Reasonable adjustments at work – good practice for paediatricians

Based on the legal guidance, paediatric trainees and doctors can use this resource to identify supporting options available to them where appropriate.
Last modified
16 March 2021

You are disabled if you have a physical or mental impairment that has a ‘substantial’ and ‘long term’ negative effect on your ability to do normal daily activities.

Equality Act 2010

Introduction

Paediatricians should expect the kindness and equality that they routinely show their patients, carers and families. Doctors with disabilities are an asset and are to be welcomed into the profession and valued for their individual contributions. Paediatrics should be an equally achievable prospect for all trainees whether they have additional needs or not.

The General Medical Council (GMC) acknowledges that disability in itself is not a barrier to practising medicine, and that a diverse population is best served by a diverse workforce (GMC, 2019).1

Circumstances are unique to individuals. Each trainee should be offered personalised support through a process of determining what reasonable adjustments they might require to remove barriers they may face and to ensure they are supported to meet the curriculum and assessment requirements. This will often entail an occupational health assessment by the workplace employer (Trust). The Trust is responsible for these reasonable adjustments.

The steps below outline some best practice guidance for this. Further information can be found with the referenced UK legislations, GMC documents and RCPCH information.

I'm a trainee (or prospective trainee) needing some adjustments. What should I do?

Needing adjustments at work is not a barrier to applying for and taking up a paediatric training post, progressing in training or becoming a consultant paediatrician.

  1. If you require adjustments to be made for you at work, or think that they may help, it is essential that you declare your need for assessment as soon as possible to avoid delay in workplace adaptation. Your assessment should be undertaken by an occupational health physician in a timely manner in line with local policy. This process can take several months to get in place, so we recommend you approach your Trust to request an occupational health assessment as soon as you know your rotations, or at least eight weeks in advance.

  2. If you would like adjustments to be made for you at interview or might benefit from adjustments being made, you need to declare your disability at application. If you meet the shortlisting criteria, you will be offered an interview with special adjustments.

  3. Raise any difficulties encountered as soon as possible with your local supervisors with the direction of escalation to the Training Programme Director (TPD), Director of Medical Education (DME), HR and trainee support service. If you are not currently part of a paediatric training scheme (eg medical student or foundation doctor), then seek advice from your local Head of School (HoS) or TPD for paediatrics. Discrimination is unacceptable and against the law.

  4. Develop individualised 'SMART2' personal development plans with your educational supervisor Support should be provided by your consultant team in line with these.

  5. Actively plan with your educational supervisor and TPD to identify areas of training where you may require reasonable adjustments and how you will meet the capabilities in the curriculum in a way that does not damage your health nor create difficulties for you in attaining your curriculum.

  6. Think about whether you are happy for the school to disseminate details of your reasonable adjustments so that local clinical supervisors and teaching programme providers are given advanced notice to support you.

  7. Be aware that there is more support available from Access to Work, a Government-funded scheme to financially support workplace adaptations and travel expenses to and from work if affected by your disability. This initiative can also fund disability awareness training for colleagues. The application can be completed online.

All paediatric trainees are entitled and encouraged to apply for Less Than Full Time (LTFT) training. The College also offers a reduced membership rate for all trainees working at 80% or less.

What should my employing trust do?

  1. Employers of anyone with a disability have a duty to make reasonable adjustments to ensure they are not disadvantaged when doing their job, following Occupational Health advice. Employers have a responsibility do this, rather than to automatically place trainees on sick leave. Emphasis should be placed on the timely progression of this process so as not to further disadvantage trainees.

  2. Examples of reasonable adjustments can include:
    • changes to working hours
    • providing additional / alternative equipment to enable you to do your job
    • educating your team to ensure best support for you through disability awareness training such as D/deaf awareness sessions
    • altering duties that would normally be expected of you, for example, not holding an emergency bleep if you are limited by mobility
    • ensuring teaching sessions are provided in an accessible format.
  3. Trusts and departments can be flexible in working to find opportunities for trainees to meet requirements; for example:

    • if a trainee is unable to work full 13 hour shifts, working an evening shift or part of a weekend shift should be an option
    • if a trainee is unable to work traditional out of hours shifts, accessing out of hours style working through working in the Emergency Department or Assessment Unit should be considered
    • trainees close to CCT (certification of completion of training) may be able to progress their training doing consultant-style duties under supervision rather than traditional registrar roles.
  4. All Trusts and regions offer support on return to work, in line with the HEE initiative Supported Return to Training programme (SuppoRTT).

