Less than full-time (LTFT) training

LTFT training is defined as training that meets the same requirements as full-time training, from which it shall differ only in the possibility of limiting participation in medical activities to a period at least half of that required of a full-time trainee.

All trainees including academic doctors, can apply to train LTFT, at any stage during their training.

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 in 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

Conference of Postgraduate Medical Deans of UK (COPMED) 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 and aligns closely to Gold Guide 11th Edition.

All trainees have a legal right to request flexible working – not just parents and carers. Therefore, all postgraduate doctors in training can apply for LTFT training, the only requirement being a well-founded individual reason.

All well-founded reasons will be considered, however support to progress the application may be dependent on the capacity of the training programme to accommodate this whilst maintaining the training opportunities available to other doctors in training on the programme. Furthermore, requests to work LTFT must be agreed by the employing Trust who can legally make a case for refusing the request. Ultimately, it is expected that most requests will be accommodated provided there is adequate notice to both the training programme and the employing Trust, usually of at least 4 months. Trainees must understand that meeting their training needs, whether FT or LTFT, remains paramount, however the request to work LTFT may limit the options for subsequent placements on the programme.

The General Medical Council (GMC) requires that trainees undertake no less than 50% WTE (whole-time equivalent). In very exceptional circumstances, your deanery may agree to an absolute minimum of 20% WTE for a specified period. For more information, please read the GMC position statements on LTFT training.

The RCOG strongly encourages those who want to train LTFT to work at least 50% WTE to ensure educational progress; any less than this is likely to result in skill retention only, not progression through the O&G specialty training curriculum (especially for practical procedures).

Pay needs to be negotiated with your employer. It is based on the total number of hours worked each week and how many of them are out of hours. 

There are several options for LTFT training such as:

• “Slot sharing” is common with more than one trainee sharing one slot 
• Two trainees occupying one FT slot working at 50% each
• Three trainees occupying two FT slots, working at 70%, 70% and 60%
• Five trainees occupying four FT slots at 80% each
• However, deanery will usually agree to fund an extra % of training time into a slot share, meaning for example that two trainees in one slot might each work at 60%, and all three trainees slotting into two slots might work 70% each, or indeed two at 70% and one at 80%. LTFT in a full time slot is becoming more common with the increasing numbers of unfilled training posts especially 80% LTFT.
• Supernumerary post. In exceptional circumstances, deanery may consider placing you in a supernumerary post for a brief period of time. However, owing to financial constraints this is becoming increasingly difficult to accommodate, even for reasons of ill health, and there can be additional problems with payment for out-of-hours duties.

Previously these posts had to be approved for training on an individual basis but as GMC approval is now granted to a complete O&G programme rather than individual posts, training within a supernumerary post should be recognised, provided training capacity is not exceeded.

First, contact your Training program director (TPD) who is responsible for managing the rotations within your Deanery and who will be aware of the potential capacity to enable a trainee to move to LTFT training.

You may consider meeting the Deanery Associate Dean with responsibility for LTFT training (or your Postgraduate Dean) to discuss your reasons for wanting to train LTFT and to check whether there is support for this. You may experience difficulties because of financial constraints within Trusts, and your Deanery may not be able to insist on LTFT placements on your behalf. Therefore, it can take some time to arrange a LTFT post, so the earlier you start discussions with your senior educator/TPD/APD, the better. The deaneries need 16 weeks’ notice and requests should ideally align with rotation time so an appropriate placement can be found, unless in unexpected situations.

If you have any problems, please contact the RCOG’s LTFT Advisor email the Policy Coordinator (Quality) or call +44 20 7772 6294.

You can request LTFT training when appointed to the training programme. You don’t have to disclose this at interview, but you should discuss your plans with the TPD in advance, to allow a post to be established as quickly as possible. Appointment committees are not allowed to take LTFT training requests (if known) into account – appointment is on merit alone. A suitable training slot will then be found if possible.

You can request to convert to LTFT training at any stage during your training. Your Deanery Associate Dean for LTFT training/TPD will need to confirm your request, and your Deanery and employing Trust will need to approve the funding arrangements.

Once you have organised a LTFT slot your timetable will be arranged with your Trust’s Human resources alongside guidance from the College Tutor and Training Programme Director (TPD). You will need to follow the local policy for each LTFT placement as these must be agreed not only by the TPD and Trust College tutor but also by HR and the finance department in the Trust in which you are placed.

