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

Postgraduate Doctor in Training

The applicant for LTFT

Training Programme Director (TPD)

1. First point of contact for trainee on LTFT and agree in principle with trainee. Form 3 months prior to commencement of LTFT

2. Give Trainee ‘Agreement in Principle’

3. Engage with Trust, LTFT Lead around post, capacity and funding

4. In the East Midland, the TPD get involve in the capacity discussion for GP practices and Trust as the rotation might impact the CCT date and Doctor might have to move GP practice

5. Approves application and send approval to the programme team.

6. First person to have an informal discussion with Trainee in the case of appeal of rejection

Educational Supervisor

1. First point of contact for trainee on LTFT and agree in principle with trainee. Form 3 months prior to commencement of LTFT

2. Give Trainee ‘Agreement in Principle’

3. Engage with Trust, LTFT Lead around post, capacity and funding

4. Approves application and send approval to the programme team.

Trust LTFT Team

1. Engage with trainee on Rotation/Placement, Funding etc

2. Engage with TPD and ES on Trainee Rotation planning, capacity planning and Post Funding

Head of School

HoS reviews the appeal request and involves the Deputy Dean (DD) if required

Rota Coordinator

Agree Rota pattern with Trainee

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

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

• LTFT Admin are not involve in the initial discussion until application is submitted

• West, Programme don’t need to speak to the trust if > 12 weeks but the east constantly speak to trust around post, capacity and funding

• In the East the TPD get involve in the capacity discussion for GP practices and Trust as the rotation might impact the CCT date and Doctor might have to move GP practice

• In the west, TPD don’t get involve with Trust/Hospital as the HEE Programme does on capacity discussion but TPD get involve with GP practices capacity discussion

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

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.

• Welfare and wellbeing

• Unique opportunities

• Religious commitment

• Non-medical development

• Flexibility for training and career development

Image Removed

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,

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
GMC: 1234567
Training programme: Test Programme
Proposed start date: 2023-11-01
Grade at time of change: ST2
Proposed working percentage: 60%

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
This application will not be processed until we have your approval.

Name: Test - Gwil Test - Williams
GMC: 1234567
Training Programme: Test Programme
Proposed start date: 2023-11-01
Grade at time of change: ST2
Proposed working percentage: 60%
Current CCT: 2024-08-06

Reason for requesting change:
Caring responsibilities

Test reason detail

Many thanks
The Midlands Programmes Team

1

Discussion/Pre-approval Stage

What's your involvement in the Less Than Full Time application process?

East Midland: Dr. Vivek Pillai.

The process from TPD perspective: TPD have initial discussion with Trainee around CCT, reason for application, around support trainee need>Trainee put application in> TPDs are informed by the programme team of application (TPD don’t get notification of when form is submitted) > Trainee print form and get ES to sign form >ES scan and send form to Trainee> Trainee send to TPD to sign form> TPD scan signed form to Trainee> Trainee then send all signed form to Programme Team> Programme Team then get Post Graduate Dean Approval> Programme Team then send approval to Trainee and need to cc TPD.

TPD don’t get notification of when form is submitted

Approval process: ES> TPD>Post Graduate Dean approves. There is possibility of rejecting at Trust level after Dean’s approval.

EM: TPD uses an LTFT calculator spreadsheet shared with trainees to put in the dates and it works out the percentage to ensure it can be accommodated, avoiding the back and forth between TPD and trainee. S/S contains list of trainees and who is rotating when and used to calculate the rotations change over dates.

EM: This TPD (ACCS) doesn’t use TIS for inputting. Although form is electronically submitted by trainee, TPD still have to print the form to complete their part, scan and upload. TPD has access to Tableau TIS reports.

EM: No supernumerary and technically not paid by HEE. No discussion with Trust on rotation planning, capacity planning.

Solution Suggestion: To have a streamlined process - Automation

EM FDN: Expected to approve any application in line with the GG. Trainee would have had a discussed with ES and Deanery already and given 3 months notice of their application to TPD/ES who then signs the form.

