Opportunities for Out of Programme Pause: A Short Term offer in response to COVID



Core Features of the Offer
Return to Training Process
The Role of HEE
Appendix 1 - Frequently Asked Questions



Health Education England (HEE) is committed to supporting trainees during and post COVID, by ensuring mechanisms are in place to support trainee’s wellbeing and educational provision. As a result, HEE is exploring how to utilise existing flexibility offers to provide this support.

Out of Programme Pause is one such offering which is currently being piloted in selected sites and specialties across HEE and provides trainees with an opportunity to step out of training for an extended period of time whilst also providing service. HEE will be extending this pilot to include all specialties and all regions. Offering OOPP to trainees may provide a welcome opportunity to take a break from their current training post, after the pandemic. At the same time, trainees who undertake OOPP will also have the opportunity to gain competencies which they may not previously been able to due to the impact of the pandemic.

This will also provide the opportunity to increase the scale of pilot, providing further data to provide a robust evaluation of the programme.

For the purpose of this guidance this model will be termed ‘OOPP Pilot expansion’.

This offer will allow the provision of wider access to Out of Programme Pause (OOPP), over a fixed period of time, in order to support trainees post COVID. It is thought that a more flexible approach may:

  • reduce ‘burn out’ and attrition;
  • aid training programme management in response to increase in extensions to training;
  • improve morale;

This offer remains part of a pilot which will be evaluated by HEE who will share findings widely.

There are a number of initiatives and projects being developed by HEE in parallel to enhance working lives for trainees; this is one of many ideas being piloted.


Out of Programme Pause (OOPP) allows trainees in specialty training to step off the training ladder and undertake work in the NHS or a similar patient-facing role in the UK. Experience and competencies gained outside of training may be then considered on the trainees return to their training programme.

The initial pilot for Out of Programme Pause (OOPP) was launched in Spring 2019, where OOPP was offered to Anaesthetics trainees in the East Midlands. Phase 2 commenced in summer 2019, with selected specialties in Wessex, North Central and East London, and the North East taking part, along with the remaining specialties in East Midlands.

A three-year evaluation has been commissioned to explore the impact of the pilot.

Further work is currently being undertaken with the Academy of Medical Royal Colleges regarding the gap analysis and return process, along with further discussions with the GMC for devolved nation approval of the initiative. The current scope of the pilot has been agreed by the GMC.

The ‘gap analysis’ process is a judgement on what competencies may have been achieved with respect to both Generic Professional Capabilities and specific curriculum outcomes. This would form the basis of a training plan on return to training.

Core Features of the Offer

HEE has determined that in response to COVID, as a support mechanism for trainees, the OOPP pilot will be expanded, for a fixed period of time and with a change in scope.

Whilst the primary aim of OOPP will be for trainees to take a break from training, OOPP would also provide an opportunity to gain competencies which they have been unable to acquire due to service disruption. An example of this would be particularly appliable to surgical trainees and undertaking OOPP would provide a mechanism for the trainees to acquire those competencies during their OOPP Placement. This would include the possibility of working outside the NHS in line with the OOPP terms and conditions.

By taking this approach, this would provide many additional benefits not previously in
scope which have been outlined below:

  • It would allow trainees the opportunity to step off their training programme for a length of time which may provide them with a welcomed break.
  • It will also lead to vacation of training posts during a time where:
    • Consultant interviews may be delayed and an increasing number of trainees possibly taking a period of grace.
    • Increasing numbers of trainees may be awarded extensions of training.
  • The potential vacancies generated by trainees taking OOPP would provide greater flexibility to training programmes to manage this increase numbers in their programmes for the reasons outlined above.

The offer in this format will allow trainees to undertake up to 12 months in an OOPP post.

OOPP can be considered if;

  • A trainee wishes to take a break from training and expects to receive either an outcome 1, 10.1 or 10.2 at their most recent ARCP.
  • Where a trainee feels it would be beneficial for their wellbeing.
    • This would follow a discussion between the trainee and Educational Supervisor to ensure that this is the most appropriate option. If appropriate the Educational Supervisor may liaise with the PSW or occupational health to explore what further or alternative support may be needed for the trainee.

The following principles have been developed for HEE local offices to aid a robust and equitable approval process for OOPP.

