TIS Self-service - LTFT Overview

Owned by Ashley Ransoo
Last updated: 22 Jul 2024
18 min read

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.

Discovery - How the discovery phase works - Service Manual - GOV.UK

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

Alpha - How the alpha phase works - Service Manual - GOV.UK

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

TIS Business Analysts 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

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

Digital Team - LTFT category 3 infographic Y2 - final.pdf - All Documents (sharepoint.com) - Published March 2022 Pending a final report due in July 2023

Useful Links for Context

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.

Yorkshire & Humber - 01 March 2023

ltft_application_approval_flowchart_final.v2.pdf (yorksandhumberdeanery.nhs.uk)

  • Postgraduate Doctors and Dentists in Training meet with their TPDs prior to submitting their application to discuss

  • A suitable post is agreed in principle

    • Note: Traditional categories are removed, anyone can consider LTFT 

  • Trainee give at least 16 weeks’ notice of their intentions where possible. Where this is not possible, their request will be considered but may not be able to be accommodated

  • Trusts are consulted on applications that have less than 12-weeks' notice 

  • Ros Roden, (Professional Support Clinical Lead) is the LTFT lead for YH

    • Note: LTFT East, South and West inboxes will cease to exist, applications will be managed by the School Programme Support Teams 

  • There is one form in use across the YH Deanery 

  • Everyone will follow the same process irrespective of School (e.g. specialty or Foundation), profession (e.g. Medical or Dental)

  • Form sent to School admin, if Supernumerary post, then may need PG Dean approval

  • May require Associate Dean support in order to receive guidance and make adjustments based on their recommendations

  • LTFT status is approved in principle by HEE

  • If <12 weeks notice given by PGDiT, TPD liaises with School admin and Trust to be contacted to accommodate. If not able to accommodate, trainee may appeal. TPD holds application.

  • Process review due in July 2023

North West - 01 Aug 2022

Flowchart.pdf (nwpgmd.nhs.uk)

Updated LTFT Policy. Updated 10/03/2023 https://www.nwpgmd.nhs.uk/sites/default/files/LTFTT Policy updated 10032023 FINAL.pdf

  • LTFT will commence only at rotation points – unless an unexpected reason is identified during a placement for example health, carer, parental leave, this includes changes in any percentage in LTFT training.

  • Increasing back to fulltime will only be allowed at a rotation change and with notice unless exceptional circumstances apply.

  • Initial application for LTFT will be in 2 windows mid March to mid April and mid September to mid October.

  • The current window of opportunity opens March 20th 2023 and closes April 21st 2023, this is for any doctors in training who rotate between August 2023 and January 2023.

  • The form will ask for the reason as it does now and in the case of ill health ask for confirmation of engagement with health care /OH (duty of care)- this will allow us to monitor the situation.

  • Completes an initial form liaising with TPD followed by an approval form sent to the trust LTFT Champion

  • LTFT Team confirms post to Lead Employer for relevant adjustments to be made to pay and CCT

  • Each subsequent rotations for a LTFT trainee will be managed as at present

  • Process review due in July 2023

East of England - 2023

ltft_flow_chart_final.pdf (hee.nhs.uk)

  1. DiT starts application process at least 16 weeks before LTFT start date

  2. ES signs the LTFT application form to confirm:
    a) Has discussed LTFT process with DiT
    b) Has signposted DiT to EoE LTFT web page
    c) Has assessed and put in place any extra support needed e.g. PSW
    d) Has agreement that accepting trust can safely accommodate DiT
    e) Has initiated the LTFT online application form with the DiT

  3. TPD signs LTFT Application form to confirm:
    a) DiT can be accommodated LTFT in Training Program
    b) To clarify any specific needs of the DiT regarding rotas, after hours work etc have been communicated to department in which doctor will be placed
    c) To confirm has direct agreement from Department in which DiT will be placed for LTFT
    d) If application is late (Submitting to HEE <12 weeks before start date) that all appropriate parties notified

  4. Practice Manager signs LTFT application form to confirm:
    a) DiT is allocated to the practice, including start date and ability to accommodate planned work schedule

  5. Confirmation email received from HEE once approved

East Midlands

Process map for LTFT

New LTFT Online MS Form: https://forms.office.com/pages/responsepage.aspx?id=K5Gn_5ewMUGcD9DoB1Wyq4AcmPAMbsJMmtf7cPn2T_xURUhWSTJGSFpGM1dMNjhRQVdLQzVZRlZENC4u&web=1&wdLOR=cAC8FAF20-21D2-46A7-A0D5-FC273CF3BBDA

  • Trainee discuss with TPD or Educational Supervisor, and reach an agreement in principle

  • Trainee completes and submits Online MS Form

  • Power Automate sends 2 emails based on Doctor’s responses based on whether submitted before code of practice deadline (3 months notice) and whether they know their Educational Supervisor yet (new programme)

  • Trusts are consulted with on applications that have less than three months' notice