EM FDN: Suggestion: TPD wants to be in the know after they have approved the application if their rota had been correctly calculated and pay correctly calculated for the trainees.

2

Discussion/Pre-approval Stage

Which specialties do you cover in regard to discussions with trainees on LTFT? (GP, Specialty, Medicine, Foundation, PH) (GP, Specialty, Medicine, Foundation, PH)

East Midlands: Vivek for ACCS

East Midlands: Klara for Foundation

3

Discussion/Pre-approval Stage

Do you get contacted by trainees who wish to change their LTFT arrangement, e.g. increasing or decreasing % WTE or returning FT?

East Midland: Yes: Have an initial discussion on moving to LTFT to see if they need help with the application and the impact of LTFT on the CCT. If less than 70% TPD speak to trainee as the max % is 80% and min % is 60%. Use an LTFT excel Calculator to calculate CCT

4

Discussion/Pre-approval Stage

Do you have any involvement in slot-sharing arrangements discussion and with who?

East Midland: Uses Excel spreadsheet for rotation. No slot share as it’s 60 - 80% . TPD calling Tableau TIS. (Pain Point)

Percentages are balanced with training needs and service capacity for the specialty. Varies from specialty to specialty.

FDN: ES confirms if able to accommodate %, with service considerations and whether trainee will be able to complete programme requirements. TPD considers service capacity and programme requirements, before approving and ES approval. E.g. whether they will be able to meet the requirements for successful ARCP.

5

Discussion/Pre-approval Stage

Do you have any involvement in Supernumerary post arrangements discussion and with who?

East Midland: No supernumerary at the moment.

6

Discussion/Pre-approval Stage

Do you have joint conversations with Head of School / Educational Supervisor on LTFT applications?

East Midland:

Educational supervisor and TPD add signature to paper form and the Post Graduate Dean approves.

TPD involves in informal discussion with trainee in case of rejection

TPD might get Head of School involve in discussion if the application is rejected

7

Discussion/Pre-approval Stage

At what point in the process do you have the discussion with the trust?

East Midland TPD: No discussion with Trust at all.

I want to think at the pre-application on capacity, funding but not sure if rota is discussed at this stage

8

Discussion/Pre-approval Stage

How do you receive the application form to complete and sign? Is it from the trainee by email? Or brought to the face-to-face meeting and completed by hand?

East Midland: The trainee email form though form is completed electronically but TPD and ES signature is needed before trainee submit signed form to Programme before approval by the PGD.

Automated email after submission of application

9

Discussion/Pre-approval Stage

How do you come to a decision that the programme the trainee is on can be accommodated on an LTFT basis and the percentage WTE required to fulfil the requirements of the programme?

East Midland:

10

Processing/Approval

Once application has been fully approved and trainee made aware, are you notified?

East Midland: Getting cc into mail for some time but now stopped because of resource problem within the programme Team

EM FND: TPD Does not get notified once they have done their bit and application is with Deanery

11

Processing/Approval

Once approved, do you get involved in the implementation of the LTFT, e.g. negotiation of Rota?

East Midland: No

12

Processing/Rejection/Appeal

What's your involvement if an application is rejected?

East Midland: No rejection. Application might get rejected because of submission not made on time- Not meet deadline.

Involve in Informal discussion with Trainee

EM FDN: Default position is to approve.

13

Processing/Rejection/Appeal

According to GMC Gold Guide we understand that "3.124 All well-founded reasons will be considered. However, support to progress the application may be dependent on the capacity of the programme and available resources as well as compliance with relevant legislation relating to CCT requirements (paragraphs 3.118 and 3.119)."

• How do you see this being implemented in practice to avoid any potential rejections?

• What factors contribute to rejection following initial discussion with yourself (TPD) with the trainee?

East Midland: Good discussion happens during pre-application stage and therefore No rejection.