This page outlines the data that have been collected from North East and West Midlands Local Offices and validated at a workshop (17th of October 2nd November 2023) to map their as-is business processes for Less Than Full Time Training.
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Application
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In London and KSS, Trainees applying for LTFT under child care / health / disability /caring responsibilities can make an application at any point throughout the training year. All other criteria applications must be submitted during the windows below, which are set according to rotation months below. All applications are submitted online via PGMDE Support Portal.
Rotation Month | LTFT Window | Head of School Sign off | HET Confirmation to Trainee Deadline | TPD Grid Deadline |
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February | 22/09/2023 - 06/10/2023 | 17/10/2023 | 18/10/2023 | 24/10/2023 |
March | 23/10/2023 - 06/11/2023 | 10/11/2023 | 17/11/2023 | 17/11/2023 |
April | 20/11/2023 - 04/12/2023 | 21/11/2023 | 19/12/2023 | 28/11/2023 |
May | 19/12/2023 - 02/01/2024 | 09/01/2024 | 18/01/2024 | 16/01/2024 |
June | 22/01/2024 - 05/02/2024 | 13/02/2024 | 16/02/2024 | 20/02/2024 |
July | 19/02/2024 - 04/03/2024 | 12/03/2024 | 18/03/2024 | 19/03/2024 |
August | 11/03/2024-25/03/2024 | 03/04/2024 | 17/04/2024 | 10/04/2024 |
September | 19/04/2024 - 03/05/2024 | 17/05/2024 | 20/05/2024 | 24/05/2024 |
October | 20/05/2024 - 03/06/2024 | 14/06/2024 | 17/06/2024 | 18/06/2024 |
November | 21/06/2024 - 05/07/2024 | 17/07/2024 | 18/07/2024 | 23/07/2024 |
December | 22/07/2024 - 05/08/2024 | 16/08/2024 | 19/08/2024 | 20/08/2024 |
LTFT Categories
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Category
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Circumstance
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Supporting documentation
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Category 1
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Disability/ill health
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A letter from GP/ Occupational Health Consultant/ Medical Specialist which includes:
Nature of disability/health requirements for LTFT Training
It must be on letter-header paper or be from an official email address which can be validated. The letter should be dated within the past 3 months.
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Responsibility for caring for children
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Trainee to confirm the anticipated or actual date of birth of their youngest child on the online application form. (No need to continue to re-apply upon each period of maternity leave, eligibility is automatic until their youngest child is 18 years old
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Responsibility for caring for ill/disabled partner, relative or other dependent
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A letter from their GP or Medical Specialist involved in the care of their partner / relative / dependent which includes:
Level of care anticipated that they will need to provide
It must be on letter-header paper or be from an official email address which can be validated, dated within the last three months.
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Category 2
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All circumstances (Other)
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Free text boxes on the online application form detailing the nature of request. They can attach letters of support and job descriptions to the application form should they wish to.
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Non-medical professional development
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Unique Opportunities for own personal/professional development
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Religious commitment
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Category 3
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Welfare and wellbeing
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Free text boxes on the online application form detailing the nature of request.
Window for East and West Midlands
There is no application window for East and West Midland. Trainee Doctors can apply anytime but most of the time it happens at rotation. All applications are submitted using MS Form (Online) NHS England - Midlands - Change of Percentage (LTFT) Application Form (office.com).
East and West Midland No longer accept the old PDF forms from Friday 1st September 2023 though there are situations where the paper form can still be accept (This is done depending on individual circumstances)
LTFT Categories
Less Than Full-Time training is available for doctors and dentists who are unable to train full-time because of “well-founded individual reasons”. It is the responsibility of the Associate Dean for LTFT Training to decide for each individual whether they have a “well-founded” reason. This decision will be made by the Associate Dean for the region in which the trainee wishes to work.
Eligibility (westmidlandsdeanery.nhs.uk)
As-Is Processes
In trying to map the LTFT end-to-end process we came up with 4 main stages in the order in which they would occur namely:
Pre-application Stage/Discussion and Notifying: 16 12 weeks or earlier, where a trainee discusses with their TPD / Foundation TPD / GP Scheme manager and Educational Supervisor and agree “in principle” a post is agreed in order for them to apply to train as LTFT .
LTFT Application Stage: With at least 16 12 weeks notice given and application submitted to HEE
3.1 Negotiation of Working pattern and agreeing start date /Work Pattern, payroll changes and Start date agreement negotiation with Trust stage, following approval of their application, typically around 8 weeks prior to commencing LTFT
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Trainee Commencing their training on LTFT basis
As-Is end-to-end LTFT process for
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East and
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West Midlands
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As-Is Approval Process for LTFT applications under Category 1
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As-Is Approval Process for LTFT applications under Category 2 & 3
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Application Numbers Feb 2022 to Aug 2023
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CCT date Calculation
East Midland - CCT date is calculated by the programme because of the portfolio update and update of TIS . The CCT and placement help to plan their ARCP.
