This page captures a summary of information and artefacts on collected data around Less Than Full Time (LTFT) application process currently used by Local Offices. The intention is to later produce a synthesized version with validated data after conducting workshops with the Secondary users at Discovery Phase.
Next Steps from Business Analysis Perspective:
- Map out as-is processes for each Local Office
- Validate as-is processes with each Local Office
- Identify gaps and pain points for each LO process
- Synthesize and summarise as-is processes insights and learnings
- Service Designer working with BA’s, secondary users, wider stakeholders & partners to align processes nationally and create to-be process/es:
- Aligning Roles, Responsibilities & Ownership for each part of the process
- Aligning potential to-be process/es with GMC Gold Guide, GDC Gold Guide & National Policy for LTFT
- Aligning SOPs for Local Offices
- Create to-be process/es options to address the pain points identified in the as-is
- Service Designer working with UR’s, BA's & the rest of the team to ensure any solutions/ options /prototypes align with to-be processes
- Testing & trying out different options/solutions/ideas/prototypes to the identified problem/s
- Best/Selected idea &/or process is build and put in use
- Iteratively build and refine options with feedback
Background
NHS Long Term Plan (From Aug 2022 Onwards - Extended flexibility under Category 3)
Previously, trainees were eligible to train LTFT only if they met certain eligibility criteria (e.g. for caring responsibilities or unique circumstances). The purpose of Less than Full Time training (LTFT) was to keep doctors in training where full-time training was not practical for limited specific individual reasons.
HEE/NHSE have refreshed the Standard Operating Procedure (SOP) on LTFT arrangements to ensure greater flexibility for Doctors in Training. This work has been part of the Enhancing Junior Doctors Working Lives aligns closely to Gold Guide 9th Edition. As part of the NHS Long Term Plan, a key objective is to enable any trainees in all specialties to be able to request LTFT training to suit their individual professional or lifestyle needs.
HEE/NHSE is committed to increasing flexibility in postgraduate medical training under Category 3. As a part of HEE’s work to Enhance Junior Doctors Working Lives several initiatives have been developed with partners to increase flexibility within Post Graduate Medical Education. Feedback from trainees indicate that many would appreciate the opportunity to pursue a more flexible approach to their training.
From August 2022, all doctors in training across England in any specialty have the right to apply to train LTFT for any well-founded reason, including for their wellbeing or through personal choice.
GMC Gold Guide
3.122 All doctors in training can apply for LTFT training, the only requirement being a well-founded individual reason. A list of illustrative examples of reasons for requesting LTFT training is included in paragraph 3.123.
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).
3.123 Reasons for requesting LTFT training – illustrative list:
i. Trainees with a disability or ill health – This may include ongoing medical procedures such as fertility treatment.
ii. Trainees with caring responsibilities (e.g. for children, or for an ill/disabled partner, relative or other dependant)
iii. Welfare and wellbeing – There may be reasons not directly related to disability or ill health where trainees may benefit from a reduced working pattern. This could have a beneficial effect on their health and wellbeing (e.g. reducing potential burnout).
iv. Unique opportunities – A trainee is offered a unique opportunity for their own personal/professional development and this will affect their ability to train full time (e.g. training for national/international sporting events, or a short-term extraordinary responsibility such as membership of a national committee or continuing medical research as a bridge to progression in integrated academic training).
v. Religious commitment – A trainee has a religious commitment that involves training for a particular role and requires a specific time commitment resulting in the need to work less than full time.
vi. Non-medical development – A trainee is offered non-medical professional development (e.g. management courses, law courses or fine arts courses) that requires a specific time commitment resulting in the need to work less than full time.
vii. Flexibility for training and career development with the option to train less than full time with flexibility that might enable development of a broad career portfolio
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).
