Less than Full Time Working Policy

CONTENTS

POLICY

1. INTRODUCTION
1.1 Less than full time training (LTFT) is the means by which doctors in training undertake their training when they are unable to work and train full time for “well-founded” reasons or to increase flexibility within Postgraduate Medical Education by allowing LTFT training for personal choice.
2. PURPOSE
2.1 The purpose of this policy is to clarify how the LTFT training scheme works, who is eligible to apply and the arrangements necessary to secure approval.
3. SCOPE
3.1

This policy applies to all doctors in training taking up appointments in Specialty Training or Foundation posts that are both educationally approved by Health Education England working across the South West and the General Medical Council (GMC) and applies to the following grades: -

  • Foundation Year 1 doctors in training
  • Foundation Year 2 doctors in training
  • Doctors in Core Training (CT1 – CT4)
  • Specialty Registrars (StR)
  • Academic Clinical Fellows (ACF)
  • Clinical Lecturers (CL)
 3.2 This policy is written to complement ‘A Reference Guide for Postgraduate Specialty Training in the UK’.   It is recommended that doctors in training review the Gold Guide in addition to this policy.
 4. ELIGIBILITY
 4.1

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:

  • Doctors in training with a disability or ill health – This may include ongoing medical procedures such as fertility treatment.
  • Doctors in training with caring responsibilities (e.g. for children, or for an ill/disabled partner, relative or other dependant)
  • 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
4.2

Those applying due to a disability / ill health or caring responsibilities (i and ii above) will be accommodated.

4.3

Requests to train LTFT for other well-founded reasons will be dependant on the capacity of the programme and the effect the request may have on the training of other doctors on the training programme.  It will therefore be subject to the agreement of the employer / host training organisation before the placement can commence.

4.4

Requests to work LTFT can either be made at point of application for entry into training or at any time they have been accepted into training.

4.5

Where a doctor in training no longer wishes or is no longer eligible to work on a LTFT basis, they will return to full time training when an appropriate placement becomes available.  Until that time the doctor in training will continue to work on a less than full time basis.

4.6

Any doctor in training wishing to work LTFT must have obtained a post in open competition.  All competitively appointed posts are offered on a full-time basis.

5. SUPPORTING DOCUMENTATION
 
Circumstance Supporting Documentation Expiry Date of Eligibility
Disability / ill health

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.

Until end of programme
Responsibility for care for children 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). Until youngest child is 18 years’ old
Responsibility for caring for ill/disabled partner, relative or other dependent.

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.

 Until end of programme
All other circumstances

Complete the free text boxes on the application form detailing the nature of your request.

Until end of programme or a request to increase hours is approved
6. FUNDING ARRANGEMENTS
6.1 The national medical postgraduate tariff is not applicable to LTFT doctors in training.
6.2

HEE will provide funding from the LTFT budget for:

  • Salary support for slot-share top ups (where two LTFT doctors in training slot-share a full-time post)
  • Salary support for LTFT supernumerary posts*

*Note – supernumerary placements will be exceptional and subject to the agreement of the Postgraduate Dean.

6.3 Statutory leave costs and out of hours enhancements are an employer funding responsibility.
7. TRAINING PLACEMENTS
  Less than full time training may be undertaken in one of three ways listed below.
7.1 Slot-Sharing
7.1.1 Slot-sharing works on the basis that two doctors in training occupy one full time post and manage the out of hours work between them.
7.1.2 Whilst each doctor in training may work up to 80% WTE consideration must be given to the educational capacity within the department and the financial impact. The TPD or HoS should discuss with the Deputy Postgraduate Dean proposals to slot-share doctors in training at greater than 60% WTE.
7.1.3 Flexibility will be required where specific working days are required by either or both parties. Typically, slot-sharers will work separate days of the week with overlap on one day or more.
7.1.4 Opportunities for slot-sharing should be explored before any alternative arrangements are considered.
7.2 Part Time in a Full Time Slot
7.2.1 A doctor in training occupies an established full-time post but works reduced hours.
7.2.2 As an established post no additional funding will be provided, however the employer may utilise any surplus funds to backfill any service gap.
7.3 Supernumerary
7.3.1 Supernumerary posts are those that are in addition to the usual complement of training posts in an employing Trust.
7.3.2 This option may only be considered provided there is no detrimental effect on other doctors within the training programme.
7.3.3 Supernumerary placements will only be considered in exceptional cases and with the agreement of the Postgraduate Dean.
8. ROTATIONS
8.1 Doctors in training will normally be expected to move between posts within rotations on the same basis as a full-time doctor in training in the same specialty, to ensure they receive a coherent programme of training that is educationally comparable with full time doctors in training.
8.2 Doctors in training on a programme that rotate through different specialties, such as the Foundation Training Programme, Internal Medicine Training, General Practice and Core Surgical Training may find their rotations change to enable opportunities to slot-share.
8.3 Doctors in training working LTFT may also find that their completion date for training may not correspond with August.
9. WORKING HOURS
9.1

Less than full time training is counted exactly the same as full time work in all respects. The table below will assist in calculating the less than full time training required to meet the full-time equivalent quota for training where one applies.

