Clinical Observation Programme

Clinical observerships are primarily for international medical graduates who have been practising abroad and who wish to gain experience and an appreciation of the nature of clinical practice in the NHS in the UK and to observe the role of doctors and other professionals within the healthcare system.

In addition, observerships are available for individuals that would like to maintain/develop their skills and knowledge within a specific area.

The guidance below provides information of those responsible for the administration, approval and supervision of the Clinical Observer and for the following groups of doctors who may make an application for a placement at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTH):

  1. Medical graduates that have been practicing abroad and who wish to practice in the UK for the first time.
  2. Doctors who wish to develop/maintain their skills and knowledge within a specific area.

On this page:

The role of the Clinical Observer

A Clinical Observer placement allows an individual to gain an overview of medical processes and systems in the UK, specifically in the NHS, by observing a consultant in a relevant specialty.  During the placement, the individual is not given any responsibility and is not able to make clinical decisions or give clinical advice.

Observers are not authorised by the Trust to provide services of any kind either in an employed or honorary capacity.

Observers whilst under strict supervision by the designated supervisor can:

  1. Attend at ward rounds.
  2. Observe consultants in clinics.
  3. Observe in theatre.
  4. Participate in patient administration (clerking) under direct clinical supervision.
  5. Undertaking of patient histories under direct clinical supervision.
  6. Contribute to discussion on diagnosis with the team post treatment (but not diagnose or advise treatment) for educational purposes.

Whilst at DBTH, as a Clinical Observer you are not permitted under any circumstances to:

  1. Prescribe.
  2. Order diagnostic tests.
  3. Order or undertake examinations.
  4. Take specimens.
  5. Initiate, advise, order or stop the treatment of patients.
  6. Undertake clinical procedures.
  7. Teach clinical procedures.
  8. Take any part in obtaining or witnessing the signature by or on behalf of a patient on a form of consent to treatment or assist with laboratory work.
  9. Copy or replicate any patient identifiable details at both in person attendance and virtually as part of the discussions taking place on this programme.
  10. Directly question or examine a patient regarding their diagnosis or condition.
  11. Present themselves as an employee of the Trust.

All attendance in hospital clinical areas must be supervised. Observers are not normally permitted to visit areas other than their base department without the express permission of the head of department or supervising consultant.

The role of the Supervising Consultant

The dedicated supervising consultant should ensure the Clinical Observer is aware of the skills essential for effective patient care within the NHS.  In addition, allowing the opportunity to attend clinics and ward rounds with focus on the following:

  1. An introduction to the NHS health care environment and to a clinical discipline
  2. The opportunity to safely shadow clinical colleagues in their clinical duties.
  3. An overview of clinical audit, clinical governance, and legal aspects of health care.

The supervising consultant will need to gain written approval from the Divisional Director and Medical Director before agreeing to accept a Clinical Observer. 

Once a consultant has agreed to supervise a Clinical Observer and approvals are in place all details will need to be sent to Medical HR with the eligibility data below confirming the name of the doctor, proposed dates of the placement and the type of Clinical Observership required.

Eligibility

Eligibility for placement, is dependent on the following:

Clinical Observer

  1. Must be a qualified doctor.
  2. Relevant visa allowing you entry to the UK to undertake placement (if necessary).
  3. Be able to satisfy the requirements of NHS Employers Identity checks standard.
  4. Occupational Health Clearance

Supervising Consultant

  1. Review of applicants CV and suitability for placement.
  2. Ability to accommodate placement within the service with confirmation of no disruption to the learning environment, specifically Post Graduate Doctors in Training.
  3. Approval from Divisional Director
  4. Confirmation of funding (if necessary)
  5. Completion of Risk Assessment

Medical HR

  1. Approval from Medical Director
  2. Approval form Medical Education Lead (if required)
  3. Will issue official offer of placement with relevant documentation and next steps.
  4. Will facilitate identification checking and clearances.
  5. Will issue Letter of Authority confirming placement (provided all criteria is achieved)
  6. Will make arrangement for observer to complete mandatory training.
  7. Will organise creation of ID badge.

