Formulating a plan for re-entry

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.