Reason

Application numbers

i. Trainees with a disability or illness

50

ii. Trainees with caring responsibilities

195

iii. Welfare and wellbeing

161

iv. Unique opportunities

16

v. Religious commitment

0

vi. Non-medical development

3

vii. Flexibility for training & career development

28

vii. Other

40

 TOTAL

493

1Revised CCT end date is asked on the form, however, there are no Local Office resources available to support the trainee apart from the Royal Colleges guidance and calculator. This has to be manually verified before inputting to TIS.

There is no SLA to process applications neither internally nor published to trainees when an application has been submitted. Trainee doesn’t have an indication of where their application are with the processing and receiving an outcome.

2

Given the new policy to extend flexible training, there has been a large number of applications and it has meant that the categories no longer exist. This in turn has made the triaging of applications almost ad-hoc and unmanageable when it comes to prioritising the processing as and when the applications are received based on the reasonsfor specialty. E.g. there is no Local process to prioritise the processing of Childcare/Disability/Health reasons applications over wellbeing ones.

3

It can take significantly more time where applications are submitted with less than 12 weeks notice to process due to approval required from Trust in Y&H process. This may require chasing the Trust who are also operating within their own constraints.

4

Y&H uses Tracker spreadsheets in order to support the processing of applications. Currently a Local and a National spreadsheet that have to be completed manually. This is an admin burden and prone-to-error practice.

5

There isn’t always an opportunity in the Y&H process for trainees to be discussing with the Trust directly regarding their ability to accommodate for LTFT for a rotation, as the trainee may not be at the specific Trust they are going to be rotating yet where they intend to train as LTFT.

6

Y&H has a extensively Although the numbers are less for Dental and GP in SWP.

3

SW uses different forms for 1) Change of percentage 2) New Application 3) Notification of Appeal. All these forms can be difficult to manage when submitted to HEE via emails. When submitted to HEE they go to personal email addresses of Specialty Education Programme managers which can be difficult to triage as to what the purpose of the email was from the trainees.

4

The role of Education Specialty Programme Managers in HEE is unclear in the approval process. For Caring responsibilities, currently they only rely on the TPD having ticked the box on the form which is an assumption that LTFT will be accommodated by the Employing Trust and therefore is an “approval” by default.

5

There hasn’t been any rejections and unclear on the implementation of this part of the process. No real guidance on approval responsibilities and process.

6

SW has a documented process with Trainee, Associate Dean and Postgraduate Dean involved, preparing cases statements, with timescales made aware to the parties involved. However, in practice, this has not yet happened as there have been no rejections yet.

.

7

For specialty and Dental, there is no monitoring of applications through reports. GP only, uses a tracker spreadsheet.

8

There is no tangible data on the number of applications received apart from referring to TIS.

9

There is a gap between Trainee and Trust and Trainee and HEE in the application process in the sense that application may have been submitted (e.g. for Disability) where supporting evidences are still being awaited for but the trainee has already started in the Trust as LTFT and NHS SW becoming aware of this until later. What constitutes an approval, isn’t defined.

10

An LTFT trainee may have more ARCPs than a full time doctor in training. It becomes a challenge in specialty school in deciding on the progression date/point.

1

Approval (Specialty)

Subject: Confirmation of Less Than Full Time (LTFT) training - Name <GMC>

Dear Olivia

Your application to train less than full time has been approved as follows: 

Image Added

You should now ensure that you draw up, in conjunction with the Educational Supervisor in the locality, a suitable work schedule. Once agreed, this will impact your pay and you will need to liaise with the medical HR team in the Trust (copied). 

Any future changes to your working arrangements, such as an increase/decrease in hours, must be prospectively approved via the submission of a ‘Change to LTFT working’ form. Should you no longer wish to train less than full time, you will be able to return to full time training when an appropriate placement becomes available. Until such time you will be required to continue working on a less than full time basis.  

Your revised working hours may impact your completion of training date, this will be reviewed and confirmed at your ARCP. 

For further information please go to the following link where you will find the LTFT working policy; 

https://www.severndeanery.nhs.uk/about-us/policies-and-procedures/less-than-full-time-working-policy-2022/

Should you have any queries please get in touch. 

Kind regards 

Joanne Pickstone

Education Programme Manager

• Trainee

1.2

Approval - GP

Dear Dr [insert name],

Thank you for submitting your LTFT application form.

The details of your LTFT working are as follows:

LTFT start date: [insert start date]

Agreed LTFT%: [%]

Prospective CCT date: [insert CCT date]

Please see here for useful information on the working week: https://primarycare.peninsuladeanery.nhs.uk/about-us/gp-specialty-trainees/medical-indemnity/gp-trainee-contact-and-working-week-rota-faq/

Rejection

(include if there are still hospital posts to complete:) Please note any doctor in training in a supernumerary or part time in a full time slot will be required to slot-share should the opportunity arise, so although your new LTFT % is approved for the remainder of training, this is always subject to the needs and capacity of the local service.

For Tier 2 or skilled worker only Don’t forget if you are on a Tier 2 visa or skilled worker visa you must inform sponsorship@hee.nhs.uk of any changes to your working arrangements.

Thank you again for completing the necessary LTFT paperwork.

With kind regards,

• Trainee

• cc Education Programme Manager

• cc Patch Ad

• cc Lead Employer

2

Rejection

N/A - since there is no rejection by HEE

3

Appeal procedure

• Trainee

N/A - not had any rejection

1

Discussion/Pre-approval Stage

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

• Trainees first point of contact for LTFT to have TPD’s support

• Trainee ticks a box on the form to confirm having done so

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)

• Radiology

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?

• New starters

• Already in a programme

• Change in pattern

4

Discussion/Pre-approval Stage

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

• Slot sharing opportunities are utilised

5

Discussion/Pre-approval Stage

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

• No, slot share mostly

6

Discussion/Pre-approval Stage

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

7

Discussion/Pre-approval Stage

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

• Rota coordinator copied into email from TPD to obtain their greenlight to accommodate

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?

• Following discussion, trainee directed to the website to download form, fill in, sign, to send to EPM/Medical Staffing to complete their part and sign (for well founded reason), then sent submitted to HEE to the Associate Dean.

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?

• Health / Disability / Caring where no supporting docs have been provided or health grounds needs verifying, EPM sends to AD / Deputy Deans to get their approval.

10

Processing/Approval

Once application has been approved by HEE / AD and trainee made aware, are you notified?

11

Processing/Approval

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

• Yes

• Discussion with the departments and rota coordinators

• Rota coord. then have to write the schedule for the LTFT

12

Processing/Rejection/Appeal

What's your involvement if an application is rejected by the AD? (re-classification of reason/criteria discussion with the trainee and meeting with HOS. e.g. Health and Disability)

• Not rejected any application from Anaesthetics/EM for wellbeing reasons at TPD pre-approval stage

• ACCS programme is difficult to accommodate LTFT, due to nature of programme

• If can’t make it work from a trainee perspective, more likely to push back on Cat 3 over category 1/2, for the only reason of not meeting programme requirements

• Try an offer a solution to the trainee mutually.

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?

May not need to ask - See UR Question

• No involvement in the appeal

• Normally try and come to a solution