Useful links (2022 - 2023):
Flexible training (bma.org.uk)
Copmed - Principles for support ting programme management of LTFT doctors in training
https://www.hee.nhs.uk/our-work/doctors-training/standard-operating-procedures
Health Matters: Can greater flexibility help attract and retain NHS doctors? | RSM UK
Enhance Junior Doctors Working Lives
Less Than Full Time (LTFT) Training Webinar - YouTube
Delivering greater flexibility | Health Education England (hee.nhs.uk)
Digital Team - LTFT category 3 infographic Y2 - final.pdf - All Documents (sharepoint.com)
As-Is Processes - To validate
Most Local Offices have had a process prior to August 2022 when LTFT was limited to certain categories. Following the changes to LTFT from August 2022, the current processes as described on the Local Offices Websites have been extracted below to be validated during the Discovery phase at workshops.
LTFT forms and current method of submission
No. | Region | Local Office & Policies | Application forms | Submission method |
---|---|---|---|---|
1 | North East and Yorkshire |
| PDF via Email | |
| PDF via Email | |||
| PDF or WORD via Email | |||
2 | North West |
| WORD DOC via Email | |
3 | East of England | PDF via Email | ||
4 | Midlands | Online WORD via Email | ||
MS Form: https://forms.office.com/e/wk9mkXbxtM (Same as EM) | Online | |||
5 | London | Medical & PH - Submit a ticket : PGMDE Support Portal (freshdesk.com) Dental - Submit a ticket : PGMDE Support Portal (hee.nhs.uk) | Online | |
6 | South East | Same as London. Medical & PH - Submit a ticket : PGMDE Support Portal (freshdesk.com) Dental - Submit a ticket : PGMDE Support Portal (hee.nhs.uk) | Online | |
Word Document Application form To submit, along with copies of supporting documents (e.g. Birth or marriage certificate), to ltft.tv@nhs.net | WORD via Email | |||
Online | ||||
7 | South West |
| WORD DOC via Email | |
WORD DOC via Email |
Preliminary Questions and Assumptions
These are some basic questions picked up during desktop research. For more specific questions to a particular Local Office process, please see their validated process map.
No. | Question/Assumption | Notes/Comments |
---|---|---|
1 | What is the purpose of LTFT? | To offer support to all trainees who, for well-founded individual reasons, wish to be considered for Less than Full-time Training (LTFT). The key aims of LTFT training are:
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2 | What is the new LTFT Category 3 from Aug 2022? | NHS Long Term Plan
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3 | Can a trainee for LTFT on a WTE post of less than 1? | NHS Long Term Plan
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4 | Who is eligible to apply for LTFT? | GMC Gold Guide July 2022 - 9th Edition: 3.122 All doctors in training can apply for LTFT training, the only requirement being a well-founded individual reason. A list of illustrative examples of reasons for requesting LTFT training is included in paragraph 3.123. 3.123 Reasons for requesting LTFT training – illustrative list: i. Trainees with a disability or ill health – This may include ongoing medical procedures such as fertility treatment. ii. Trainees with caring responsibilities (e.g. for children, or for an ill/disabled partner, relative or other dependant) iii. Welfare and wellbeing – There may be reasons not directly related to disability or ill health where trainees may benefit from a reduced working pattern. This could have a beneficial effect on their health and wellbeing (e.g. reducing potential burnout). iv. Unique opportunities – A trainee is offered a unique opportunity for their own personal/professional development and this will affect their ability to train full time (e.g. training for national/international sporting events, or a short-term extraordinary responsibility such as membership of a national committee or continuing medical research as a bridge to progression in integrated academic training). v. Religious commitment – A trainee has a religious commitment that involves training for a particular role and requires a specific time commitment resulting in the need to work less than full time. vi. Non-medical development – A trainee is offered non-medical professional development (e.g. management courses, law courses or fine arts courses) that requires a specific time commitment resulting in the need to work less than full time. 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). |
