It is possible, in certain circumstances, for trainees to undertake the Foundation Programme on a Less Than Full Time (LTFT) basis. Trainees must show that, for them, Full Time training would not be practical, with well founded reasons. There is a formal application process. 

Severn has a long history of facilitating Flexible/LTFT Training. We work with trainees to take into account their individual needs and preferences, although - for logistical reasons - we cannot guarantee their original programme allocation (if they have one).

From the UKFPO Website (FAQS):

http://www.foundationprogramme.nhs.uk/pages/foundation-doctors/faqs#answer402

Is it possible to undertake foundation training less than full-time?

Less than full-time working is available for the Foundation Programme*. The main reasons include:

  • a disability, which means the doctor needs individual arrangements
  • ill health
  • responsibility for caring for children
  • responsibility for caring for ill/disabled partner, relative or other dependant.

* Please note that Tier 4 sponsored doctors are NOT permitted to work less than full-time; this is a condition of the UK Border Agency visa.

From the Foundation Programme Reference Guide

Less than full-time training

6.64 HEE, NES, NIMDTA and Wales Deanery have a strong commitment to helping all doctors in training to reach their full potential and to supporting those with child-caring or other caring responsibilities, health concerns, or individual developmental opportunities, to continue training on a Less Than Full Time (LTFT) basis. All doctors in training can apply for LTFT training, and every application will be treated positively. Those wishing to apply for LTFT training must show that training on a full-time basis would not be practical for them for wellfounded individual reasons.                   

6.65 Those in LTFT training must meet the same requirements as those in full-time training, from which it will differ only in the possibility of limiting participation in medical activities by the number of hours worked per week.

6.66 The aims of LTFT training are to:

  • retain within the workforce doctors who are unable to continue their training on a fulltime basis
  • promote career development and work/life balance for doctors training within the NHS
  • ensure continued training in programmes on a time equivalence (pro-rata) basis maintain a balance between LTFT training arrangements, the educational requirements of both full and LTFT doctors and service need.

6.67 HEE/NES/NIMDTA/Wales Deanery/foundation school has responsibility for ensuring that all LTFT training of any kind is undertaken in GMC prospectively approved posts and programmes which meet the statutory requirements. HEE/NES/NIMDTA/Wales Deanery/foundation school will usually approve LTFT training, unless the introduction of LTFT training affects adversely the training available to other foundation doctors in the programme. The GMC has agreed that if a post is approved for training, then it is also approved for training on a LTFT basis. 

6.68 As far as possible, HEE/NES/NIMDTA/Wales Deanery/foundation schools will seek to integrate LTFT into mainstream full-time training by:

  • using slot/job shares where it is possible to do so
  • using full-time posts for less than full-time training where it is possible to do so and
  • ensuring equity of access to study leave.

6.69 Where such arrangements cannot be made, HEE/NES/NIMDTA/Wales Deanery/foundation school may consider the establishment of personal, individualised posts which are additional to those funded through routine contract arrangements, subject to training capacity, GMC approval and resources.

6.70 Foundation doctors training LTFT will:

  • reflect the same balance of work as their full-time colleagues: day-time working, on-call and out-of-hours duties will normally be undertaken on a basis pro rata to that worked by full-time foundation doctors in the same grade and specialty, unless either operational circumstances at the employing organisation or the circumstances which justify LTFT training make this inappropriate or impossible, provided that legal and educational requirements are met
  • normally move between placements within rotations on the same basis as a full-time foundation doctor and
  • not normally be permitted to engage in any other paid employment whilst in LTFT training.

6.71 Decisions by HEE/NES/NIMDTA/Wales Deanery/foundation school only relate to educational support for the application. Employers/LEPs must make a separate decision about the employment aspects of any request, including the proposed placement and any associated out of hours work. Contractual provisions are addressed in the NHS employers guidance: Equitable pay for flexible medical training (2005). 

6.72 The GMC has issued a position statement on the minimum time base for LTFT training and an additional statement for LTFT for academic trainees

6.73 Employment legislation setting out the statutory right to request flexible working sets the minimum standards with which an employer must comply. The legislation does not set a priority order around reasons for requesting flexible working. Building on the 2005 agreed principles document, this Reference Guide should be considered as providing additional rights to this legislation, in the context of requesting to undertake LTFT in the foundation programme. This reflects the tripartite nature of current practice of supporting LTFT training between the foundation doctor, HEE/NES/NIMDTA/Wales Deanery/foundation school and the employer/LEP. 

6.74 Further guidance may be found on HEE, NES, NIMDTA, Wales deanery, NHS Employers and foundation school websites. 

6.75 As for all foundation doctors, LTFT doctors will need to meet the requirements for progression in training as set out in the curriculum and will be assessed in accordance with the ARCP process set out in section 7 of this reference guide. For clarity, key points with regard to progression in training for LTFT foundation doctors have been set out below. 

6.76 The ARCP is normally undertaken on at least an annual basis for all foundation doctors, both full time and LTFT. Although foundation doctors undertaking less than full-time foundation training may meet the necessary foundation professional capabilities before they complete two full years of training, they still need to complete:

  • an overall total of one year (full-time equivalent) of F1 training; and
  • an overall total of one year (full-time equivalent) of F2 training.

