Flexible working is the way of the future. More and more people are choosing to prioritise a work/life balance and this is something to be encouraged. However, this new way of working does bring about challenges, particularly in systems such as health and social care where it is essential that workplaces have enough people with the right skills to provide high-quality care. This position statement aims to support both employers and employees to navigate flexible working and provides examples of how it might work in practice.
This statement was first published in 2021 and focused on flexible working for doctors in training working in geriatric medicine. This 2026 review is intended to update the previous statement and make it relevant to the entire multiprofessional team. We recognise that there are specific challenges facing doctors in training who wish to work flexibly (such as the rotational nature of training). However, we believe that the principles of flexible working should apply across all professions. Where there are specific differences, these have been noted.
Introduction
As an organisation, we wholeheartedly support national workforce plans that have highlighted flexible working as a priority. NHS England have prioritised flexible working in the NHS Long Term Workforce Plan*1 which is accompanied by the National Flexible Working People Policy Framework published in 2024.2 The NHS in Scotland has published a flexible working policy, supported by guidance for managers and frameworks to support both managers and employees.3 A flexible working policy has also been developed in Wales4 which is supported by guidance from Health Education and Improvement Wales.5
We know that more people across health and social care are choosing to work flexibly and the 2023 Focus on Physicians survey found that 27% of higher specialty trainees and 32% of consultants across all specialties work LTFT.6 However, according to our database of members, just over 200 BGS members (3.7%) have indicated that they work less than full-time (LTFT) at 60% or less of Full Time Equivalent. While this is an increase from around 100 in 2021 when we first published this statement, it is likely that these figures are underestimates as many members may be working LTFT above 60% and below 100%. Some may choose to change to LTFT working after they join BGS and fail to inform us. BGS members in Category B (encompassing doctors who are pre-CCT) are most likely to work LTFT (5.2%), followed by Category C members (healthcare professionals including nurses and AHPs) at 4% and then Category A members (senior doctors) at 3.3%. BGS does offer a discount for members who work LTFT at 60% or below which may incentivise people to tell us.
It is however important to recognise that LTFT working and flexible working are not synonymous. While LTFT working is included as one approach to flexible working, working arrangements can be flexible in other ways. This document aims to set out how LTFT and flexible working practices can be improved for the benefit of our members and the people they care for. As highlighted earlier, we acknowledge that there may be differences regarding flexible working across the multiprofessional team and where these exist, we have stated them. However, we support flexible working practices across the whole workforce delivering healthcare for older people and we aim for this document to be relevant to BGS members regardless of profession.
In this statement we first outline the benefits of flexible working for individuals and organisations before setting out the principles of this statement.The principles are then explored in further detail and are followed by a series of hints and tips for those wishing to work flexibly and those in roles supporting flexible working.
Benefits of flexible working
The right of an employee to request flexible working is enshrined in law. The Employment Rights Act 2025 states that any employee in England, Scotland or Wales is entitled to make a flexible working request from day one of their employment.7 Different rules apply in Northern Ireland where employees must have worked for the employer for 26 weeks before making a flexible working request.8 While employers do not have to agree to a request for flexible working, they must consider such requests, and if it is not possible, they must respond in writing justifying the reasons the request has been turned down, and giving clear, demonstrable operational reasons why flexible working is not possible. There is a right to appeal for employees who have a flexible working request turned down.7 Flexible working arrangements can enable those who might otherwise be disadvantaged in the workforce to access employment opportunities. These people might include (but are not limited to) staff with a disability or long-term health condition(s), staff returning to work following parental leave or adoption leave, staff with caring responsibilities and older workers wishing to remain in the workforce but reduce hours.7
Flexible working enables people to have a family life and care for children and other dependents while maintaining a fulfilling career. However, flexible working is not reserved for those with caring responsibilities and employees may wish to work flexibly for a range of reasons, including other career commitments (such as undertaking research), special projects or professional development programmes, or for personal reasons (such as pursuing sport or creative activities).9 Guidelines published by NHS Employers remind managers that employees are not required to give a reason for wanting to work flexibly.10 Detailed guidance on the provision of flexible working is provided in the NHS Terms and Conditions of Service handbook which applies to all staff directly employed by NHS organisations, including health and social care organisations in Northern Ireland, except very senior managers and staff within the remit of the Doctors’ and Dentists’ Review Body.11 Flexible working regulations stipulate that all employees have the legal right to request flexible working including a change to the number of hours they work, when they start or finish work, the days they work and where they work. Employers are advised that they must deal with such requests in a ‘reasonable manner’, including assessing the advantages and disadvantages of the application, discussing possible alternatives to the request and offering an appeal process.
