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This page outlines the data that have been collected from Thames Valley Local Office and validated at a workshop (28th of November 2023) to map their as-is business processes for Less Than Full Time Training.

Application Windows 2022 - 2024 for TV

Some schools (for example General Practice and Acute Medicine) receive large numbers of applications from trainees wishing to work LTFT. This may mean that you must apply within a specific window, usually at least three months ahead. Application form is in Word format with the same form completed for all Dental, Medical, Public Health and Foundation.

Medicine requires 4 months/16 weeks notice. Windows are 11th of April for 1st of August Rotation, 12th of October for 1st of February Rotation.

Although more notice required in Medicine, 3 months is the strict minimum notice required to apply for LTFT.

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.

All well-founded reasons will be considered. Support to progress the application will be dependent on the capacity of the programme and the effect the request may have on the training available to other doctors in training on the programme. 

It is expected that all those applying due to disability or ill health and caring responsibilities (1/2 below) will be accommodated. 

No.

Reason selection

Circumstance

Supporting documentation

1

Disability or ill health

This may include ongoing medical procedures such as fertility treatment.

  • If you are requesting LTFT for health reasons, we require a copy of an Occupational Health or other medical report supporting the application

The letter should be dated within the past 3 months. - TBC

2

Caring responsibilities

Trainees (men and women) with caring responsibilities (e.g. for children, or for an ill/disabled partner, relative or other dependant)

  1. If your reason for this request is responsibility for existing children, you will need to send a copy of their birth certificate(s)

  2. If you are still on or about to go on maternity leave, confirmation of your eligibility under this criterion will be subject to receipt of the birth certificate when this is available

  3. (No need to continue to re-apply upon each period of maternity leave, eligibility is automatic until their youngest child is 18 years old - TBC

  4. If you are applying because you are directly caring for an ill/disabled partner, relative or other dependent we require a copy of a medical report confirming the needs of your dependents and that you are directly responsible for their care

3

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).

Applications relating to personal choice and/or individual professional or lifestyle needs will be considered by the TPD. Whilst these applications are not subject to judgement, agreement is dependent upon service considerations.

4

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.

None - reason specified on the form

5

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).

None - reason specified on the form

6

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

None - reason specified on the form

7

Flexibility for training and career development

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

None - reason specified on the form

As-Is Processes for Thames Valley

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:

  1. Pre-application Stage: 3-4 month before Rotation starts, where a trainee discusses with Trust LTFT champions and with their TPD / Foundation TPD / ES / HOS. The outcome at this stage is “in principle” a post is agreed in order for them to apply to train as LTFT. Trainee obtains signature on the Word Document form from TPD with relevant section filled in.

  2. LTFT Application Submission Stage: With at least 12 weeks notice, application submitted to Y&H to the NHSE Thames Valley Inbox England.ltft.tv@nhs.net.

3.1 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

  1. Trainee Commencing their training on LTFT basis

Pain Points in the process

No.

Pain Point / Area to improve

Comment

1

Revised 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.

2

Once approved, does it remain for the duration of the programme or until trainee decides to make a change by submitting an application? Until end of prog. Or new request to change. Sometimes it doesn’t get fed down. Which can have implication on their pay if the % is not reflected without paperwork.

3

There is no SLA published to trainee on expectation of dates on outcomes of applications

4

Applications applied too early are rejected and trainees asked to re-apply within application window. E.g. If a child is not born yet and an application is made on the basis of childcare, they are rejected and asked to apply after child birth.

5

Calculation of CCT for GP is done by the GP team whereas in Specialty they are done by the admins team. The reason GP moved to Royal Colleges was because of the amount of errors in calculating the data.

6

TV uses Local and National 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.

7

TV has documented process with Trainee, Associate Dean and Postgraduate Dean involved in an appeal process, however, in practice no rejection insofar has reached to this stage following rejection.

8

The form is a WORD Doc and can be filled in manually or by using a Computer. It is an prone to miss filling in required information. It can also be time-consuming having to print, manually fill, scan and send to NHSE TV.