  • If form sent on time:

    • Email sent to programmes of application received

    • Email sent to TPD and ES from team inbox asking to approve, trainee copied in

    • Programme team complete and sends approval letter to all parties

  • If form sent on time and doctor doesn’t know ES:

    • Email sent to programmes of application received

    • TDP replies with approval or rejection

    • Rejection send to APD for discussion

    • Programme team complete and sends approval letter to all parties

  • If form sent late and doctor knows ES:

    • Email sent to programmes of application received

    • Email sent to TPD and ES asking to approve, trainee copied, including details of who has agreed late application

    • TPD and ES replies with approval or rejection

    • Rejection sent to APD for discussion

    • Programme team complete and sends approval letter to all parties

  • If form sent late and Doctor does not now ES:

    • Email sent to programmes of application received

    • Email sent to TPD asking of approval and informing of doctor not aware of ES, trainee copied in, including details of who has agreed late application

    • TPD replies with approval or rejection

    • Rejection sent to APD for discussion

    • Programme team complete and sends approval letter to all parties

West Midlands - 21 Aug 2023

  • Note: Pre-Aug 2023 WM used Paper form and all now replaced with the new online form.

  • Apply online via MS form since Aug 2023 for the following

    • Going from full time to less than full time training (LTFT) 

    • Changing between different LTFT percentages

    • Going from LTFT back to full time

  • Educational supervisor (if in a post) to approve (email address entered by PGDiT on the MS Form)

  • Automatic email goes to TPD to the email address supplied on Form

  • TPD to approve and respond by email

    • If Dual Specialty, TPD for dual specialty informed

  • If TPD planning to reject, they should discuss it with appropriate Assoc PGD for LTFT to ensure all avenues explored

  • TPD sends tentative CCT date calculated for PGDiT back in the email along with approval

  • No need for Associate Dean to sign if straightforward application at 60 or 80%

  • Same form for application and change of percentage

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

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:

  • To retain doctors within the NHS workforce who are unable to train on a full-time basis 

  • To promote career development and work/life balance for doctors training within the NHS  

  • To ensure continued training in programmes on a time-equivalent (pro rata) basis

  • To maintain a balance in LTFT arrangements with regards to educational needs and those of the service

2

What is the change from Categories and Category 3 from Aug 2022?

NHS Long Term Plan

  • From Aug 2022 - all specialties for their year (no limit of 4 months) of training without needing to meet Category 1 & 2

  • Following the publication of the Gold Guide (9th Edition, July 2022), the categories for LTFT training have been removed, allowing all doctors in training the opportunity to apply to train LTFT for any well-founded reason, including for their wellbeing or through personal choice.

  • All applications made to HEE Local Office

3

Can a trainee for LTFT have a WTE post of less than 1?

NHS Long Term Plan

  • Yes, with agreement and at the discretion of PG Dean

4

Who is eligible to apply for LTFT?

GMC Gold Guide July 2022 - 9th Edition:

5

What options exists for LTFT training?

  1. Slot Share - 2 trainees share a full time slot, Often both trainees working 60% of time in a week (~3 days) with 50% on-calls shared between them with minimal overlap

  2. Reduced Hours Post - 1 trainee works fewer hours in a full time slot , often 80%

  3. Supernumerary - Very Flexible but limited number of these posts due to funding restrictions

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):

  • Burden of additional costs

  • Detrimental effect on ability to meet customer/patient demand

  • Inability to re-organise work among existing staff

  • Inability to recruit additional staff

  • Detrimental impact on quality

  • Detrimental impact on performance

  • Insufficiency of work during the periods the employee proposes to work

  • Planned structural changes

  • Training requirements (including GMC, NIHR and Gold Guide)

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.

  • Time based - e.g. time to complete a 12 months FT training can be completed in 13 months if LTFT at 90%, 15 months if LTFT 80%, 17 months if LTFT at 70%, 20 months if LTFT at 60%, 24 months if LTFT at 50%

  • Competency based - Training extended by length of time required to achieve competencies. An LTFT rota should have a proportional share of the Shifts worked by full time trainees.

15

What is the impact of LTFT on ARCPs?

  • Even though trainee has not completed full competency in a 12 months period, they still have to do ARCP every 12 months or not later than 15 months if training on LTFT.

  • Can be assessed in accordance to their LTFT percentage for the last 12 months.

  • All Locums must be declared on Form R for ARCP.

GMC Gold Guide:

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.

Analysis of As-Is Processes

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).

Documents

  File Modified

Microsoft Word Document SOP_LTFT_Final 2022.docx

30 Nov 2023 by Ashley Ransoo

Microsoft Word Document Checklist For LTFT Conversation ES and PGDIT Jan 2024.docx

05 Feb 2024 by Ashley Ransoo

Slack: https://hee-nhs-tis.slack.com/
Jira issues: https://hee-tis.atlassian.net/issues/?filter=14213