WTE 6 months 12 months 18 months 24 months 30 months 36 months
F5 (50% WTE) 12 months 24 months 36 months 48 months 60 months 72 months
F6 (60% WTE) 10 months 20 months 30 months 40 months 50 months 60 months
F7 (70% WTE) 9 months 17 months 26 months 34 months 43 months 51 months
F8 (80% WTE) 8 months 15 months 23 months 30 months 38 months

45 months

For example, a doctor in training on a three-year full-time training programme working 60% whole time equivalent may take 60 months (five years) to complete, subject to satisfactory progression.

The table above should be used as a guide only.  The duration of training for less than full time doctors will be determined in consultation with the Training Programme Director / Head of Foundation School.

9.2 In line with the GMC position statement (2017) on less than full time training, doctors in training will be required to undertake no less than 50% full time training. 
9.2.1 Only where a doctor in training experiences exceptional difficulties may the Postgraduate Dean reduce the time requirement further.  The absolute minimum is 20% of full-time training with the expectation that doctors in training should not take a placement at this level for more than 12 months.
10. OUT OF HOURS WORK
10.1 Day time working, on-call and out of hours duties will be undertaken on a pro-rata basis to that worked by full time doctors in training in the same grade and specialty.
10.2 The only exceptions to this are circumstances for LTFT training which make this impossible, provided that legal and educational requirements are met.
11. UNDERTAKING ‘OTHER WORK’ WHILST TRAINING LESS THAN FULL TIME
11.1 Doctors in training on LTFT placements are not precluded from undertaking other work although they should ensure that in undertaking this work they practice according to the GMC’s good medical practice and that this does not impact negatively on their training.
11.2 Where undertaking additional work within the remit of holding a licence to practice the doctor in training must utilise the annual submission of the Form R to ensure the Postgraduate Dean as their designated Responsible Officer is aware.
12. PAY
12.1 The basic pay for doctors training less than full time is calculated in line with the Doctors and dentists in training terms and conditions (England) 2016 or 2002.
12.2 Basic pay and pay enhancement queries should be directed to the employing Trust, usually via the Medical Staffing department. 
13. STUDY LEAVE
13.1 Less than full time doctors in training are expected to make appropriate personal arrangements to access fixed training days when they are not rostered to work.  This will require flexibility on part of the doctor to ensure they have access to all of the educational components of the training programme equivalent to their full-time counterparts.
13.2 Less than full time doctors in training should refer to the Study Leave guidelines for information on the allocation and application process.
14. FREQUENCY OF ARCP 
14.1 Less than full time doctors will have an ARCP at points where decisions relating to progression in training are required and should be assessed not less than annually.  There should be no more than a 15-month interval to facilitate Revalidation.  Consequently, LTFT doctors in training will have more ARCPs than a full-time doctor in training.
15.  PERIOD OF GRACE
15.1  The purpose of the period of grace is to provide Doctors in Training (excluding those in General Practice) time to secure a Consultant or other post following attainment of their CCT. Please refer to the POG policy for more information.
15.2 The maximum duration of the period of grace is six months whether the doctor in training is full time or LTFT.
16. ACTING UP
16.1 Doctors in training may apply to act up as a consultant and credit that time towards a CCT.  This will normally be for a period of three months or pro-rata for LTFT doctors in training.  Please refer to the Acting Up as a Consultant Policy.
17. INTER DEANERY TRANSFER

17.1

Doctors in training accepted into the South West via an inter-deanery transfer who are already working LTFT will not have to re-establish eligibility.

18.

APPLICATION PROCESS AND NOTICE PERIOD

18.1

For applications made for reasons other than disability, ill health or caring responsibilities, doctors in training must discuss any plans for LTFT training with their department lead and employing trust medical staffing department prior to submitting an application. Applications without support from a suitable signatory within the trust will not be approved. A list of trust signatories can be found on the LTFT Policy page of the deanery website. Applications must also have the support of the doctor's Training Programme Director.