5 | What options exists for LTFT training? |
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6 | What is the trigger for submitting a new LTFT form? | Varies between Local Offices from sometimes by specialty. Some at 16 weeks or earlier, some at 12 weeks, some at 4 months. Some Local Offices have Windows during which notice have to be given. However, they all have to meet the Codes of Practice. Typically, to begin the process no later than 3 months before the commencement to train at LTFT, although for some LO’s this is before the commencement of their rotation. The doctor in training should complete the LTFT relevant application form/s depending on LO’s and specify which category/reason/circumstance they are applying under. This should normally be submitted along with any relevant supporting documentation (as required) (depending on LO’s), allowing sufficient time for the application to be processed and at least 12 weeks’ notice to be given to the Trust before the commencement of the proposed changes to working patterns. |
7 | What is the process for getting approval on their LTFT application? | See Process maps for each Local Office. |
8 | Can an LTFT application process be rejected? If so, what are the alternative/appeal processes in each Local Office? | Yes. Although some LO’s have not rejected any applications. See Process maps for each Local Office. |
9 | What are the grounds for rejection of an LTFT application? |
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10 | What happens if a trainee wishes to change their LTFT pattern? | Depending on LO, a new application has to be submitted. Some LO uses the same LTFT form used for new application (e.g. LDN) whereas some LO’s have separate forms for change of pattern, e.g. WES and YH. |
11 | Are the LTFT application processes similar for Dental or Public Health programmes? | These trainees are currently covered under TSS. This varies between Local Offices. See Process Maps. |
12 | EOE seems to have an approval process built in the application form for TPDs to fill in and confirm, whereas London’s online form does not have this. Does the process needs to be aligned across all Local Offices before a form can be considered for TIS Trainee Self Service that would work nationally. What is/should be the nationally agreed national process? | South - (Neil - Lead BM for LTFT) Common policy to be defined/aligned nationally as well as Processes. BM’s to agree and taken to English Deans for Sign off. This was previously taken to be raised at TIS PAG (Process Alignment Group), now a defunct group. @Lead PM/ Service Designer to determine. |
13 | At what % of full time can a trainee work? | YH is normally supported in placements at 50%, 60% or 80% of full-time contracts. Should a trainee wish to train at a percentage other than 50%, 60% or 80% this will require written support from the TPD and the authorisation of the Deputy Dean (DD) for LTFT training. LDN: Note: The minimum number of sessions trainees in LaSE can work is 50% and the maximum is 80%. If you are on a phased return to work, you should select the percentage that you wish to work at when you return to your usual number of sessions. Very few under 50%. EOE: Percentages ranging from 50%-90% with increments of 5% NATIONAL: In exceptional circumstances it is possible to request to train less than 50% but approval must be sought from the Postgraduate Dean given the minimum requirements for recognition of training as set by the GMC. Support should be sought outside of this application process. Varies from LO to LO currently. |
14 | What is the impact of LTFT on CCT / Completion of Training? | Varies according to specialty. Some specialties are time-based and some competency-based.