Application Numbers in TV

May to October 2022 and 2023 comparisons by specialty and reasons

Speciality School

May - Oct 2022

May - Oct 2023

Foundation

3

6

GP

21

30

Anaesthetics

7

8

Emergency Medicine

3

9

Medicine

24

21

Ophthalmology

0

0

Paediatrics

11

9

Histopathology

2

1

Public Health

2

2

Obs & Gynae

2

6

Psychiatry

1

8

Radiology

0

2

Surgery

6

4

Dual Emergency Medicine / Medicine

2

0

 TOTAL

84

106

No.

Category

May - Oct 2022

May - Oct 2023

1

Health/Childcare

59

12 (Health), 53 (Childcare)

2

Unique Opportunities

4

5

3

Welfare / Wellbeing

21

26

4

Flexibility for training and career development (new)

n/a

10

LTFT Email templates

These are the email templates managed by specialty teams and LTFT Admins that are sent to trainees in the relevant events

No

Email Template

Body / Content

Sent to

1

Approval

Dear Dr  <TPD>  

Dr Anne Edwards has confirmed DR <Trainee> is eligible to be considered for LTFT under category <NUMBER> .  <Dr TRAINEE> is an <ST ?> in <SPECIALITY> Training.   The relevant school and the employer will determine whether this can be accommodated, the start date and the % of WTE time to be worked.  A start date of <DATE>    has been requested. 

The options for providing LTFTT are:

· A slot share and working at 60%, sharing the responsibilities and salary of the post. We pay an extra 10% for each trainee so that they can handover and attend regional teaching etc. Training at 50% is also possible, though this is not recommended long-term.

· The second option is to work LTFT in the full time post, this being an option if there are vacancies in the scheme.

· The third option is Exceptional funding, which may be available occasionally for a limited period at the discretion of the LTFTT Dean.

The ARCP remains an annual process. Annual leave and study leave are on a pro rata basis.

If they should wish to return to full time training at any point then <Dr TRAINEE> would need to let you know so that they can move in to a vacant full time post when one arises.

Please advise <EPM> whether <Dr TRAINEE> will be in a full-time post or a slot-share, the date and location of the anticipated starting placement, and agreed percentage of training.

Kind regards

  • Trainee

  • TPD

  • Educational Programme Manager

2

Enquiry

Dear Trainee  

Thank you for your email.   You will find all the information relating to LTFT on our website copied below.    Please ensure yourself and your TPD complete the application form on our website  prior to returning it to me for approval of eligibility.  Please also include evidence per category you wish to apply under with  your application.

https://thamesvalley.hee.nhs.uk/resources-information/trainee-information/training-options/less-than-full-time-training-ltftt/

If you have any other queries please do not hesitate to get in touch.

Thanks

Debbie

  • Trainee

3

Rejection

N/A - due to no rejection

4

Appeal procedure

N/A - due to no rejection

CCT Calculator

For GP, the Royal Colleges is responsible for calculating and inputting of the the CCT date on TIS following LTFT application processing. For Specialty, the HEE admins are responsible to input them and would only happen around ARCP time.

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?

  • Trainees first point of contact for LTFT

  • Sending of the plan (extracted from S/S) to tutors and department to inform and ensure it can be accommodated

  • Authorisation of the application following greenlight from Tutors and Rota coordinator

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)

  • Anaesthetics care & EM

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

4

Discussion/Pre-approval Stage

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

  • Yes - spreadsheet

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?

  • Following discussion, plan sent to tutors for their consideration and greenlight to accommodate the plan

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, send to ES to complete their part and sign, then sent to TPD to have their part completed and signed/approved to be 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?

  • Use spreadsheet to plan out what their trainees are doing

  • Emailing info from S/S to tutors and the plan and getting their approval on whether they are happy with the arrangement

    • Training %, specialty, trainee name, Rota coordinators, summary of the slot sharing arrangement on the post - sent to tutors, rota managers

  • Anaesthetics School website may have the spreadsheet in use in the background to interact with

  • TPD approves it at the stage they get the greenlight back from the tutors, rota coordinators

  • Health reasons applications are reviewed annually, although unsure how it is tracked

    • ES sign, TPD sign following review

    • TIS gets updated, trainee made aware via email

10

Processing/Approval

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

  • Yes, notified of approval by AD

  • TPD sometimes not knowing that the trainees have accepted their post

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

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