This page outlines the data that have been collected from South West Peninsula & Severn Local Offices and validated at a workshop (29th of November 2023) to map their as-is business processes for Less Than Full Time Training.
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Application Windows for SW
There are no application windows in the South West. It is advised that Doctors in training must give at least 16 weeks’ notice of their wish to train LTFT to allow sufficient time for the employing Trust to be notified and to discuss with the Training Programme Director for the purposes of rotation planning. If less notice is received the application will still be considered but the start date may be delayed.
Application form is in Word format with the same form completed for all Dental, Medical, Public Health and Foundation. (TBC).There have been few cases where for Dental the form from the Dental Gold Guide with the minimum dataset has been submitted.
Application Numbers
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 |
LTFT Reasons
All employees have a legal right to request flexible working – not just parents and carers. Therefore, all doctors in training can apply for LTFT training and section 3.123 of the Gold Guide provides a list of illustrative examples for requesting LTFT training.
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No. | Reason selection | Circumstance | Supporting documentation |
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1 | Responsibility for caring for children | Responsibility for caring for children
| You will need to confirm the anticipated or actual date of birth of your youngest child on the application form. (Please note you do not need to continue to re-apply upon each period of maternity leave, eligibility is automatic until your youngest child is 18 years old). |
2 | Health related reasons | This may include ongoing medical procedures such as fertility treatment.
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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. |
3 | Direct carer for ill/disabled partner, relative or dependant |
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It must be on letter-header paper or be from an official email address which can be validated, dated within the last three months. |
4 | Other well-founded reasons (options):
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As-Is Processes for South West
In trying to map the current LTFT end-to-end process we came up with 4 main stages in the order in which they would occur namely:
Pre-application Stage: 16 weeks or earlier, where a trainee discusses with their TPD / Foundation TPD and for well-founded reasons to have also discussed with Department Lead and Employing Trust Medical staffing and obtaining their signature on the form with relevant section filled in. For GP, there is an additional step with the trainee discussing with the Educational Programme Manager (EPM) to ensure it can be accommodated before an application is put in.
LTFT Application processing Stage: With at least 16 weeks notice given, applications are processed by HEE Specialty Programme Schools to the relevant Specialty Programme Manager or Programme Manager for Specialty and GP VTS admins for GP.
3.1 Work Pattern, payroll changes and Start date agreement negotiation for trainees with disability, health caring responsibilities reasons with Trust, following approval of implementation at Trust level, assuming agreement with TPD was obtained at an earlier discussion prior to 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 South West
TBC
Actors in the process (TBC)
TBC
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No.
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Role
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Responsibility
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1
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Postgraduate Doctor in Training
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Review LTFT guidance on the HEE SW website
Make an application with all information completed
Provide 16 weeks’ notice of intentions where possible
Meet with Training Programme Director, utilising the crib sheet
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2
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Training Programme Director (TPD)
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Support the Postgraduate Doctor in Training
Meet with the Postgraduate Doctor in Training, utilising the crib sheet
Complete the TPD section of the application
Facilitate slot-shares where possible
Manage the rotation
Maintain a good understanding of the LTFT process
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3
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School Hub administrative team
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Take oversight of the administrative process
Respond to queries from TPDs, Trusts and Postgraduate Doctors in Training
Ensure data quality to enable accurate reporting
Understand the LTFT process and relevant SOPs
Ensure website is kept up to date
Maintain all national and local documentation relating to LTFT
Save applications and supporting documents to file, adhering to HEE records retention policy
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4
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Medical Staffing (Trust)
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Support the Postgraduate Doctor in Training
Enable LTFT where possible via the Rota Co-ordinator
Provide 8 weeks’ notice of the rota to the Postgraduate Doctor in Training (in line with Code of Practice requirements)
Have a basic understanding of the LTFT process
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5
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Flexible Working Champion/Guardian of Safe Working
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Support the Postgraduate Doctor in Training at their place of work
Champion safe and flexible working within the Trust
Have a detailed understanding of the LTFT process
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6
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HEE Professional Support Associate Dean
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Meet with the Postgraduate Doctor in Training, where applicable
Provide on-going support for Postgraduate Doctors in Training where health and caring responsibilities are impacting on their training
Have a detailed understanding of the LTFT process
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7
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Educational Supervisors
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Be aware of the support available (HEE SW website, Trust contacts, TPD) to signpost ➢
Have a basic understanding of the LTFT process
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8
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Sponsorship Team in Yorkshire and Humber
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Our role is to monitor HEE Sponsored Postgraduate Doctors in training and signpost for further/advice guidance
Where LTFT is concerned, our role is to ensure HEE sponsored doctors in training meet the minimum salary requirements for Tier 2/Skilled worker visas
Have a basic understanding of the LTFT process
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9
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HEE Deputy Postgraduate Dean
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South West have mentioned that the process is likely to change following a re-structuring of the schools and discussion currently in progress on certain areas around approval roles in the LTFT process.
Drawio sketch | ||||||||||||||||||||||||||||||||||
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Pain Points in the process
TBC
No. | Pain Point / Area to improve | Comment | ||||||||
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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. |
Application Numbers
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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. |
LTFT Email templates
These are the email templates managed by specialty teams and LTFT Admins that are sent to trainees in the relevant events - (TBC)
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No | Email Template | Body / Content | Sent to |
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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: 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; Should you have any queries please get in touch. Kind regards Joanne Pickstone Education Programme Manager |
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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/ (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, |
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2 | Rejection Trainee | N/A - since there is no rejection by HEE | |
3 | Appeal procedure |
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CCT Calculator
The link provided to trainees to calculate their CCT is the following in South West is….TBC
N/A - not had any rejection |
CCT Calculator
GP Team calculates the CCT using Royal Colleges Calculator and inputs this to TIS. Specialty Team do not calculate this at this stage but left until ARCP panel to be worked out and inputted to TIS.
TPD LTFT Process Questions
No | Stage of Process | Question | Responses / Comment |
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1 | Discussion/Pre-approval Stage | What's your involvement in the Less Than Full Time application process? |
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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) |
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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? |
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4 | Discussion/Pre-approval Stage | Do you have any involvement in slot-sharing arrangements discussion and with who? |
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5 | Discussion/Pre-approval Stage | Do you have any involvement in Supernumerary post arrangements discussion and with who? |
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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? |
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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? |
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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? |
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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? |
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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) |
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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)."
| May not need to ask - See UR Question
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Documents
Attachments | ||||
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