Employer companion
2026 digital edition · Dr Naeem Aziz DGM FRCP · 4 min read
Begin with an accurate account of the work
A career conversation is useful when it identifies what the doctor needs and what the service can decide. Ask whether the immediate issue is development of a capability, evidence of existing practice, access to an opportunity or an employment decision. More than one may apply. Do not commission a generic programme before understanding the problem.
For a doctor already leading a defined activity, compare actual work with the job description and job plan. Ask the people who know the work to describe the basis of their view. The task may be to correct documentation and use an applicable process, while addressing a small number of specific gaps. For a doctor new to an activity, the task may be to design a supported opportunity. Both require attention to scope and governance.
Establish the applicable route early. A development plan, a secondment, recruitment and regrading are different decisions. Identify the current national and local documents and who holds each authority. Give the doctor a named contact for questions that cannot be answered in the clinical discussion. A supportive statement should not be mistaken for a promise of appointment.
Agree support that operates in the real service
Specify the activity, responsibilities, exclusions, available advice and arrangements during absence. Make the review process workable for the supporting clinician as well as the doctor. If support depends on a single individual's goodwill or availability, the service arrangement needs attention.
The review should examine reasoning, communication, recognition of limits and follow-through. It should also ask whether the promised support and opportunity were actually provided. An unsuccessful arrangement can reveal an organisational problem. Do not attribute every difficulty to the doctor or interpret appropriate escalation as lack of seniority.
Changes in support must follow the evidence and context. Closer support may be appropriate when the activity changes, even for a doctor with well-established autonomous practice elsewhere. A review can retain the current arrangement, change it, obtain further evidence or pause an activity pending a safer arrangement. There is no requirement to move in one direction at each meeting.
Make time and opportunity explicit
Discuss the work required for clinical development, improvement, leadership, education and evidence review. Identify what can happen within normal duties and what requires a change. Consider preparation and follow-up as well as the visible event. Record which existing activity changes if a new responsibility is added.
Use the operative contractual documents for entitlements and distinguish these from professional recommendations and individually negotiated arrangements. Do not substitute a generic SPA allocation copied from another contract. The practical question is whether the agreed work can be done within the actual plan, with the resources and support needed.
Check whether access is equitable. A course or meeting held only on a non-working day may be inaccessible to a less-than-full-time doctor. A service with limited local opportunities may need a different arrangement. Prior overseas experience should be examined for what it demonstrates, with any required verification and local adaptation made explicit.
Seek useful evidence and record decisions
Ask for evidence proportionate to the claim and process. Explain what observation, corroboration or further information would resolve uncertainty. Avoid repeated collection of similar documents when the real issue is that no one has described the doctor's contribution. A well-selected record with an honest limitation can be more informative than a large unstructured collection.
When providing feedback, state what you observed and what you did not. Describe strengths and areas for development with examples. Distinguish a clinical opinion from a formal assessment decision. If you are being asked to verify a record, verify only what you can support.
Close the discussion with a written account of decisions, reasons, owners and dates. Mark pending decisions as pending. If an opportunity cannot be provided, explain why and consider an alternative. Where the doctor seeks a formal process, follow its requirements rather than using indefinite informal development as a substitute.
Review the arrangement after a role change
Appointment, secondment or regrading does not remove the need for induction and support. Confirm the scope, relationships, job plan and review arrangements for the actual role. A secondment also needs clear written terms, including its duration and what happens afterwards, checked with the appropriate employment advisers.
Development and formal recognition require separate decisions. A temporary opportunity should have a defined purpose, reliable support and a review point. Where responsibilities change, review the role documents and contractual arrangements through the applicable process.
An employer can use this companion as a discussion agenda: establish the starting point, define the work, resource the arrangement, review evidence and record the decision. These principles support discussion and planning. The applicable policy and contract determine formal requirements.