Failure to progress, accommodate or satisfy the requirements laid out in this document may result in DBTH withdrawing the authorisation for your placement.

Application process

Those wishing to undertake a Clinical Observership are required to follow the three-stage application process below.

It is important to note that you are not guaranteed to secure a placement as it is dependent on service availability, approval and completion of checks and clearances in line with NHS Employers guidance.

Stage One: Pre-Application

Provisional placement has been agreed with a supervising consultant and notification of agreement emailed to dbth.medicalhr@nhs.net.

The initial placement request is subject to approval by the Medical Director and Director of Education to ensure the post is educationally sound.

Stage Two:  Application

Once stage one is completed, and dates of placement have been discussed the applicant should fully complete and submit the online application form at least 12 weeks prior to the expected date of placement.

The link for completion of the application is here https://forms.office.com/e/VPWQujHb0j

The applicant will receive an automatic response once application has been completed.  At this point an option to download the application submitted will be available.

Incomplete applications will not be considered.

Stage Three: Checks and Clearances

Once your application has been reviewed and confirmed you will be required to undertake the necessary checks/clearances required to allow you to take up placement at DBTH.

The checks required are set out below and are dependent on the route you will be applying.

UK – NHS Employed

Document Responsibility for Completion
DBTH Observership Programme Application Form Applicant
Observership Request for Information DBTH Medical HR and Substantive Trust Medical HR
Confidentiality Form Applicant
Risk Assessment Observational Supervisor
OH Clearance DBTH Medical HR and Substantive Trust Medical HR
ID Badge DBTH Medical HR
Letter of Authority DBTH Medical HR
Mandatory Training DBTH Medical HR and Substantive Trust Medical HR

UK – Not NHS Trust Employed

Document Responsibility for Completion
DBTH Observership Programme Application Form Applicant
Confidentiality Form Applicant
Risk Assessment Observational Supervisor
Identity Check Applicant and DBTH Medical HR
Visa Check (if required) Applicant and DBTH Medical HR
DBS/Criminality Check Applicant
Qualifications Applicant
GMC Registration (if applicable) Applicant DBTH Medical HR
IELT/OET Certificate (if applicable) Applicant and DBTH Medical HR
Occupational Health Clearance Applicant and DBTH OH
References Applicant and DBTH Medical HR
ID Badge DBTH Medical HR
Letter of Authority DBTH Medical HR
Mandatory Training DBTH and Applicant

International Applicants

Document Responsibility for Completion
DBTH Observership Programme Application Form Applicant
Confidentiality Form Applicant
Risk Assessment Observational Supervisor
Identity Check Applicant and DBTH Medical HR
Visa Check Applicant and DBTH Medical HR
Criminality Check (Police Check Clearance) Applicant
Qualifications Applicant
IELT/OET Certificate (if applicable) Applicant and DBTH Medical HR
Occupational Health Clearance Applicant and DBTH OH
References Applicant and DBTH Medical HR
Accommodation Applicant and Accommodation
ID Badge DBTH Medical HR
Letter of Authority DBTH Medical HR
Mandatory Training DBTH and Applicant

Occupational health

All candidates will need to access an Occupational Health pre-placement questionnaire, following the validation of their application form and supporting documents. This will be accessible through the our recruitment system (Trac). Completion is time sensitive. Any delay at this stage may cause issues in receiving full Occupational Health clearance before the start of the placement. This may lead to automatic withdrawal from the placement allocation.

The Occupational Health questionnaire includes submitting details relating to general health and previous immunisations. To limit delays, we strongly recommend that all candidates contact their GP (if relevant, previous Occupational Health provider) in advance, to request a copy of their immunisation records. Immunisation records can then be uploaded in conjunction with their Occupational Health Questionnaire to help expedite the clearance process.

All individuals are advised to submit evidence of any previous vaccinations. Please refer to the table below for information of immunisations that are relevant to the clearance process.