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16 | What is the impact of LTFT on ARCPs? |
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As-Is Processes - Validated at Workshops
LTFT - London & KSS processes - 17 October 2023
LTFT - East Midlands & West Midlands processes (draft) - 2 November 2023
LTFT - East of England (EoE) processes - 6 November 2023
LTFT - Yorkshire and Humber (Y&H) Processes - 7 November 2023
LTFT - North West processes (draft) - 31 October 2023
LTFT - Thames Valley Processes (Draft) - 28 November 2023
LTFT - South West Peninsula & Severn (Draft) - 29 November 2023
LTFT -North East processes (draft) - To be Scheduled
Existing Form Fields Analysis (Old)
Order | Field name | National/Regional data set? | TIS field to pre-populate with | Reference Table | Example value | Type (free text, drop down, check box) & Interaction (auto populate etc.) | Mandatory for submission (Y/N) | Validation/Error messaging | Notes |
---|---|---|---|---|---|---|---|---|---|
Section 1: Personal Details | |||||||||
1 | I have discussed my request to train LTFT with my Training Programme Director / Foundation School Manager / GP Scheme Director and they are aware I am submitting an application to train LTFT Note: You must discuss your application with your Training Programme Director before completing this application form so they are aware for rotational planning. | LDN | YES | YES/NO | Y | LDN: Form cannot be completed without YES. | |||
2 | Please select an application type Note: If you have previously been approved to train LTFT under category 1 but wish to apply under category, please select ‘I am applying to train LTFT for the first time.’ | LDN/EOE |
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3 | Title | NAT | Title | Y | |||||
4 | First Name | NAT | Forenames | Y | |||||
5 | Surname | NAT | Surname | Y | |||||
6 | Maiden Name | NAT | Maiden name | N | |||||
7 | GMC Number | NAT | GMC Number | One of the registration numbers must be provided |
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8 | GDC Number | NAT | GDC Number | One of the registration numbers must be provided |
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9 | Public Health Number | NAT | Public Health Number | One of the registration numbers must be provided |
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10 | Email address | NAT | Email address? | Y | |||||
11 | Telephone number | NAT | Telephone number | Y | |||||
12 | LDN - Do you/will you hold a Tier 2 visa? EOE - Are you a Tier 2 Visa holder? SW - Are you a Tier 2 Visa holder? | NAT | N | What if UK resident applicant? I guess some guidance notes to go with it that is applicable to those requiring a Visa to train as a Doctor/Dentist in the UK. | |||||
13 | What is your current specialty? | LDN | |||||||
14 | What is your current grade of training? | LDN | |||||||
15 | Have you recently been offered a training post in LaSE via national or local recruitment? | LDN | |||||||
16 | Are you currently an Academic Clinical Fellow? | LDN | |||||||
17 | Are you currently a Clinical Lecturer? | LDN | |||||||
18 | Are you currently out of programme? | LDN | |||||||
19 | Are you currently on parental leave? | LDN | |||||||
Section 2: Application Details | |||||||||
20 | Will you be training in a post in London or Kent, Surrey and Sussex when you wish to train LTFT? Note: We can only accept application from people who will be training in a post in London or Kent, Surrey and Sussex. If you train in a post in another region then you must apply to your Local Office. | LDN | |||||||
21 | I am currently a | EOE | Y
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22 | Which Trust will you commence LTFT at? (Not your current post) | NAT | Y - CURRENT values from Trust Reference table | Y |
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23 | Which specialty are you applying to train LTFT in? | LDN | |||||||
24 | Name of Training Programme | NAT | Y | ||||||
25 | Current Programme End Data | EOE | |||||||
26 | If you are a GP trainee, do you still have hospital placements to complete? | EOE | YES/NO | ||||||
27 | Level you will be working at | NAT | Y | ||||||
28 | Select the category under which you are applying to train LTFT Note: Please note you can only apply to train LTFT under one category at a time. LDN: Categories definition:
EOE: A. Responsibility for caring for children (Category 1) B. Health related reasons (Category 1) C. Direct carer for ill/disabled partner, relative or dependant (Category 1) D. Unique opportunity for professional development / short term extraordinary responsibility / religious commitment / other (Category 2) E. Trainees who choose to train LTFT as a personal choice - Applicable for Paediatrics, O&G and Emergency Medicine (Category 3) | NAT | Y - New Depending on agreed list - TBD | Y | |||||
