1. From the frontline: F2s and career breaks Dr Kate Emmerson Foundation Doctor Advisor UKFPO

2. From the frontline: Foundation Doctors and career breaks It’s easy for you to climb the career ladder, you just lay your eggs and go: No need for maternity leave!

3. Overview  Overview of changing face of workforce  Reasons for taking time out of programme  Problems with the current system  Illustrated by foundation doctors’ experiences  Positive aspects of the current system  Summary and steps forward

4. Changing workforce  62% of current F1s are female  20% are >25years old

5. Taking time out of Programme  Maternity leave  Child care  Caring for a sick relative  Bereavement  Relocation of partner’s job eg. Overseas  Return to home country eg. National service

6. Operational Framework Guidance  Geared towards taking 12 months out of programme  Decisions taken and process managed at school or programme level  Trust must agree  6 months notice required both to leave and to return to programme

7. Problems  Lack of flexibility due to annual timelines  Example: Mary  Completed 2 out of 3 F2 placements  Abroad for 2 years due to husband’s job  On return, had to repeat whole of F2  No scope to complete 1 placement and achieve sign- off for the year  Example: Mena  Took 3 months out during F1 to care for her dying mother  Had to repeat whole F1 year in order to achieve sign- off

8. Problems  Lack of flexibility on annual timelines  Example: Sally  Pregnant, due end of September F2 year  Advised to take mat leave at the end of F1 year (from August) as would be easier for the Trust  Asked to take full year off rather than go back part way through year, again as easier for the Trust  Unpaid maternity leave  Lost all annual leave due for maternity leave period – told she should have taken it during F1 even though she had not accrued it then and would not have been allowed to take it

9. Problems  High level of service provision in Foundation Programme jobs creates rota problems  Example: Maddy  Sick leave 8 weeks into her pregnancy  Unable to return so took early maternity leave  Job not filled ‘mid-year’  Unable to fill position over next 6 months  Rota already 1 doctor short due to a resignation  Remaining FDs required to cover day job and on-call commitments  One of the remaining FDs needed time off due to stress as a result

10. Problems  Lack of protocols / knowledge in HR  Example: Amy  Pregnant during F2 year, due after completing F2  Initially told she did not qualify for maternity leave as had not worked in that particular Trust for 1 yr (F1 job in a different Trust, same Foundation School)  Had to involve BMA to resolve this  Had a place to start specialty training but advised to defer until after maternity leave  Trust struggled to work out how to ‘bridge’ her contract to cover the time from end of F2 until start of maternity leave  Despite 2 occupational health risk assessments, at 33 weeks she is still performing duties deemed inappropriate eg. Working nights, long sessions in operating theatres  Made to feel very guilty about the ‘problems’ she is causing

11. Problems  Lack of understanding of flexible training  Example: Chloe  Graduate entry medical student  Two children aged 2yrs and 5months at time of starting F1  Requested flexible training for F1 – declined by first choice deanery but agreed with another deanery  Started working at 70% of full-time (3.5 days/week)  Impossible to leave at 5pm due to commitments scheduled for after 5pm eg. Pre-op clerking  Often working a 12hr+ day so major problems with child care

12. Chloe contd.  Prejudice from other F1’s  ‘I can’t believe you’re getting away with not working nights’  Made to feel she wasn’t a proper part of the team  No understanding of the fact that she needed to leave on time to pick up her children  Constantly had to explain that she was not ‘skiving’ but was on an agreed part-time contract  Also trying to express milk during the day!  Quit after 8 months, just prior to starting a notoriously busy MAU job  Can start again in August ‘10 but will have to start from scratch. Equivalent of 6 months FT F1 does not count

13. From the deanery perspective  7 trainees took time out Aug ‘08 – Aug ‘09  All due to return to start F2 in August ‘09  3 female, 4 male  1 x female did not return - family/children  2 x males did not return - change to non-medical career  1 x male did not return - other reason  2 x females returned to start F2 (1 now on maternity leave)  1 x male returned to start F2

14. Summary of problems  Foundation Programme timelines not flexible  Partially completed years do not always count towards sign-off  No flexibility within system to deal with staff shortages  HR staff are not expecting FDs to take time out and are struggling to know how to manage this  Advice is often therefore poor and/or inaccurate  FDs made to feel VERY guilty  FDs encouraged / coerced into doing what suits the Trust rather than what suits them  General lack of understanding and empathy!  FDs feel that they would be treated very differently if they were a nurse / midwife / other healthcare professional  Difficult for deaneries’ workforce planning as no guarantee will return to full time training or return at all after time out!

15. Positives  Deaneries have in general been much more supportive and helpful than individual Trusts  BMA very helpful, clear advice, supportive but not everyone is a member  Planning for return to work a lot easier than planning to take time out  Most FDs have encountered support and encouragement from senior doctors – it is the administrative staff who have caused problems and made them feel guilty!  Self-help booklet and online forum for trainees with young families being developed by one deanery in conjunction with trainees

16. In summary  2 year fixed programme works well for majority  Small group for whom more flexibility is needed  Could argue not worth it for small numbers but…  Often ‘value-added’ Foundation Doctors  Already given up a lot to pursue medicine, very committed  Hard working, reliable, responsible, empathic  Life experience invaluable  Seems a shame to lose them!  How to manage workforce planning?  Specialty training much better set up to cope with flexible working / time out – provides a potential model to follow

17. Thank you for listening