Your LTFT training programme should be comparable to that of a full-time trainee and must include the following clinical sessions on a pro-rata basis:

• Antenatal clinic
• Labour ward
• Gynaecology clinic
• Operating list
• Special interest (e.g., colposcopy, ultrasound) – this should rotate so you experience the various subspecialties in O&G
• Postgraduate education/audit/administration

It may not be possible or appropriate to include all the basic clinical sessions at all stages of training. You may have a modular timetable, with a block of time spent focusing on gynaecology, then a similar period focusing on obstetrics. Other timetables have components occurring in alternate weeks. There does not need to be a rigid arrangement if the totality of training is balanced. You should attend a proportional amount of postgraduate education sessions compared with your full-time colleagues.

You should try to have some continuity in your training (e.g., attend a gynaecology clinic/operating list with the same consultant).

You shouldn’t be used as just an extra pair of hands in your department, but equally you shouldn’t expect to cherry-pick sessions.

As a LTFT trainee, your on-call work should be proportional to that of a full-time trainee within your department, including weekend and night duties. Similarly, the number of ‘off’ sessions should be pro-rata. Your out-of-hours work should reflect the type of working pattern in your department (i.e. on-call rota) and must be discussed with the Human Resources department.

As a LTFT trainee, you should rotate between units in your training programme and spend a similar proportion of time in teaching and district general hospitals as full-time trainees. However, some rotations may pose geographical problems for trainees with domestic commitments. Although most Deaneries will try and take geographical issues into account when arranging placements some compromises may be required for you to receive a full breadth of training.

You should regard rotation positively, as it will broaden your experience and increase your employment opportunities, as you’ll become known in several departments.

All trainees, full-time or LTFT, need to meet the requirements for progression in training as set out in the relevant GMC-approved curriculum and will be assessed in accordance with the ARCP process.

Assessment of training time is calculated pro-rata. Assuming that assessments of progress are satisfactory, the calculations are as follows:

Like full-time trainees, LTFT trainees may need to move Deanery/LETB during training and can apply for an inter-deanery/LETB transfer (IDT). There is a national system for IDT applications. It can take some time to arrange an IDT, and this will depend on a LTFT slot becoming available in the new Deanery. You should discuss any requests as early as possible with your TPD/Postgraduate Dean. It is advisable to declare your LTFT working request to your new deanery so an appropriate placement can be arranged.

As a minimum, you should meet with your Educational Supervisor approximately every month but on a pro rata basis. Working LTFT provides fewer opportunities for informal meetings and conversations with your ES, and an argument can be made for saying that meetings should be monthly. 

You will have an ARCP each year as the assessment is annual and must be performed every 12 months even if you are not working full time. It’s important to note that the requirements in the RCOG training matrix refer to a full training year and so progression over 12 months in a LTFT position will be assessed pro-rata. You will need to complete the TEF annually and you should have at least one completed TO2 every year.

If the extension relates to clinical experience or training requirements (e.g., ultrasound skills) it will be pro-rata. If the extension is because of a requirement to pass an exam it will also be pro rata.

It is possible to revert or move to full-time training, but you may have to wait until the next full-time training slot becomes available. You should discuss this with your deanery and Training Programme Director as far in advance as possible.

The time allowed is not pro-rata as stated in the Gold Guide which addresses this. As for all trainees, LTFT trainees may apply for a period of acting up as a consultant, up to a maximum of three months. This is on a fixed-term basis and not pro rata. Trainees may be able to take time out of programme to act up as a consultant and may be able to credit this time towards a CCT or CESR (CP). If this kind of post is formally included in the approved specialty curriculum, additional prospective approval is not required from the GMC. Trainees acting up as consultants will need to have appropriate supervision in place, and approval will only be considered if the acting up placement is relevant to gaining the competences, knowledge, skills and behaviours required by the curriculum. In these circumstances, OOPT will normally be for a fixed-term period of three months for both full-time and LTFT trainees.

The arrangements for extension of training after award of a CCT (the ‘period of grace’) are the same for LTFT and full-time trainees with no pro-rata extension for LTFT. The standard Period of Grace is 6 months after the CCT date.