MMR All candidates must supply evidence of two MMR vaccinations or evidence of

positive antibody tests for measles and rubella (blood test).
Chicken Pox

(Varicella-zoster)

 It is advised that candidates check with a family member/guardian, who knew them as a child, in relation to ever having this illness.
Tuberculosis (TB) More information provided under stage two, pre-placement appointment.

If candidates are unable to provide evidence of any immunisation listed above, they are still required to submit their immunisation records for review by the Occupational Health Team.

Once completed and submitted, the questionnaire will be reviewed by the Occupational Health department. Following this review, candidates will be contacted by the Occupational Health department, via Trac/email, regarding a pre-placement appointment.

Pre-placement appointment

The pre-placement appointment is a mandatory condition of all placement allocations and must be

attended in person. All pre-placement appointments are undertaken by the Occupational Health Team, at the Doncaster Royal Infirmary site. All candidates are required to attend an appointment before clearances can be confirmed.

During the pre-placement appointment, candidates may be required to have their bloods taken for further testing. Candidates are required to arrange their pre-placement appointment at least 14 days before the start of their Clinical Attachment placement. This is to allow enough time for clearances to be confirmed ahead of a candidate’s placement allocation.

Tuberculosis (TB)

During the pre-placement appointment, all candidates travelling from a country with a high incidence of Tuberculosis (TB) will be checked for evidence of a previous TB immunisation (BCG). This includes the checking for a BCG scar. All individuals travelling from countries with a high incidence of TB will require further testing for TB once they arrive in the UK. This involves a QuantiFERON blood test.

To enquire about areas considered high risk please click here: High TB burden country Profiles

Candidates who are NOT travelling from a country with a high incidence of TB will be required to undertake a QuantiFERON test, if they are not able to provide evidence of a BCG or BCG scar. QuantiFERON is a laboratory test for the detecting immune responses to tuberculosis infection.

If a candidate receives a positive QuantiFERON result, they will be required to attend an appointment with a Respiratory specialist before they can commence their placement. The DBTH Occupational Health Team can help refer candidates to the Respiratory Team, however they must be registered to a GP in the UK and have an NHS number. The Respiratory Team will NOT accept any candidate referral without prior registration with a GP AND a valid NHS number. This process can take several weeks (depending on NHS waiting times) and this may impact the confirmation of full clearances, leading to automatic withdrawal from the Clinical Attachment allocation.

It is strongly recommended that any candidate who has previously tested positive for active or latent TB or has previously undergone treatment for TB, provides evidence of this when submitting their immunisations and pre-placement questionnaire.

Attendance at an appointment with Occupational Health may be required to formalise clearance.  In the meantime, it is advised that collecting proofs of immunisations be undertaken so that this can be provided to the Occupational Health Department to assist with clearance.

Disclosure and Barring Service (DBS) or Criminality Information

It is a requirement that proof of criminality information is provided from the most recent place of residence if applying for placement from overseas.

If required to complete a DBS check a prompt to do so will be sent through DBTH recruitment system, Trac.  The DBS form is completed online and will require documentation be provided in line with the NHS Employment Checks Standards.

Visa

Applicants from outside the UK and Ireland are required to hold a relevant visa allowing them to undertake a Clinical Observer placement.

Confirmation of placement

Once all clearances and checks are satisfied applicants will receive confirmation of placement by email.  With this email applicants will receive a Letter of Authority granting approval of placement.

The individual will be indemnified by the Trust liability indemnity cover. Observers must maintain their own professional indemnity cover through the duration of the placement.

It is important to confirm that a Clinical Observer confers no employment rights or entitlements beyond the indemnity detailed in this document.  You are expected to abide by the provisions laid out in this document whilst undertaking your observational placement at DBTH.

The placement is without remuneration from DBTH, therefore you are not entitled to paid annual or sick leave by the Trust or to pay contributions to the NHS Pension Scheme.

