This page outlines the data that have been collected from East and West Midlands Local Offices and validated at a workshop (2nd November 2023) to map their as-is business processes for Less Than Full Time Training.
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Application 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 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:
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Trainee Commencing their training on LTFT basis
As-Is end-to-end LTFT process for East and West Midlands
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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– 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 |
|---|---|---|
1 | 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 |
|---|---|
Approval | Dear 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 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 |
TPD LTFT Process Questions
No | Stage of Process | Question | Responses / Comment |
|---|---|---|---|
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 |
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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)."
| East Midland: Good discussion happens during pre-application stage and therefore No rejection. |