Flexible working helps people to maintain a balance between their work and personal life which is beneficial to mental health. Employees then have more energy and resilience to bring to their clinical role. In 2025 nearly 32% of NHS staff experienced burn out as a result of their work.12 Offering flexible working is acknowledged to be one of the most effective options in supporting staff members who have experienced burnout to return to work.13 In addition, flexible working helps to support retention of talent, something that the NHS has struggled with in the past. Research from the University of Bath asked NHS staff why people doing their jobs leave the NHS, with 29% of respondents citing lack of flexible or part-time working as a ‘very important’ reason.14
Latest figures from the NHS Staff Survey show that while 72% of staff agree that they are able to approach their manager to speak openly about flexible working (an increase from 67% in 2021), only 57% of staff say that they are able to achieve a good balance between their work and home lives.12 Allied health professionals, healthcare scientists and scientific and technical staff were most likely to be satisfied with their options for flexible working at 58%. This was followed by registered nurses and midwives at 57%. 51% of medical and dental staff reported being satisfied with flexible working options and the lowest level of satisfaction was among operational ambulance staff at 35%.12
Flexible working helps to promote diversity in the workforce, particularly by enabling new parents to combine their work and childcare commitments. While flexible working is open to everyone and both mothers and fathers may wish to work flexibly to combine work and parenting, the reality is that women are more likely to take up the option of working flexibly. Offering flexible working can help women returning from maternity leave to return to work in a way that suits them and their child(ren). As well as helping to increase gender parity in the workforce, flexible working can also help older staff members to remain working for longer. People approaching the end of their career may wish to make flexible working requests to reduce their hours or change their working pattern as they move towards retirement.15
Principles
- Flexible working should be normalised within the NHS and the health and all care sectors. It should be available to all staff working within the NHS and social care, regardless of profession, without it being viewed as abnormal or exceptional.
- All staff should have access to support in requesting flexible working. For medical staff, this support may be provided by flexible working champions which all Deaneries, NHS Trusts and Health Boards should have. Non-medical staff may be able to find support through trade unions or the NHS Flexible Working Network.16 Those in senior roles across all professions should lead by example.
- Staff applying for or returning to work from a period of leave should be supported by their employers to make transitions as straightforward as possible.
- Opportunities for training, professional development, research or management roles should be adapted to ensure that those working flexibly are not disadvantaged.
- Organisations providing educational opportunities (such as conferences) should consider involving flexible workers in their planning.
- Discriminatory language and attitudes towards flexible working among staff of any profession should not be tolerated.
- Non-contracted days should not be referred to as ‘days off’ or ‘non-working days’. An alternative term used in some NHS organisations is ‘flexi-time’ which is acceptable as long as everyone involved understands what is meant by it.
- LTFT employees should not be made to feel they are ‘not pulling their weight’ compared to full-time working colleagues, and not be asked to fit a full-time workload into a LTFT schedule.
Normalising Flexible Working
Flexible working means different things to different people and can relate to when, where and how we work. It should be up to the individual whether to disclose the reason for working flexibly. Flexible working is not reserved for those with parental responsibilities; it should be available to all. Flexible working takes many forms, including working LTFT, compressed hours, working in different locations or delivering work in different ways.