A Clinical Observership placement is subject to maintaining the strictest confidentiality and maintaining acceptable standards of conduct.  Failure to abide by the conditions will result in Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust withdrawing the authorisation for your placement.

The placement

The supervising consultant is responsible for agreeing objectives prior to the placement commencing.

Clinical Observers will generally be welcome to attend academic and postgraduate meetings but should not be directed to attend any protected teaching sessions for Resident Doctors in Training.

An ID badge will be issued upon placement commencement, and this must be worn at all times.  It is the Clinical Observer’s responsibility and that of the designated supervisor to ensure that the observer is identified to the patient and the observer’s status is obtained.

Observers are always required to behave in accordance with departmental policies and protocols, and the policies and procedures established by the Trust. In particular:

Professional Responsibility

Professional healthcare staff are responsible for complying with the relevant standards set by their regulatory or professional bodies.  A breach of such standards may lead to action by the Trust independent of any taken by the regulatory or professional body concerned.  It will be investigated fairly, and appropriate steps taken to prevent a recurrence and address any wider causes.

The observer may be withdrawn at any time if found to be in breach of any Trust policies, procedures, or the terms of this agreement. The observer may also be withdrawn for any other reason at the discretion of the Medical Director.

Health and Safety at Work Act 1974

Under the provisions contained in the Health and Safety at Work Act 1974, the Trust undertakes to ensure so far as is reasonably practicable the health, safety and welfare at work of all its People.

It is your duty to:

  1. take reasonable care of yourself and others at work;
  2. co-operate with the Trust as far as is necessary to enable them to carry out their legal duty;
  3. Not intentionally or recklessly to interfere with anything provided, including personal protective equipment, for health and safety or welfare at work;
  4. Advise the Trust promptly of any injury sustained whilst at work or sustained elsewhere that might affect your ability to carry out the duties and responsibilities of your role;
  5. The fire procedure relevant to the Division. The department of your honorary appointment will be explained to you and you are required to comply with these.

Clinical Governance

Clinical Governance is the framework through which this Trust is accountable for continuously improving the quality of its services and safeguarding the high standards of care.   It does so by creating and maintaining an environment in which excellence in clinical care will flourish.

If you have concerns on any Clinical Governance matters these should be raised with your line manager, professional adviser, or more senior member of management.   Every Division has regular clinical governance meetings.   The Trust is committed to providing safe and effective care for patients.  Your attention is drawn to the Trust Policy on Freedom to Speak Up Policy “Speak up to make a difference” CORP/EMP 14 v7.

All staff (including medical observers) must complete mandatory Information Governance Training on an annual basis to ensure they are up to date on Trust policies and procedures.  If you are currently employed within the NHS and have undertaken IG eLearning, proof will need to be provided.

Confidentiality of Information

All information concerning the Trust’s patients must be treated as strictly confidential at all times and may only be disclosed with the authority of your Head of Department.  Unauthorised disclosure of confidential information will result in your placement being terminated with immediate effect.  If the breach is proven notification will be sent to your substantive employer and regulatory body as appropriate.

Personal information concerning members of staff may be divulged only with their consent, or if the giving of it is a necessary part of official procedure.  Unauthorised disclosure of confidential information will result in a disciplinary hearing and be investigated under the Disciplinary Procedure and could result in your honorary contract being withdrawn.

Under no circumstances may any information be given to representatives of the media on any subject concerning the Trust’s facilities, its patients, or staff, without the written authority of the Chief Executive.  Any member of staff who has a particular concern should raise this in accordance with the Trust’s Raising Concerns Policy CORP/EMP 14 v6.  Copies of this guidance are available via People and OD Department.  In circumstances where this Guidance is not followed, this will result in a disciplinary hearing and be investigated under the Disciplinary Procedure and could result in your honorary contract being withdrawn.

Nothing in the foregoing prevents the representative of a recognised Staff Organisation from communicating with the media as a representative of his organisation.