6.77 If the relevant time in training has not been achieved, then the foundation doctor should not be given an ARCP outcome and be issued with an ‘N’ code (N3 - doctor not in post long enough).

6.78 LTFT foundation doctors will be expected to undertake the requirements for assessment as set in the curriculum on a pro-rata basis and to spread the balance of workplace based assessments evenly. 

6.79 If an extension to training is required, following the award of an ARCP outcome 3, this will be on a pro-rata basis if training requirements for progression have not been met. 

Eligibility for Less Than Full time Training

6.80 Foundation doctors appointed to stand-alone F2 programmes may apply for LTFT training, and must complete the process in the usual way. However identification of a placement may not be immediately available. Due to the fixed term nature of such appointments, if the standalone F2 programme is undertaken LTFT it will be recognised on a whole time equivalent basis as a proportion of the duration of the post. There is no entitlement to an extension of the fixed term period of training on a pro rata basis. 

6.81 All foundation doctors wishing to apply for LTFT training must show that training on a fulltime basis would not be practical for them for well-founded individual reasons. This requirement for entry to LTFT medical training is set out in European legislation (93/16/EC). 

6.82 Formally, the only requirement to be permitted to train LTFT is a well-founded individual reason. In practice, the Conference of Postgraduate Medical Deans (COPMeD) has agreed the following categories which serve as guidelines for prioritising requests for LTFT training. However, these categories are not exhaustive. It should be noted that requests to undertake LTFT cannot be guaranteed. The needs of foundation doctors in Category 1 will take priority.

Category 1:

Those foundation doctors with:

  • disability or ill health (this may include on-going medical procedures such as fertility treatment)
  • responsibility for caring (men and women) for children or
  • responsibility for caring for ill/disabled partner, relative or other dependent.

Category 2

  • Unique opportunities – foundation doctor is offered a unique opportunity for their own personal/professional development, and this will affect their ability to train full time. For example, training for national/international sporting events, or short-term extraordinary responsibility, for example a national committee.
  • Religious commitment – foundation doctor has a religious commitment which 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 - foundation doctor is offered non-medical professional development such as management courses, law courses, fine arts courses, which requires a specific time commitment resulting in the need to work less than full time.

6.83 Medical research will not be considered as a reason to request to train LTFT. Such opportunities should be managed through academic programmes. 

Applying for less than full-time training

6.84 The normal process for acceptance to LTFT training will include the following stages:

  • All foundation doctors (including those in an academic foundation programme) can apply for LTFT training either at the point of application for entry onto the foundation programme or at any time once they have been accepted into foundation training. As for all other applicants wishing to enter into foundation training, competitive appointment is required but must not be affected or influenced by the applicant’s wish to be considered for LTFT training.
  • The foundation doctor will need to first submit their reason for requesting LTFT to HEE/NES/NIMDTA/Wales Deanery/foundation school which will be assessed and prioritised based on the categories above in order to be considered for a LTFT placement.
  • Once a LTFT training programme has been identified, the foundation doctor will then need to agree a LTFT training plan with HEE/NES/NIMDTA/Wales Deanery/foundation school. The postgraduate dean or foundation school director will approve the training plan in conjunction with the foundation training programme director/tutor. Approval will normally be given for the duration of the programme and be subject to annual review.  The LTFT programme and funding will also be subject to agreement with the employer/host training organisation before the placement can be approved.

6.85 HEE/NES/NIMDTA/Wales Deanery/foundation schools should make it clear how foundation doctors, including those undertaking an academic foundation programme, may access less than full-time training. The conditions for access to less than full-time training, funding and study-leave arrangements should be clear and fair. 

6.86 The administration of an application may take up to three months, and applicants must not expect to be placed immediately; the giving of as much notice as possible will facilitate the process for all concerned. The inability of HEE, NES, NIMDTA and Wales Deanery to find a post at short notice should not be taken as a refusal of LTFT training; an individual’s needs and expectations must be considered in the context of educational standards and service capacity, and because of this LTFT cannot always be guaranteed. 

6.87 Further details of the application and appeals processes can be found on HEE/NES/NIMDTA/Wales Deanery/foundation school websites. 

6.88 LTFT foundation doctors who wish to revert to full time training must, in the first instance, contact their training programme director/tutor and relevant LTFT lead in HEE/NES/NIMDTA/Wales Deanery/foundation school. Identification of a suitable full time placement may not be immediately available, and will depend on the current LTFT arrangements for the foundation doctor and the training programme. The relevant LTFT lead in HEE/NES/NIMDTA/Wales Deanery/foundation school must be informed of the planned start date for a return to full time training.

