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* 1. About yourself

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* 2. About your current situation

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* 3. Length of time out of work/anticipated if not yet returned.

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* 4. Previous roles and reason for being out of work.

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* 5. Please rate your responses using the number system provided.

  1 2 3 4 5 6 7 8 9 10
How motivated are you to return to your previous role? 1 = extremely unmotivated, 10=extremely motivated
How supported do you feel returning back to work? 1=unsupported, 10=fully supported
How self-confident do you feel returning back to work? 1=no self-confidence, 10=extremely self confident.
How confident do you feel keeping up to date with professional administration on returning? (e.g. subscriptions, appraisal etc) 1=no confidence, 10=extremely confident
How confident do you feel being clinically up to date on returning? 1=no confidence, 10=extremely confident
How confident do you feel being up to date with local events/ pathway/ guideline changes on returning? 1=no confidence, 10=extremely confident
How confident do you feel using the computer system on returning? 1=no confidence, 10=extremely confident
Have you seriously thought about leaving general practice while off? 1=very seriously, 10=not at all.

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* 6. Do you have any sources of professional support while off e.g. mentor or a peer network, if so what?

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* 7. Do you have any planned process to help your transition back into practice? (e.g. Keeping In Touch days/ induction/ named buddy)

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* 8. Are there any barriers making your return more difficult e.g. health problems, childcare, financial?

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* 9. What are your biggest worries about returning to work?
(e.g. Workload, not being up to date, appraisal, stigma)

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* 10. Is there anything else you would like to share/ would find useful  regarding the process of coming back into work

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