18.2

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.
18.3 Requests to train LTFT received at short notice on health grounds will be agreed on a case-by-case basis.
18.4 Where a doctor in training wishes to increase or decrease their whole time equivalent (WTE), they must make an application providing at least 16 weeks’ notice.
19. APPEALS PROCESS
  An appeal is an opportunity to question a decision or complain about treatment which a doctor in training considers to be unfair. An appeal will allow all parties to have the case heard before an independent panel, and a decision to be reached on the facts that have been presented.
19.1 Eligibility for Appeal
19.1.1 Doctors in training refused access to the LTFT training scheme are eligible to appeal.
19.1.2

The appeals process should not be used for:

  • Issues with the employing Trust relating to salary calculation or pay enhancements.
  • Provision of out-of-hours in excess of those (if any) required for educational approval.
  • Employers’ refusal to employ a less than full time doctor in training on costs grounds.
19.2 Registering an Appeal
19.2.1 Appeals should be submitted using the ‘Notification of Appeal’ available from the website.
19.2.2 The Notification of Appeal form must be sent to traineeinformation.sw@hee.nhs.uk within 15 working days of the decision about which you are appealing being made.
19.3 Process Following an Appeal Being Registered
19.3.1 The doctor in training will be invited to attend an appeal hearing to be held within 15 working days of the submission of the appeal where possible.
19.3.2 The doctor in training will be required to provide a Statement of Case which will need to be provided at least 5 working days before the hearing.
19.3.3 The relevant Associate Dean / Head of School who refused access to less than full time training will also be required to provide a statement of case at least 5 working days before the hearing.
19.3.4 Both parties will be given copies of each other’s statement of case.
19.3.5

The statement of case will allow the Postgraduate Dean (or nominated deputy) to study all written material and should include the following:

  • The reason for appeal
  • A simple list of events in date order
  • Copies of all correspondence and written evidence
19.4 The Appeal Panel
19.4.1 The appeal will be heard by an independent appeals panel.
19.4.2

 The appeals panel will comprise as follows: -

  • Postgraduate Dean (or nominated deputy) who will chair the appeal.
  • One doctor in training nominated by the BMA.
  • Lay person
19.4.3  The panel members will not have been involved in the original decision that gave rise to the appeal.
19.5 How the Appeal is Carried Out
19.5.1 The appeal will be a meeting between the panel, the relevant Associate Dean / Head of School and the doctor in training.
19.5.2 The doctor in training, or representative, will be given the opportunity to put forward the reason for appeal.
19.5.3 The relevant Associate Dean / Head of School will be given the opportunity to explain why the decision was made.
19.5.4 Each side will have the opportunity to question the other on issues of fact.
19.6 Decision of Appeal
19.6.1 The decision of the panel, and the reasons for making that decision, will normally be  announced at the end of the appeal; this decision will be confirmed in writing within 5 working days.  If, for any reason, a decision cannot be made at that time, a further date may be arranged to hear any further evidence pertaining to the appeal.
19.6.2 The decision of the panel is final.

TRUST SIGNATORIES

Trust

Email address for trust approval of LTFT applications

Avon and Wiltshire Mental Health Partnership

awp.dme@nhs.net

Cornwall Partnership

lowenna.stockman@nhs.net

Devon Partnership

dpt.medicaleducation@nhs.net

Gloucestershire Health and Care

tbc

Gloucestershire Hospitals

Requests must be discussed with the clinical or specialty tutor to gain support before forwarding to the DME for approval via preetham.boddana@nhs.net.

Great Western Hospitals

sue.chalstrey@nhs.net

Livewell Southwest

livewell.medical-staffing@nhs.net

North Bristol Trust

Requests must be sent to both donna.paddon@nbt.nhs.uk and susan.nutland@nbt.nhs.uk

Northern Devon Healthcare NHS Trust

ndht.MedEd@nhs.net

Public Health Trainees

tbc

Royal Cornwall Hospital

rch-tr.JuniorDoctors@nhs.net

Royal Devon and Exeter

rde-tr.MedicalEducationDepartment@nhs.net

Royal United Hospitals Bath

ruh-tr.MedicalHR@nhs.net

Somerset NHS FT

Medical.Administration@somersetft.nhs.uk

Torbay and South Devon

sdhct.Medicalhr@nhs.net

University Hospitals Bristol and Weston

Jane-Claire.Sconce@uhbw.nhs.uk

University Hospitals Plymouth

plh-tr.medicalhr@nhs.net

Yeovil District Hospital

Lee-Ann.Toogood@SomersetFT.nhs.uk