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Practice Experience Program – Extenuating and Unforeseen Circumstances Guidance Document


1. Introduction

1.1 This guidance document provides specific information on Extenuating and Unforeseen Circumstances for participants of the Practice Experience Program – Standard Stream and the Practice Experience Program – Specialist Stream.

2. Context

2.1 This document provides guidance to prospective and current participants of the Practice Experience Program (hereafter ‘participants’), the circumstances which may qualify under extenuating and unforeseen circumstances. It details evidence the RACGP requires to make an accurate assessment of the circumstances. The RACGP uses the evidence a participant submits to determine the options available for a participant experiencing such circumstances.

This document does not cover leave for legislative purposes (such as parental leave), or personal/recreational leave for other reasons not covered under the definitions of extenuating and unforeseen circumstances in the Practice Experience Program – Standard Stream Leave and Extensions Policy, the Practice Experience Program - Standard Stream Transfer Policy or the Practice Experience Program Specialist Stream Leave Policy.

3. Guidance

3.1 Extenuating and unforeseen circumstances is defined as “circumstances which were unforeseen, outside the participant’s control and which can be shown to have a direct and significant impact on the participant’s ability to complete the PEP requirements.”

3.2 Participants may experience extenuating and unforeseen circumstances prior to or during the program that temporarily prevents:

  1. Completion of the necessary entry requirements to the program (including sitting the PEPEA);
  2. Participation in the program including work as a medical practitioner in the capacity of a General Practitioner at a minimum of 14.5 hours over 2 days per week;
  3. Meeting an assessment submission deadline or engaging in a clinical assessment, e.g. workplace based assessment; or
  4. For PEP Standard, participation in self-directed learning demonstrated through Continuing Professional Development activity.
  5. For PEP Standard, meeting the requirements outlined in the Practice Experience Program – Standard Stream Satisfactory Completion Framework;
  6. For PEP Specialist, meeting the requirements outlined in the Practice Experience Program Specialist Stream Satisfactory Completion Framework

3.3 Options available to candidates

In the event of extenuating and unforeseen circumstances, participants can apply for:

  1. Leave from the educational and post education phases of their program;
  2. Extension to the educational and post education phases of their program;
  3. Transfer between Training Providers;
  4. Variation to provider number location conditions to receive medical treatment not available in an MMM2-7 location.

Participants cannot apply for leave or extensions once their exam candidacy has commenced. For further information about exam candidacy suspension in extenuating and unforeseen circumstances refer to the Fellowship Exam Attempts Policy.

3.4 Communication with the RACGP

  1. Participants can apply for consideration of extenuating and unforeseen circumstances if either the participant themselves or a first degree relative experiences extenuating and unforeseen circumstances outlined in clause 3.i – iv.
  2. To apply for consideration of extenuating and unforeseen circumstances, participants should apply to the RACGP as soon as possible by submitting the Change in Circumstances form with supporting evidence. This form can be accessed by emailing PEPApprovedPlacement@racgp.org.au.
  3. Applications must be made via email to PEPApprovedPlacement@racgp.org.au with the following naming convention:
    Change in Circumstance (extenuating and unforeseen circumstances) – Dr [LAST NAME] – [RACGP ID]
  4. The participant must inform the RACGP of leave taken during any phase of the program due to extenuating and unforeseen circumstances as soon as possible. The RACGP recognises that the nature of some extenuating and unforeseen circumstances will prevent the participant from making a timely application. However, where possible, the application should be made within one calendar month of the circumstances arising. This will allow the RACGP to accurately assess timely fulfilment of program requirements and ongoing access to a provider number under the PEP, including for the purposes of extension. Information about application processing timeframes can be found in section 3 under application outcomes.
  5. The RACGP will not accept applications for recognition of extenuating and unforeseen circumstances if the application is received more than 6 calendar months after the circumstances have arisen, or the application is supported by evidence that is dated more than 6 calendar months prior to the application.
  6. If a participant is unable to personally communicate with the RACGP, third party requests for recognition of extenuating circumstances may be made. In such cases, evidence must be provided as to why the participant cannot personally make the request, and where possible consent must be given for third party communication to take place

3.5 Examples of extenuating and unforeseen circumstances

Extenuating and unforeseen circumstances may include, but are not limited to:

  1. Ill health
    1. Life-threatening illness;
    2. Serious Accident;
    3. Hospitalisation;
    4. Illness that could become life-threatening if not treated correctly;
    5. Diagnosed mental health condition;
    6. Unforeseen pregnancy complications;
    7. A chronic illness or disabling condition that if not treated correctly will prevent the person from performing their normal occupation (minimum 14.5 hours over 2 days a week of General practice);
    8. Inability to receive necessary medical care in an MMM 2-7 location (for example, radiotherapy treatment or treatment requiring frequent attendance at a MMM 1 medical facility).
  2. Acute adverse life circumstances
    1. Bereavement;
    2. Significant personal / family circumstances being encountered by the participant (for example, a spouse’s mandatory employment move);
    3. Unusually severe stress in response to work and life circumstances preventing the participant from working the minimum part time program requirements of 14.5 hours over two days per week;
    4. Illness of a first degree family member.
  3. Employment conditions
    1. Loss of Ahpra registration;
    2. Ahpra process difficulty or delay in obtaining registration due to circumstances beyond the participant's control, such as Health Complaints Commissioner (HCC) proceedings;
    3. Loss of employment due to factors beyond the participant’s control (such as a practice closing down);
    4. Loss of employment due to factors relating to the participant’s work environment (such as a dispute with staff, patient complaint, undergoing investigation by Ahpra);
    5. Loss of Supervisor, where the participant is subject to Ahpra supervision levels 1-4;
    6. Change in immigration status affecting the ability to continue working.
  4. Other circumstances
    Unique life events include but are not limited to:
    1. Emergency or disaster;
    2. The onset of a Pandemic;
    3. Attendance at legal proceedings;
    4. Australian Defence Force (ADF) deployment or other military service.
  5. If a participant experiences any extenuating and unforeseen circumstances not listed in this document that have a significant impact on their ability to continue with program requirements, they should submit a Change in Circumstances form so that their application can be assessed and appropriate support and guidance can be offered by the RACGP. The examples above are not exhaustive, and any submitted to the RACGP will be assessed on a case by case basis.

3.6 Submitting Evidence

This section provides guidance regarding the type of evidence required to demonstrate the presence and impact of extenuating and unforeseen circumstances for the purposes of an application for leave, extensions or transfer.

  1. Ill health
    If the participant or a first degree relative experiences ill health, including ill mental health, the evidence submitted should include the following information (where appropriate):
    1. Details of diagnosis;
      1. Where possible, this should be a recognisable diagnosis using objective criteria. Where the issue pertains to mental health, the diagnosis should reference a tool such as the DSM; and
      2. Date of first diagnosis.
    2. Impact of diagnosis;
      1. How long the relevant specialist has been providing treatment;
      2. Frequency of treatment (for example, how many visits in the past month)1
      3. The reasons why treatment prevents the participant from meeting the program’s minimum part time requirements in a MMM 2-7 location (for example, if specialist services such as radiotherapy are required);
      4. Expected duration of illness; and
      5. The estimated time for which the participant will be unable to meet the program’s minimum part time requirements.
    3. Where the participant is providing care to a first degree relative evidence should be also be provided regarding the;
      1. Level of care provided – for example, the number of visits to medical services the relative requires, the number of hours spent providing care, and the forms of care and assistance provided.
    4. Where medical services required for treatment of the participant or the first degree relative are situated in another location applications will only be considered where the individual requires medical care that;
      1. The participant provides a letter of support or other evidence (from a GP or other relevant specialist) that the treatment is not available or suitable in their current location;
      2. Is required more than once every two months2 and
      3. The treatment is generally recognised as appropriate for the medical condition.
  2. Acute adverse life circumstances
    Accepted evidence includes, but is not limited to:
    1. Statutory declaration;
    2. Death certificate;
    3. Evidence of mandatory employment relocation; or
    4. Specialist letter of support or letter from a GP, including evidence of the participant’s involvement in treatment.
  3. Employment conditions
    Accepted evidence includes, but is not limited to:
    1. Ahpra communications;
    2. Statutory declaration;
    3. Letter from place of work indicating circumstances; or
    4. Evidence from the Australian Department of Home Affairs or relevant international equivalent detailing the change in circumstances.
  4. Other circumstances
    Accepted evidence includes, but is not limited to:
    1. Evidence of residence in an area affected by natural disaster, emergency or the onset of a pandemic;
    2. Evidence of employment with an organisation managing fallout of natural disaster, emergency or the onset of a pandemic;
    3. Court summons/subpoena evidence; or
    4. Letter from ADF confirming deployment.

