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.

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 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: 12 weeks or earlier, where a trainee discusses with their TPD / Educational Supervisor and agree “in principle” a post .
LTFT Application Stage: With at least 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

3.2 Appealing the decision stage, where their application was rejected, typically 8 weeks before commencing

Trainee Commencing their training on LTFT basis

As-Is end-to-end LTFT process for East and West Midlands

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
Postgraduate Doctor in Training	The applicant for LTFT
Training Programme Director (TPD)	First point of contact for trainee on LTFT and agree in principle with trainee. Form 3 months prior to commencement of LTFT Give Trainee ‘Agreement in Principle’ Engage with Trust, LTFT Lead around post, capacity and funding 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 Approves application and send approval to the programme team. First person to have an informal discussion with Trainee in the case of appeal of rejection
Educational Supervisor	First point of contact for trainee on LTFT and agree in principle with trainee. Form 3 months prior to commencement of LTFT Give Trainee ‘Agreement in Principle’ Engage with Trust, LTFT Lead around post, capacity and funding Approves application and send approval to the programme team.
Trust LTFT Team	Engage with trainee on Rotation/Placement, Funding etc 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

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 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

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 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

LTFT - East Midlands & West Midlands processes (draft)