29 | Please provide clear and concise details to support this application in order for us to process your request as quickly as possible. We recommend 500 word limit on your response. Note: How does this request benefit your future career? How does it benefit the wider NHS? How long is the request for? Is it paid or unpaid employment? How do you plan to manage the time commitment between your training and the additional role? What was the outcome of your last clinical ARCP? | LDN | Y - If any of the 'Category 2' reasons have been selected in #23. | ||||||
Section 3: Proposed Less Than Full Time/Working Pattern/Training Plan | |||||||||
30 | When do you wish to commence training LTFT? Note: You must provide 16 week’s notice of your request to train LTFT. If less notice is provided, Trusts may refuse to accommodate your request as they have been given insufficient notice to make changes to rotas. | NAT | |||||||
31 | LTFT end date (if known) | NAT | |||||||
32 | Please tell us the Whole Time Equivalent you wish to work LDN: Note: The minimum number of sessions trainees in LaSE can work is 50% and the maximum is 80%. If you are on a phased return to work, you should select the percentage that you wish to work at when you return to your usual number of sessions. NAT: In exceptional circumstances it is possible to request to train less than 50% but approval must be sought from the Postgraduate Dean given the minimum requirements for recognition of training as set by the GMC. Support should be sought outside of this application process. | NAT/LDN/EOE | Various ranges used by the different LO’s what should be the allowed range on a national form? | ||||||
33 | I confirm I have discussed my LTFT working timetable with my Educational Supervisor and it meets my curricular needs. | EOE | Is this similar to #1? | ||||||
34 | I will be working (if unsure please contact HR at your Trust/Lead Employer) | EOE |
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35 | Please provide your weekly proposed timetable | EOE | |||||||
Section: Proposed LTFT Training Plan Approval | Training Programme Director or Head of School Approval & Declaration - TDP/FTPD or Head of School to complete all sctions | EOE | This section is used in EOE for approval with the TPD - Is this approval chain required on the form? London does not seem to have an approval chain integrated in the form. | ||||||
36 | LTFT start date | EOE | |||||||
37 | LTFT end date | EOE | |||||||
38 | Whole time equivalent (e.g. 0.8 = 80% of full time) | EOE | |||||||
39 | Type of slot arrangement for this trainee | EOE |
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Section 4: Application Declaration | Note: We require a minimum of 16 weeks’ notice to train LTFT. For applications submitted with less than 16 weeks’ notice the start date will be 16 weeks from the date of application. Exceptional cases will be reviewed on a case by case basis. | ||||||||
40 | I have read the FAQs and the 'Guidance to training LTFT' and understand that if I do not provide the appropriate evidence my application will not be processed | LDN | Do we need all these declarations? | ||||||
41 | I have read the HEE policy on less than full time training. | EOE | |||||||
42 | I understand that I will normally be expected to move between posts and rotations on the same basis as a full time trainee in the same specialty. | EOE | |||||||
43 | I understand personal information is recorded on HEE databases and shared with those who have responsibility for the organisation, management and delivery of training to help them execute their function in the planning and delivery of training. This is in line with GDPR regulation. | EOE | |||||||
44 | I have agreed my application with my Training Programme Director and I give HEE permission to contact him/her regarding my application if necessary. | EOE | same as #1 but only makes reference to TPD? | ||||||
45 | I understand I may now do additional paid work, including locums. This will not count towards my training time and must comply with the terms of my contract. I agree any additional work will form part of my practice and I will declare this on my Form R Part B. | EOE | |||||||
49 | I understand that if I wish to change the percentage at which I am training, I must complete a and submit a ‘Change In Plan’ form. | EOE | |||||||
50 | I agree the information given in this application is accurate to the best of my knowledge and belief. | EOE | |||||||
51 | Trainee Signature | Proposed | N/A |
| Y | As with Form R Part A | |||
52 | Date | Proposed | N/A | Pre-populate
| Y | As with Form R Part A | |||
Section 5: Evidence Upload | LDN | Perhaps we can move #40 in here with the options to attach evidence. | |||||||
53 | Category 1: Caring Responsibilities for a family member You have selected 'Caring Responsibilities for a family member', you will need to upload the following evidence:
Applications will not be processed without this information Category 1: Disability or health reasons You have selected 'Disability or health reasons', you will need to upload the following evidence:
Applications will not be processed without this information | LDN |
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