3.7 Medical practitioner requirements

Medical evidence may include a detailed letter of support from a GP or relevant specialist.

However, to ensure that objective medical information relating to a participant’s circumstance is submitted, the RACGP requires independent medical evidence from a health professional who is free from any potential conflicts of interest. This means that evidence submitted by a medical practitioner must meet the following requirements to be recognised:

  1. The practitioner is not related to the participant/first degree relative;
  2. The practitioner does not have other personal connection to or relationship with the participant or first degree relative;
  3. The practitioner does not work within the participant’s current general practice workplace and is not a prospective employer; and
  4. The practitioner is an AHPRA-registered GP or treating specialist directly involved with the diagnosis or treatment of the participant or first degree relative

3.8 Application outcomes

Upon receipt of an application for leave, extension or transfer for extenuating and unforeseen circumstances, the RACGP will assess the circumstances against the criteria outlined in this document. The RACGP may request additional information to supplement the application.

  1. Following a leave or extension application, the participant should receive an outcome within 10 national office business days of receipt of the application.
  2. Following a transfer application, the participant should receive an outcome within 12 weeks of receipt of the application. This is to allow for the administrative processes of applying for a new provider number for the new place of employment, in line with the Practice Experience Program – Standard Stream Transfer Policy.
  3. Following an application for entry into the Practice Experience Program under Extenuating and Unforeseen Circumstances the applicant will receive an outcome for their extenuating unforeseen circumstances application and eligibility application at the same time.
  4. Application approved
    1. The duration of the leave or extension, or the terms of the training provider transfer, is determined on the grounds of the severity of the medical condition, the supporting evidence provided, the stage of the PEP program, and the impact on the participant’s Ahpra registration.
    2. Participants are not permitted to undertake work using their PEP provider number during any period of leave, including during leave for extenuating and unforeseen circumstances, and it is expected that no other clinical work will be undertaken. Access to the PEP educational units via the Learning Management System (LMS) will remain active during periods of leave.
    3. The workplace-based assessment for the term in which the leave falls will be postponed until clinical work is recommenced unless the training provider is willing and able to offer simulated sessions and the participant is available to attend.
  5. Application denied
    If the participant’s conditions do not fit the criteria for extenuating and unforeseen circumstances, other options may be offered, such as:
    1. Taking personal leave (i.e. leave for any other reason not included in the definition of extenuating and unforeseen circumstances in this document and relevant policy);
    2. Taking parental leave (where applicable) instead of extenuating and unforeseen circumstances leave;
    3. Reduction in working hours (subject to the participant continuing to meet the program’s minimum part time requirements);
    4. Deferral of entry to the program (if circumstances arose prior to entry).

3.9 Circumstances not considered grounds for recognition

Participants are advised that the following are not on their own considered sufficient grounds for recognition of extenuating and unforeseen circumstances:

  1. General
    1. Circumstances for which appropriate adjustments have already been made by the RACGP;
    2. Circumstances stated to be unforeseen that a reasonable person would view as foreseeable or preventable;
    3. The participant has previously been issued a SAPP provider number for another 3GA workforce program or a SAPP provider number under the Department of Health extenuating circumstances (the participant must also apply for the RACGP’s extenuating circumstances recognition and be reassessed).
  2. Employment
    1. Loss of employment that extends beyond three month permitted clinical break;
    2. Disputes with employer or working conditions;
    3. Inability to complete program requirements due to working more than 38 hours per week.
  3. Medical
    1. Self-certified illness or medical circumstances;
    2. A claim for recognition of a medical condition that relies on evidence that does not relate to the time when the illness or condition occurred, or was documented more than six months prior to application;
    3. A long-term health condition where there is no evidence of a sudden worsening;
    4. A minor illness that would not normally lead to a responsible and reasonable employed person to take sick leave;
    5. An uncomplicated pregnancy or where birth occurs prior to the start date.
  4. Personal
    1. Holidays, including getting married, attendances at marriages, festivals and other personal events;
    2. Divorce or relationship breakdown;
    3. Financial hardship;
    4. General stress or emotional isolation not associated with a diagnosed mental health condition. When a participant is experiencing some degree of stress while on the program, it is recommended that they reduce their working hours (provided that they continue to work the 14.5 hour minimum) to ensure adequate time can be given to other responsibilities and self-care.
  5. Geographical
    1. Geographic isolation in MMM 2-7 location;
    2. Request for metropolitan placement based on age, religion, ethnicity or language skills;
    3. Request for a metropolitan location to access specific services (e.g. child care, educational needs for children etc.).

