This page captures the Business Analysts approach to provide a summary of artefacts and data collected around Less Than Full Time (LTFT) Training application processes.
Business Analysis Plan & Perspectives
The Business Analysts approach to discovery and delivery broken down by each of the GDS phases.
- Map out as-is processes for each Local Office
- Validate as-is processes with each Local Office
- Validate with Local Office LTFT admins
- Validate with TPD & ES
- Validate with Trust / Department / Rota Coordinators / Medical Staffing
- 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 latest 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 process/es
- Testing & trying out different options/solutions/ideas/prototypes to the identified problem/s to the selected participants
- Best/Preferred/Selected idea &/or to-be process is build and put in use
- Iteratively build and refine options with feedback
Background on LTFT
We have looked at various sources of information around policy and guidance (Local & National) in summarising the below information to provide context on Less Than Full Time Training (LTFT). We have looked at the NHS Long Term Plan, GMC Gold Guide 9th Edition amongst other on-going work related to this area. The page also provides a list of useful links for further reading into the subject matter.
NHS Long Term Plan
From Aug 2022 - 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.
GMC Gold Guide Guidance
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.
3.123 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 for Context
Useful links (2022 - 2023):
Flexible training (bma.org.uk)
GMC Position Statement on LTFT
Copmed - Principles for support ting programme management of LTFT doctors in training
NHSE/ HEE 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)
Study/ Extracts of current processes to validate with Local Offices
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 planned workshops.
Pre-discovery Questions and Assumptions
These are some basic questions and assumptions picked up during desktop research by Business Analysts. 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 change from Categories and Category 3 from Aug 2022? | NHS Long Term Plan
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3 | Can a trainee for LTFT have 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: (see above) 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? |
This varies from Local Office to Local Office. |
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. See Process maps for each Local Office. |
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? | Reasons for rejection as per the SOP 2022 and legislation (See document below):
|
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 Local Office 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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15 | What is the impact of LTFT on ARCPs? |
GMC Gold Guide: 3.133 Key points relating to LTFT trainees are: i. LTFT trainees should have an ARCP not less than annually but at intervals of no more than 15 months (to comply with the revalidation requirement) but may need an ARCP at a critical progression point in training. |
Application Forms
This is the link to all application forms and submission methods by each Local Office.
Validated As-Is Processes
This is the link to the validated As-Is processes for Less Than Full Time Training for each region.
/wiki/spaces/NTCS/pages/3944251572
This is the link to the analysis of the As-Is processes
Analysis of Pain Points & considerations for Alpha
Given the identified challenges and issues related to the LTFT (Less Than Full Time) process. It's clear that there are several pain points, including communication gaps, unclear processes, and administrative burdens. This page provides a summany of those along with some potential suggestions or actions that could help address some of these challenges.
National Dataset for LTFT
This is the National Dataset that has been agreed and signed off by Deans and Business Managers and can be found in the National SOP 2022 for LTFT (See Documents section).
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