West Midland– Ask Trainee to use CCT calculator and review at ARCP
Actors
Actor |
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Postgraduate Doctor in Training | The applicant for LTFT |
Training Programme Director (TPD) |
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Educational Supervisor |
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Trust LTFT Team |
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Head of School | HoS reviews the appeal request and involves the Deputy Dean (DD) if required |
Rota Coordinator | Agree Rota pattern with Trainee |
Application Numbers Feb 2022 to Aug 2023
Month - Year | Application in progress or did not complete | Approved | Grand Total |
Nov - 2022 | 3 | 28 | 31 |
Dec - 2022 | 1 | 12 | 13 |
Jan - 2023 |
| 21 | 21 |
Feb - 2023 |
| 11 | 11 |
Mar - 2023 |
| 22 | 22 |
Apr - 2023 |
| 40 | 40 |
May - 2023 | 2 | 61 | 63 |
Jun - 2023 |
| 40 | 40 |
Jul - 2023 |
| 19 | 19 |
Aug - 2023 |
| 34 | 34 |
Sep - 2023 | 1 | 28 | 29 |
Oct - 2023 | 20 | 19 | 39 |
Nov - 2023 | 5 |
| 5 |
Grand Total | 32 | 335 | 367 |
Pain Points in the process
No. | Pain Point / Area to improve | Comment | |||||||||||||||||||
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1 | Trainees have difficulty understanding Deanery and HEE (NHSE) being the same entity. | 2 | TPD / FTPD / GP Scheme manager are not normally discussing the impacts of LTFT on their training. E.g. impact on their CCT date and pay changes when having their initial discussion | 3 | A significant proportion of rejections due to trainees submitting applications outside published window. (See above table.) | 4 | Trainees having to reapply for LTFT following rejections, where they have applied outside HET window. | 5 | Trainees having to reapply for LTFT where rejection was due to insufficient supporting evidence despite being chased. | 6 | Approval emails are automatically sent to trainees except for Childcare reason where this is sent manually. | 7 | There is no SLA published to trainees currently in managing their expectations, but only internal to the HEE team on processing applications timeline. | 8 | The only determining factors and national guidelines available are for rejections where either there were insufficient supporting evidence/s for the LTFT category applied under. The HET window is a Local Office arrangement and decision to reject applications under respective categories. (See approval processes) | 9 | The negotiation of work pattern not taking place until an approval received from HEE(NHSE). | 10 | There is currently no specific ETA/SLA by Head of Schools / Deputy Deans in providing a decision for an appeal where the application was rejected. | LTFT can’t be controlled by the LO as Trainee can apply anytime. TPD can only Advise Gold Guide states ‘Well founded reasons’ | Pre- application |
2 | The process of discussion with Trust not very clear | Pre- application
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3 | Some Trainees applies without discussion with TPD/ES | Pre- application | |||||||||||||||||||
4 | The fields are all mandatory but trainee can type in anything to progress the form. So programme still need to check after submission and request more information via email | Application | |||||||||||||||||||
5 | No dedicated team for LTF. Just the programme team. | Application | |||||||||||||||||||
6 | No process for Appeal yet but the TPD should be responsible here not the programme | Application | |||||||||||||||||||
7 | Issue with form around submission on time or late submission; Progressive submission. Still allows submission with missing fields | Application |
LTFT Email templates
These are the email templates maintained on the London & KSS PGMDE Portal and sent to trainees in the relevant events.
Email Template | Body / Content |
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Approval | Dear Dr XXXX,I’m pleased Application for Change of Percentage (Less Than Full Time Training (LTFT)) – Confirmation of Approval I am writing to inform you that NHS England – East Midlands has approved your application has been approved to train at (Percentage) from (start date). Your trust will be notified of your request to train LTFT via the trust portal. This will inform them of your placement and the number of sessions you are working at. You no longer need to submit a LTFT form upon each rotation, only if you wish to inform us of a change. The workforce team will also notify your Training Programme Director that you have been approved to train LTFT. Your tentative CCT date is XXXX and this will be ratified at your next ARCP. Ensure that you have read the LTFT applicant guide and the frequently asked questions as these should address the majority of LTFT queries. If you wish to submit an enquiry, please do so by clicking into any of the LTFT FAQs and submitting an enquiry. We aim to respond to all enquiries within 5 working days. Please note that Heath Education London and the South East is not an employer. Any issues you have with how your pay is calculated as a LTFT trainee should be submitted to the medical staffing department of your employing trust. |
Rejection (insufficient evidence) | Dear Dr XXXX, Thank you for submitting your application to train at Less Than Full Time. Unfortunately you have not provided the supporting evidence with your request, and without this we are unable to proceed with your application. Therefore on this occasion we have had to close your application down. A reminder that if you apply under caring responsibilities, health or disability you must supply a letter of support, dated within the last 3 months, from your GP or Occupational Medicine at your current Trust, recommending that you train at LTFT. Please submit a new application with the evidence requested and we will proceed with your request. If we do not receive a new LTFT application from you with the evidence required, we will assume you no longer wish to train LTFT. Kind regards, |
Rejection – application not made within window | Dear Dr XXXX, Thank you for submitting your application to train at Less Than Full Time. All applications made under the criteria listed below, must be made within the LTFT Application Windows so your application has been rejected at this time. A reminder that these windows are according to the month/s you rotate.