  5. Each deanery is required to have a Professional Support Unit where trainees and supervisors can seek support and guidance.

  6. All Trusts should ensure that employees are enabled to attend their healthcare appointments. (This must not be taken out of annual leave as per GMC Guidelines.)

  7. As with British Medical Association (BMA) recommendations, each hospital should have rest facilities for those working night shifts along with provision of healthy food options. One-and-a-half hours break should be taken every 13-hour night shift; If these are missed, they should be exception reported.

  8. Each hospital should look after its employees’ wellbeing. Initiatives are often co-led by the hospital’s management team, Human Resources department, Health and Wellbeing group and Trainee’s Wellbeing Initiative Groups, for example Well and Resilient Doctor’s Group in Severn Deanery.

What should my Paediatric School (ie Supervisors, TPDs and Heads of School) do?

  1. All Supervisors, Heads of School and TPDs should advocate wholeheartedly for the implementation of reasonable adjustments and support their trainees through this process. They should advocate for Trusts to make alternative arrangements for rota cover for service provision and support the rights of the trainee needing reasonable adjustments.

  2. All Heads of School and TPDs should take into account individual trainee needs when organising rotational jobs, including travel needs. It is not necessary for trainees to rotate through multiple hospitals unless it is decided as necessary to achieve curriculum capabilities or to facilitate the trainee’s professional development plan. Once a Trust has organised for reasonable adjustments to be made it may be beneficial to reduce trainee rotation out of this Trust for continuity. Bear in mind that Occupational Health assessment can take some time to initiate and have recommendations put in place. Making a trainee rotate every six months means having this process re-started each time with a significant potential impact on the trainees wellbeing and level of reasonable adjustments put in place.

  3. Trainees should be supported by their supervisors to meet their training capabilities, while maintaining their own health and wellbeing. The Paediatric School should support a trainee in escalating any concerns of discrimination and support supervisors to design SMART2 objectives for their trainees, facilitating them to complete their curriculum.

  4. Additional funding for reasonable adjustments in the workplace is available via Access to Work.

  5. Cases of excellence can be recorded as a future resource to share best practice.

  6. Information on the reasonable adjustments needed by trainees can be disseminated with their consent to their supervisors and those who will be providing teaching for those trainees so that provision is universal.

  7. Face-to-face ARCPs (Annual Reviews of Competence for Progression) may be more helpful for those trainees requiring reasonable adjustments.

Background information

Disabilities as defined by the Equalities Act include not only visible physical disabilities, but also learning disabilities (including specific learning disabilities such as dyslexia), sensory impairments and chronic disease including both physical and mental health disorders. All doctors with disabilities, like all employees, are legally entitled to reasonable adjustments under the UK Equalities Act 2010. Reasonable adjustments are defined by the GMC as employers taking "positive steps to remove barriers that place individuals at a substantial disadvantage because of their disability" (GMC, 2019).1

The GMC document, Welcomed and Valued clearly states that doctors with disabilities should be welcomed into the profession and valued for their contribution. They acknowledge that disability in itself is not a barrier to practising medicine, and that a diverse population is best served by a diverse workforce. Organisations must make reasonable adjustments in line with legislation (GMC, 2019).1

What is the remit of RCPCH?

RCPCH has responsibility for overseeing paediatric training as a whole. Assessment strategy, curriculum and ePortfolio are overseen by the College, along with many other resources provided. The College must ensure that their interviews, curriculum and assessments do not unlawfully discriminate against those with disabilities. This also applies to assessments conducted by the College, such as exams and the START assessment). The College has a statutory responsibility to make reasonable adjustments under the Equality Act (2010).

In order to gain a CCT in Paediatrics, the trainee must spend a minimum of four years in a GMC approved UK training programme, and complete all levels of the training programme. Aside from this, training is capability-based not time-based, and trainees may progress through training in fewer than eight years, provided they have met the capabilities and learning outcomes specified in the RCPCH Progress curriculum.

Trainees must evidence their capability in providing acute unscheduled care – that is their ability to manage babies and children who present in an acute and non-elective manner. There is no specific requirement to work the traditional ‘out of hours’ model, as there are many different ways of providing care at different times of the day and week. For example, trainees might work twilight shifts; however, such bespoke working patterns might prolong the time taken to gain all necessary capabilities before CCT.