  • Training programmes will make every effort to provide the opportunity for trainees to gain all required competencies within their programme. However, for trainees who undertake OOPP, any relevant competencies gained can be assessed and counted on return to training.
  • Suitability of OOPP post in relation to trainee’s rationale for applying for OOPP e.g. if applying due to wellbeing, is OOPP the most appropriate option.
  • Does the trainee have the support of their TPD and HoS? Approval would be based upon trainee need and training programme stability.
    • Additionally, the educational supervisor must be satisfied that the OOPP post is a suitable placement for the trainee, taking into account their level of training and the support that will be available.
  • Would the training programme be able to accommodate the gap? It is expected in the majority of cases, where there has been an increase in extensions to trainees training programmes, these gaps will accommodate additional trainees still in programme. However, we recognise that in some cases there will be fragility in the system and local offices will need to make informed decisions to ensure service provision is not compromised.
  • Is the trainees OOPP post appropriate by providing opportunities to undertake required competencies?

There must be assurance that the viability of the training programme will not be compromised. For larger training programmes it is reasonable that the maximum number of trainees permitted to undertake OOPP does not exceed 5-10% per training programme per region.

Applications under “OOPP Pilot Extension” will be processed on a first come first served basis. Availability will be reviewed regularly to ensure stability of the workforce and to ensure any patient safety risks are identified and managed; approval of OOPP will be dependent upon exigencies of the service.

HEE Local Offices will manage and administer applications for the pilot within existing OOP mechanisms.

Trainee doctors within the offer will need to identify their OOPP post prior to application.

Trainees who have a current Tier 2 Certificate of Sponsorship or require a Tier 2 Certificate of Sponsorship should discuss eligibility for the pilot with the relevant HEE Local Office and UK Visas and Immigration prior to submitting an application.

Return to Training Process

The Specialty Trainee would return from OOPP alongside/after completing any relevant return to training (RTT) programme elements and have an initial educational appraisal meeting with their Educational Supervisor to review the experience and any competencies gained during their OOPP.

The trainee may want all, some or none of their competencies gained whilst OOPP to count toward their training. A ‘gap analysis’ would be conducted with a judgement on what may have been achieved with respect to both Generic Professional Capabilities and specific curriculum outcomes.

This would form the basis of a training plan.

Once the initial educational appraisal meeting has taken place, the trainee will have an opportunity to demonstrate their skills and capabilities as part of their prospectively approved training programme. This would ideally be undertaken in the first three months following return to training, to allow the Trainee and Educational Supervisor to ensure the training plan is appropriate and properly focus learning objectives in advance of the next Annual Review of Competence Progression (ARCP);

Following OOPP, if the Trainee and their Educational Supervisor do not want to count competences and did not feel an adjustment to the CCT date would be appropriate then there would be no requirement to do so.

At the ARCP, a formal determination of outcome would be made with an adjustment to the CCT in light of demonstration of competencies evidenced following return to training and the Educational Supervisor’s report; this would be in accordance with Gold Guide and GMC guidance.

A guide will be issued shortly containing further information regarding the Return and gap analysis process. This guide will be issued to HEE local offices for dissemination to OOPP trainees.

The Role of HEE

Local and regional HEE offices will play a key role in monitoring and support. This will allow flexibility for trainees and LEPs to apply within established processes and take into account local needs.

HEE will govern the pilot by ensuring nationwide communications, monitoring, evaluation, reporting, learning and provide a platform for the sharing of best practice.

The Lead Deans will liaise with stakeholders as needed to support the continuation of the pilot and ensure an evaluation is undertaken.

The Postgraduate Dean will remain the Responsible Officer for the trainee whilst on OOPP.


The timeline for implementation will be at the discretion of the local office to accommodate notice periods and varying rotation dates.

Where possible, in line with all applications to take time out of training, trainees will be expected to give three months’ notice. As with other OOP requests this should align with programme rotation dates. When trainees are considering applying for OOPP they should keep HEE informed of plans as early as possible and continue to update on progress and any changes to plans to return to training on a regular basis.

However, we note that due to the short term nature of the pilot and the pace of introduction, there will be instances where a shorter notice period may be given and this may help create capacity in the training porgramme. In the first instance the trainee should contact their local office to determine whether they can undertake their OOPP with a shorter notice period. Where there are instances of trainees with extensions in a training programme, local offices may be able to accommodate a notice period of less than 3 months.

Appendix 1 - Frequently Asked Questions

FAQs have been developed for both trainees considering OOPP