Data Protection Obligations

Data Protection Act – Under the Data Protection Act 1984 (as amended by the Data Protection Act 1998) all Clinical Observers that operate computer systems are required to adhere strictly to the legal requirements for confidentiality.  This means information must not be passed on to unauthorised person and that only personal data that is registered under the Act is processed.  If in doubt, assistance/guidance can be sought from the head of department.  Breach of these requirements could render the observer liable to disciplinary action.  Obtaining or disclosing data other than as described in the register entry or without authority is an offence under the Act and could render the individual liable to prosecution.

In keeping with good human resources practice, the Trust retains and processes personal data on its employees/placements.  In addition, the Trust may, from time to time, retain and process “sensitive personal data” (as defined by the Data Protection Act 1998), for example in relation to sickness and occupational health records, appraisal schemes, equal opportunities monitoring or for the prevention of fraud or other illegal activities.

You agree and explicitly consent to the Trust processing such data and acknowledge that such data may be legitimately disclosed to appropriate employees and to the Trust’s professional advisors, in accordance with the principles of the Data Protection Act 1998.

The Trust has established proper safeguards to prevent the misuse of such data [and should it be necessary to transfer such data outside the UK, appropriate measures will be taken to ensure that adequate safeguards are in place].

The Trust takes all reasonable steps to ensure that the data it holds is accurate, complete, current and relevant.  If you consider that data held on you is or may be inaccurate, or if you wish to have access to such data, please contact your Directorate Human Resources Department.

The Caldicott Principles laid down by the NHS Executive must also be followed by the Trust:

  • Principle 1 – Justify the purpose(s)

Every proposed use or transfer of patient-identifiable information within or from the organisation should be clearly defined and scrutinised, with continuing uses regularly reviewed by an appropriate guardian.

  • Principle 2 – Do not use patient-identifiable information unless it is absolutely necessary.

Patient-identifiable information items should not be used unless there is no alternative.

  • Principle 3 – Use the minimum necessary patient-identifiable information.

Where use of patient-identifiable information is considered to be essential, each individual item of information should be justified with the aim of reducing identifiability.

  • Principle 4 – Access to patient-identifiable information should be on a strict need to know basis.

Only those individuals who need access to patient-identifiable information should have access to it, and they should only have access to the information items that they need to see.

  • Principle 5 – Everyone should be aware of their responsibilities.

Those handling patient-identifiable information – both clinical and non-clinical staff – must be aware of their responsibilities and obligations to respect patient confidentiality.

  • Principle 6 – Understand and comply with the law.

Every use of patient-identifiable information must be lawful.

In the Trust, the Caldicott Guardian, responsible for ensuring that the organisation complies with legal requirements is Dr Tim Noble, Executive Medical Director.

Failure to maintain patient information in a confidential manner can result in disciplinary proceedings begin taken against a member of staff.

Equal Opportunities

DBTH is an Equal Opportunities Employer, and your attention is drawn to the Equal Opportunities Policy.  That can be found on the link below.

https://www.dbth.nhs.uk/about-us/our-publications/publication-scheme/our-policies-and-procedures/

Additional Conditions

The Trust advises that responsibility is not accepted for articles lost or damaged on hospital premises, whether by fire, theft or otherwise, with the exception of money or valuables which have been handed over for safe custody and for which a receipt has been given.  You are advised to cover yourself by insurance so far as you think proper against all risks.

Observers must maintain a minimum of 95% attendance. If the observer’s attendance level falls below 95% the issue must be escalated.

Staff must not use any of the Trust’s IT systems to make an unauthorised disclosure or copy of confidential information belonging to the Trust.

Completion of Clinical Observership

Those completing a Clinical Observership may request a letter confirming the Clinical Observership from the Medical HR Department.  The Supervising Consultant must confirm the successful completion of the placement prior to a letter being issued.

Return of DBTH Property

On completion of placement, you must return any property that is owned by DBTH including your identification badge.  This can be handed to the Medical HR Team or your Supervising Consultant on your final working day.

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