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.

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. 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.

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 will be accommodated.

No.	Reason selection	Circumstance	Supporting documentation
1	Responsibility for caring for children	Responsibility for caring for children Expiry Until youngest child is 18 years’ old	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. Expiry is until end of programme	Must include a letter from your GP/ Occupational Health Consultant/ Medical Specialist which includes: Nature of disability/health requirements for LTFT Training 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	Expiry is Until End of Programme	You must include a letter from your GP or Medical Specialist involved in the care of your partner / relative / dependent which includes: Level of care anticipated that you will need to provide. 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): Welfare and wellbeing Unique opportunities Religious commitment Non-medical development Flexibility for training and career development Other	Welfare and wellbeing – There may be reasons not directly related to disability or ill health where doctors in training may benefit from a reduced working pattern. This could have a beneficial effect on their health and wellbeing (e.g. reducing potential burnout). Unique opportunities – A doctor in training 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). Religious commitment – A doctor in training 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. Non-medical development – A doctor in training 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. 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 Expiry is Until end of programme or a request to increase hours is approved	Further details textbox to support the selected reason and nature of the request

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 Programme Manager for Specialty and GP VTS admins for GP.

3.1 Work Pattern, payroll changes and Start date 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

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

Trainee Commencing their training on LTFT basis

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.

Pain Points in the process

No.	Pain Point / Area to improve	Comment
1	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 when it comes to prioritising the processing as and when the applications are received for specialty. E.g. there is no Local process to prioritise the processing of Childcare/Disability/Health reasons applications over wellbeing ones. 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 TPS 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. 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)

N^o	Email Template	Body / Content	Sent to
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; https://www.severndeanery.nhs.uk/about-us/policies-and-procedures/less-than-full-time-working-policy-2022/ Should you have any queries please get in touch. Kind regards Joanne Pickstone Education Programme Manager	Trainee
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,	Trainee cc Education Programme Manager cc Patch Ad cc Lead Employer
2	Rejection	N/A - since there is no rejection by HEE
3	Appeal procedure	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
1	Discussion/Pre-approval Stage	What's your involvement in the Less Than Full Time application process?	Trainees first point of contact for LTFT to have TPD’s support Trainee ticks a box on the form to confirm having done so
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)	Radiology
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 Change in pattern
4	Discussion/Pre-approval Stage	Do you have any involvement in slot-sharing arrangements discussion and with who?	Slot sharing opportunities are utilised
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?
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, to send to EPM/Medical Staffing to complete their part and sign (for well founded reason), then sent 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?	Health / Disability / Caring where no supporting docs have been provided or health grounds needs verifying, EPM sends to AD / Deputy Deans to get their approval.
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?	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

Documents

	File	Modified

LTFT - South West Peninsula & Severn