Examples of reasonable adjustments that may be made in MRCPCH / DCH exams and START assessment

These are examples of some of the areas the RCPCH can offer - not all options apply to all exams and assessments. For further information, please contact us - for exams, exams@rcpch.ac.uk, or for START assessment, training.services@rcpch.ac.uk,

  1. Extra time in exams
  2. Language adjusted papers 
  3. Printed format papers in different font/ coloured paper 
  4. Exam scribe
  5. Being allowed to take reasonable breaks with “stop the clock” during exams to rest/ take medications/ eat to regulate sugar levels
  6. Adding additional rest stations to Clinical exams
  7. Verbal exam instructions also provided in writing as a transcript
  8. Subtitles on all examination videos
  9. Being allowed to use online versions of British National Formulary for Children
  10. Use of electronic/ tactile stethoscopes in Clinical exam 
  11. Reasonable adjustments to the number of examination attempts allowed

What is the remit of the GMC?

The General Medical Council is bound by public sector equality duty to promote equality and eliminate discrimination (GMC, 2019).1 It sets standards for medical education and state that those providing medical education must support disabled learners, including through reasonable adjustments.

It also have a remit over organisations responsible for all aspects of training design and implementation. It sets standards for revalidation, but states that these standards allow flexibility to adapt requirements to individuals’ circumstances (GMC, 2019).1

What is the remit of the employing Trust?

The Trust has a duty to make reasonable adjustments so that those employees with disabilities are not disadvantaged in the workplace (Equality Act 2010).

The GMC's Welcomed and Valued guidance suggests a case management model to develop an action plan to support doctors in training (GMC, 2019),1 and that there is a shared responsibility for implementing the action plan between the employer, deanery or HEE local team and the doctor in training (GMC, 2019).

The Trust should ensure that timely assessment by their Occupational Health Department has occurred prior to trainees starting work or as soon as need is identified. Access to Work can be used to contribute towards the additional cost of specialist equipment, adaptations to the workplace, communication support, travel to and from work because of disability and disability awareness training for colleagues.

See the GMC's step by step guide to ensure all reasonable adjustments are supported and regularly reviewed (includes a diagram).

Examples of reasonable adjustments

This is not a complete list, and all reasonable adjustments must be tailored to the individual.

General

  • Disability awareness training for the team 
  • An understanding that doctors with disabilities are more likely to have a higher sickness rate in relation to their disability. This must be recognised and acknowledged as part of the ARCP review to minimise penalising this cohort of paediatric trainees 
  • The team to enable the trainee to attend any required appointments without being penalised for having this time off

Hearing impairment

  • A spare electronic stethoscope on site, as they would not be able to use any other alternatives should their usual electronic stethoscope malfunction
  • Vibrating bleeps/ pagers
  • Handouts / copies of presentations at teaching sessions
  • Subtitles on all video materials in teaching (for example, use automated captioning tool in YouTube)
  • Simulations sessions face to face, watching via video monitors can be difficult if unable to hear or lipread
  • Amplified phones or cordless phones/mobiles to enable calls to be taken in a quiet area if needed 
  • Departmental meetings / Grand Rounds around a table rather than in seated rows, which better enables lipreading 
  • Provision of palantypist / speech-to-text typists for conferences and study days

Visual impairment

  • Electronic notetaking 
  • Accessible rooms
  • Consider whether doctor can / should carry the emergency bleeps
  • Screen reader / speech to text computer programme to enable documentation of electronic notes 

Limited or difficult mobility

  • Consider how the doctor would access bed / resuscitate in an emergency or routine situations 
  • Consider whether the doctor can / should carry the emergency or time-critical bleep 
  • Provision of a chair to allow doctor to sit down when undertaking practical procedures/ ward rounds 
  • Accessibility to wards/ meeting rooms
  • Allowing breaks during ward rounds 
  • Supportive equipment such as adjustable chair, cushions, supportive furniture
  • Specialist mobility equipment 

Learning disabilities / Autistic Spectrum disorder

  • Provision of software (such as spell-checker or screen reader) to use when completing e-referrals/ discharges, etc.
  • Support with getting ePortfolio assessments completed
  • Training to support with communication skills

Mental health conditions

  • Access to a counsellor or a named support person at the trust
  • Amendments to working hours