and/or supervisor.
  • Undertakings to the Board that have to be met before and after re-entry.

The checklists in Appendix 1 (‘Intended absence from practice’) and Appendix 2 (‘Re-entry to practice’) will assist in identifying all the relevant issues. For every identified issue, it is important to consider, as fully as possible, the likely impact on clinical performance and the resulting implications for practice.

Having identified the issues that may affect re-entry, the next step is to complete a learning needs assessment. This will determine which areas of knowledge and skills require updating, and the activities that will be completed to address the identified needs.

A well-formulated learning plan will include the following:

  • All factors impacting on clinical practice and how they will be addressed.
  • Learning plan (a list of study activities for the period leading up to re-entry and the period of transition)
    • identified gaps in knowledge and skills
    • learning style
    • goals of learning
    • the activities and programs that will be undertaken
    • update of medico-legal obligations
    • funding of the learning plan.
  • Realistic schedule (for the period leading up to re-entry and the transition period after re-entry)
    • clear time frames for the achievement of the objectives
    • anticipated completion date of the plan.
  • Orientation to the proposed workplace (details of how it will be conducted and what will be covered).
  • Support, psychological as well as day-to-day practice, because lack of confidence and/or lack of support can have significant impact on clinical performance
    • mentoring and level of supervision that may be required
    • terms of engagement with the mentor and/or supervisor
    • allocated time for regular formal feedback and/or performance reviews by the mentor/supervisor
    • ready availability of a colleague, who may be the supervisor, or the practice manager to answer questions and assist with any day-to-day concerns.
  • Evaluation
    • ongoing review of learning needs. Most knowledge and clinical skills deficits will be identified in the course of consulting and provision should be made for addressing these needs
    • action that will be taken if the stated goals are not achieved in the stated time frames.

It is the individual GP’s responsibility to ensure their safety to practise. Supervisors and mentors have a duty of care to the public and also to the re-entering GP. If, at any stage during the implementation of the re-entry plan, the safety of either is compromised, action should be taken. It may be that notification to the Australian Health Practitioner Regulation Agency (AHPRA) is mandated. In the first instance, however, the supervisor and/or mentor should speak to the re-entering GP and try to resolve any concerns. AHPRA should be consulted when it has been involved in the re-entry plan because it will be in a position to make a decision. The RACGP is unable to make decisions but may be able to advise.

When a GP has been absent from work for more than 36 months, the Board’s requirement is that they work under supervision. In some instances, the Board may also require a formal assessment of clinical skills prior to re-entry. Sometimes, the required level of supervision as well as its duration is stipulated by the Board. The Board will inform the GP, when applying for re-entry, about any such requirements for assessment and/or supervision.

Good supervision and feedback within a supportive environment enhances the improvement of clinical skills. It promotes the practitioner’s strengths, elucidates the areas that need improvement and provides direction and strategies for improving performance. Even if the Board doesn’t mandate it, supervision is advisable for any GP who has been away from practice for a substantial period of time, because it:

  • provides evidence as to the practitioner’s safety to practice and that the public is not at risk
  • monitors and supports the practitioner throughout the duration of the re-entry plan to ensure that objectives are being met.

The need for supervision will be influenced by individual circumstances, including the:

  • reasons for absence
  • length of time away
  • specific practice where the practitioner will be working (ie patient demographics and any associated risks)
  • supports that will be in place (other than the supervisor)
  • experience of the practitioner.

Supervision should be both formal and informal, tailored to the GP’s needs:

  • Formal supervision involves regular, scheduled time that enables in-depth discussion and reflection on clinical practice. It may include
    • review and feedback on performance, identifying strengths and weaknesses and performance issues
    • direct observation of consultations, including procedures
    • case discussion, including random case analysis
    • prescribing and medical record reviews
    • review of systems and practice procedures.
  • Informal supervision may include
    • day-to-day observation, communication and interaction providing advice, guidance and support as required (many learning needs will arise during the course of consulting)
    • observing the supervisor’s consulting.

The supervisor should be onsite when a re-entry GP is practising. When the supervisor is not onsite, they should be readily available by phone, or a secondary supervisor should be nominated to provide assistance.

Supervision should be directed towards self-management, starting with a higher level of supervision for an initial period and gradually reducing over a defined period. The level of supervision and its duration will be influenced by the re-entry GP’s skill level, confidence and rate of progress.

The terms of engagement, with respect to supervision, will be fairly well defined. The mentoring relationship can vary considerably from informal and short term to formal and long term. The role of the mentor is both supportive and developmental. The mentor’s role entails:

  • assisting in the preparation of the learning plan
  • providing ongoing advice, guidance and support (pre and/or post re-entry)
  • periodically meeting formally and/or informally with the practitioner to discuss pertinent issues.
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