3.10 The GP Support Program

  1. The RACGP recognises that doctors experiencing extenuating and unforeseen circumstances may feel distressed and overwhelmed. To assist its members, the RACGP offers access to its counselling and support service, The GP Support Program. The service is delivered by LifeWorks by Morneau Shepell. LifeWorks by Morneau Shepell EAP is a free and confidential service available to all RACGP members and their immediate family members, where they can access professional advice to help cope with life stressors that can impact on wellbeing, work, and psychological health.
  2. For more information or to access LifeWorks by Morneau Shepell please call 1300 361 008.
  3. If you have any queries about how this service operates, please call the RACGP member helpline on 1800 331 626. Your queries will be handled discreetly

4. Glossary

Acute adverse life circumstances

Personal or work circumstances under which a participant is unable to work the minimum part time program requirements of 14.5 hours over two days per week.

ADF

Australian Defence Force

Ahpra

Australian Health Practitioner Regulation Agency

Clinical break

A period of up to three months during which the participant may continue educational program components while not working clinically.

Disaster

A disruptive occurrence that causes suffering of a level that exceeds the adjustment capacity of the affected community.

DSM V

Diagnostic and Statistical Manual, 5th Edition

DPA

Distribution Priority Area

Emergency

A serious, unexpected and dangerous occurrence that requires immediate action.

Extenuating and unforeseen circumstances

Circumstances which were unforeseen, outside the participant’s control and which can be shown to have a direct and significant impact on the participant’s ability to complete the PEP requirements, including:

  1. ill-health (other than minor illnesses) with valid certificates;
  2. carer’s leave with valid certificates;
  3. bereavement;
  4. acute adverse life circumstances;
  5. hospitalisation;
  6. Australian Defence Force deployment leave;
  7. Loss of employment, medical registration or provider number; or
  8. Other circumstances involving significant changes to a participant’s circumstances.

Immediate family member

Parents (mother, father, and step-parents), siblings, spouse/partner/de facto/fiancé, child/children and anyone for whom the GPiT has primary carer responsibility.

Legislative leave

Parental, sick and carers leave granted pursuant to the participant’s workplace entitlements under the Fair Work Act 2009 (Cth); and

Any other form of leave as permitted under the National Employment Standards.

LMS

Learning Management System, through which participants access the PEP learning units.

Minimum part time

Part time general practice must comprise a 14.5-hour minimum working week, over a minimum of two days per week, of which a minimum of 10.5 hours must be in face-to-face, rostered, patient consultation time undertaking general practice activities.

MMM

The Modified Monash Model is a classification system that categorises metropolitan, regional, rural and remote areas according to both geographical remoteness and town size.

Pandemic

An outbreak of a disease that occurs over a wide geographic area and that affects an exceptionally high portion of the population.

Participant

A medical practitioner who has been accepted into the PEP and who for the purposes of this document is applying for leave, extension or transfer.

Personal leave

Any leave requested which does not fall into the definitions of legislative leave or extenuating and unforeseen circumstances leave. This leave is capped at three months per program in addition to four weeks’ annual leave.

PEP Portal

Program management platform

Practice Experience Program

The program supporting doctors towards vocational recognition via Fellowship of the RACGP; the program includes both an educational phase and a post-education phase.

SAPP

Special Approved Placements Program administered by the Department of Health. The SAPP closed to new participants on 30 June 2019.

Stress

The expected impact of work/personal events under which the participant is able to work the minimum part time program requirements of 14.5 hours over two days per week.

Training provider

Training provider, which for the purposes of this document encompasses Regional Training Organisations (RTOs), the Remote Vocational Training Scheme (RVTS) and the RACGP.

5. References

  1. Practice Experience Program - Standard Stream Leave and Extensions Policy
  2. Practice Experience Program - Standard Stream Transfer Policy
  3. Practice Experience Program – Standard Stream Satisfactory Completion Framework
  4. Practice Experience Program - Specialist Stream Leave Policy
  5. Practice Experience Program - Specialist Stream Satisfactory Completion Framework
  6. Fellowship Exam Attempts Policy
  7. RACGP GP Support Program

 

 
Version Date of effect Amended by
1 2/9/2019 Education Policy and Guidance Lead
Amendment details  

Enquiries

 1800 626 901

 racgpeducation@racgp.org.au

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