 If you wish to reapply please resubmit your application during the appropriate date range above. |
Rejection- include appeal procedure | Dear Dr NAME, Thank you for submitting your application to train at Less Than Full Time. Unfortunately your application has been rejected for the following reasons XXXXX If you wish to appeal this decision please submit a ticket via the portal outlining your reasons why and this will be revied by your Head of School. Kind regards, |
Documents
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Change of Percentage application as follows: GMC/GDC Number Specialty New Percentage Start Date of New Percentage New Estimated CCT Date Changes in your percentage training hours may impact on your original completion date. To ensure this is considered appropriately we have supplied an estimate above based on the percentage change and have updated your TIS record accordingly. This will be reviewed and confirmed with your TPD in your ARCPs/RCPs. This change to your percentage may also impact any rotations you were allocated as part of your original offer. We cannot guarantee you will be able to work in those same rotations.
This letter is confirmation of your new training percentage (whole time equivalent) but is not a guarantee of any specific working patterns as NHS England is not your employer. You will, therefore, need to negotiate your specific working patterns and rota with your upcoming employer (or appropriate department) for any affected placements. For late applications these conversations must have been underway, if not finalised, before submitting your application. Please let us know if there are any issues.
If you wish to change your training percentage again in the future, you will need to complete a new application form. Once you have started on your new percentage, it is your responsibility to ensure you check on your payslip that you have been paid correctly. Failure to do this could lead to overpayment, which would need to be repaid to your employer, or underpayment. We recommend you also check you are receiving the correct allowances to support LTFT training. Please also keep us informed regarding any training gaps including prolonged periods of absence.
If any of the information you submitted on your application form has changed, or you wish to rescind your application altogether, you must contact us as a matter of urgency.
Please do not hesitate to contact us if you have any questions.
Yours sincerely,
Name NHS England - East Midlands Programmes Administrator
On behalf of Caroline Brown Associate Postgraduate Dean (East Midlands) /Senior Educator Team, East Midlands | |
Rejection (insufficient evidence) | |
Rejection – application not made within window | |
Rejection- include appeal procedure | |
LTFT/Change of Percentage Application for Test Programme | Dear Programmes team, THIS IS A NOTIFICATION THAT AN APPLICATION HAS BEEN SUBMITTED, NOT THAT IT HAS BEEN APPROVED. PLEASE ENSURE THE ACTIONS LISTED ARE COMPLETE BEFORE SENDING APPROVAL LETTER A new change of percentage application form has been submitted by Test - Gwil Test - Williams (1234567) in East Midlands Test Programme. You must do the following before sending our approval letter: Training Programme Director approval - Wait for an email to be recieved from foundationprogrammes.em@hee.nhs.uk confirming they approve this application. Educational Supervisor approval - Wait for an email to be recieved from gwilym.williams1@nhs.net confirming they approve this application. Please see below for the relevant sections of this application. The full form can be found on MS Forms and these details will be added to the tracker automatically: Name: Test - Gwil Test - Williams This is an automated email generated by Power Automate on completion of our online form. |
LTFT/Change of Percentage Application for Test - Gwil Test - Williams 1234567 | Dear all, This is an automated email generated when a doctor or dentist in training completes our online change of percentage form A new change of percentage application form has been submitted by Test - Gwil Test - Williams (1234567) in East Midlands Test Programme. They have put your email addresses as Training Programme Director and Educational Supervisor. If they have indicated that they are a dual specialty doctor then this email will also be copied to the second specialty TPD for their information only. Please could you review the below application and respond to this email if you approve or have any queries. If you are planning to reject this application please discuss it with the appropriate APD for LTFT so we can ensure all avenues have been explored. You may have already calculated a new estimated CCT date for this doctor. If so, please could you send it through along with your approval Name: Test - Gwil Test - Williams Reason for requesting change: Test reason detail Many thanks |