 

Principles

  • Foundation trainees who start LTFT Training in August will normally be expected to complete two years per Foundation Year at 0.5 FTE (50%) to keep them in synch with other trainees, and to enable efficient planning/use of posts
  • LTFT Training applications require deanery approval and funding. In general, approval will only be granted if a suitable slot share can be identified. Supernumerary posts will only be funded in exceptional circumstances
  • The Foundation School will not approve supernumerary placements in General Practice due to the extra costs involved
  • Once allocated to programme, working arrangements (hours, work patterns, rotas, etc) are negotiated directly with the Trust employer
  • Trainees may be moved to a different location for their second period of F1 or for F2
  • Study Leave entitlement is pro-rata

Process

Current Severn FS trainees

  • Discuss your plans with your Educational Supervisor and/or Trust Foundation Programme Director in the first instance
  • Contact the Foundation School
  • Contact the LTFT Training Administrator
  • Complete the LTFT Training application form and return to the Deanery

Potential Severn FS trainees

  • Apply for FP through national process in the normal way; once allocated to Severn
  • Contact the Foundation School
  • Contact the LTFT Training Administrator
  • Complete the LTFT Training application form and return to the Deanery

 

Severn Deanery LTFT Training webpage, where you will find further information and the application form. 

 

Trainee Feedback

Rebecca Gray, a Severn Trainee who completed F1 LTFT, has written an article for BMJ Careers:

Training less than full time during foundation years

 

Sethina Watson and Helen Burt, two Severn LTFT Foundation Trainees, conducted a national survey of LTFT trainees in 2012. A summary of the results can be downloaded here:

LTFT Survey 2012

Their poster, which was presented at the UKFPO/MEE/Northern Deanery Careers Conference on 11 September 2012, can be downloaded here:

LTFT Poster

A link to the published article in 'Medical Woman Magazine' Volume 33, Issue 2, Autumn/Winter 2014 (pages 26/27):

On Being Less Than

 

Why did you choose to train LTFT?

As a mum of four I chose to train LTFT to spend more time with my young children. I was able to have two babies during my LTFT training. It enabled me to continue with a career I was passionate about but also spend time with my family. I found that my job fitted in around my family rather than my family fitting in around my job.

Pros

Happier with work-life balance.
Experience in 7 different specialty rotations rather than 3 had I been full time.
Ability to do audits, service improvement, teaching, presentations and courses over longer period of time. Can build good CV of experience.
Adaptability & Efficiency – need to quickly orient to ward, become team member and use time at work efficiently to maximise patient care. Must develop good organizational, communication and prioritizing skills.
A good job share partnership can be an asset to any team. 

Cons

Having to convince colleagues that even though I’m part time I’m still very much committed Overcoming negative attitudes from others
Slow process completing training
Lower pay
Doing lots of extra work commitments in your ‘time off’
If FY1 – the initial learning curve can be very steep and for much longer than your counterparts, this can lead to confidence issues 

Top tips/advice

If in a job share, you need to really work hard with your partner to deliver a smooth service. To them you are ‘one person’. You must share workload equally, handover extremely well, proactively anticipate problems and document notes well. Done well, a job share can be a real asset to the team. Done poorly, a job share can create problems for all concerned. My advice is to meet your job share frequently, define working days, suitable times for handover (10pm at night may not suit your partner) and divide up on-calls & weekends equally. Communication is the key – there is nothing worse than coming in and not knowing about a patient that has urgent needs or jobs outstanding. Both need to share the same work ethic and attitudes, which can be difficult if you do not know each other. But can be worked out with time and effort. 

Your experience of training LTFT

I have worked with two different job share partners and in supernumerary positions. Each experience has its pros and cons. I’ve enjoyed the variety of jobs experienced and been able to do many extra projects during my training to build a good portfolio. It has been hard seeing others move on ahead of me but know that the time spent with family has been more than worth it. 

Anything else you think would be helpful for trainees considering/about to start LTFT training

Set up a shared calendar – Google Calendar is good, you can have it downloaded to your phone. (Not for patient details but days off, teaching and any other important things). Work out your method of handover – paper, phone, text etc. Decide between you the best time to do that handover. Getting a 16 patient handover just after you’ve laid down for sleep isn’t great.

Sethina Watson, F2 Trainee

 

Why did you choose to train LTFT?

I have a 2 and a half year old son and training LTFT allows me to spend time with him in these formative years 

Pros

Pros include being able to spend time with family and other things outside work and being able to manage a better work-life balance. 

Cons

Cons include 'everything takes a little longer' but if you are not in a hurry that might not be an issue. Also I find that it is generally harder to keep up with the pace of things alongside others who work full time as your experience is will inevitably be different 

Top tips/advice

Find out what days in your job would give you most clinical experience and try and work those days. 

Your experience of training LTFT

My supervisors have generally been very supportive. Sometimes, however, it might be harder working alongside full time colleagues who do not understand the choice you have made and have certain expectations of you.

Su Ann Woo, F2 Trainee

 

Supervisor Feedback

I am Educational Supervisor to two trainees who are currently doing an F1 job share here. I just wanted to tell you what a great job they are doing. They have worked out the logistics of job share amazingly well. They get on really well together and communicate fully with each other – eg always phone each other on Sunday nights for an update. They get on so well that they are even looking to choose a specialty which they both like to train together.

I feel they are a real success story and would be a great example for others who want to go down this route, or for GP/consultant colleagues who want to organise job share programmes.

 

Key Contacts

Foundation School
SEVFoundation.SW@hee.nhs.uk

Trainee Support
Trainee Support webpage