Workforce planning should acknowledge LTFT training and flexible working. National medical training numbers should be increased to provide an adequate number of full-time equivalent posts, leaving flexibility for some of these roles to be taken up by those on flexible or less than full-time contracts. Planning for non-medical posts, such as those in nursing and allied health professions, should allow for individuals working flexibly to take on the roles. An individual working LTFT should not be expected to do the work of a full-time colleague. One way to manage this is to encourage job sharing, as this ensures a service is adequately resourced and counters the guilt an individual may feel about working LTFT. Individuals working LTFT may feel guilty about their working pattern, particularly if they are made to feel they are not pulling their weight or their working arrangement means they sometimes have to say no to colleagues or managers. Whatever approach is used, an individualised approach to job planning is required.
Box 1. Examples of flexible working introduced during the COVID-19 pandemicThe COVID-19 pandemic allowed for the introduction of flexible working to accommodate those staff that might be shielding and to reduce the number of non-clinical staff in clinical spaces. Some of these innovations have been retained while others have not and vary across the country.
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Flexible Working Champions
Information about flexible working options should be available in all deaneries, NHS Trusts and Health Boards. Flexible Working Champions were introduced as part of the 2018 Junior Doctor Contract Review17 and are employed by Trusts in England to help change the culture on flexible working within the NHS. This role is designed to improve rather than replace existing support for those working flexibly.
They:
- Should be present in every deanery, NHS Trust and Health Board
- Should have an overview of all LTFT resident doctors within their Trust
- Can advise and assist any resident doctor on any concerns they have over the LTFT process and experience, regardless of grade and specialty
- Can advise and support consultants working flexibly
- Are a good point of contact for supervisors who are not familiar with supporting a LTFT resident doctor.
We support the role of Flexible Working Champions and encourage our members to liaise with their local support network. However, this role is specifically intended to support medical staff who wish to work flexibly and is usually fulfilled by a consultant. There does not appear to be an equivalent role to support non-medical staff and we would encourage Trusts, deaneries and Health Boards to ensure that flexible working options are available to all staff from across the multiprofessional team. Support is available for both individuals and line managers across all professions from NHS Employers18 and the NHS Staff Council.19
Transitions to and from a period of leave
Individuals can take time out of work for many reasons. Some situations provide the opportunity to plan ahead of time, such as research, parental leave, career breaks, additional training or working abroad. Others occur unexpectedly, such as sickness, bereavement, carer’s leave or suspension. At any one time, approximately 10% of resident doctors in England are taking approved time out of their training.20 There are clear processes for resident doctors on how to apply for time out of training in each of the four nations, which are easily accessible online.21-24 NHS staff on Agenda for Change contracts are entitled to take unpaid career breaks of between three months and five years, and the terms of such breaks should be established through negotiation between employers and local staff representatives. Further information about career breaks can be found in Section 34 of the NHS Terms and Conditions of Service Handbook.11
Returning to work after a period away can be a difficult time. People feel a mixture of emotions about the transition back to work. There is support available for resident doctors, both during the period that they are not working and during the transition back to work.20,25,26 For consultants seeking support, we would encourage contacting a Flexible Working Champion. The Nursing and Midwifery Council provides advice for nurses returning to practice after time away, including details on updating their skills and rejoining the nursing register.27 Advice is also available for each of the four nations of the UK.28-31 For allied health professionals, the Health and Care Professions Council has advice about returning to practice32 and nation-specific advice and support is available in England,33 Scotland34 and Wales.35
Many people may wish to change their hours when they return to work after a period of absence. Those employed on the NHS Scheme have the right to return to the same job under their original contract. Those planning to reduce their hours may need to renegotiate their job plan and consider the impact this will have on service provision, including on-call availability. NHS employers have a duty to try to facilitate this for junior doctors in England, as supported by the NHS People Plan, and for all staff on Agenda for Change contracts, as set out in the NHS Terms and Conditions of Service Handbook.11 While line managers do not have to agree to flexible working requests, they must be considered fairly, with employees having the right to escalate their request and appeal a decision if a flexible working arrangement cannot be agreed to.
LTFT for resident doctors and consultants
Training programme directors (TPDs) and educational supervisors (ESs) should ensure that doctors undertaking LTFT training are adequately supported. They must be familiar with common issues that can arise for these resident doctors including rota management, access to educational opportunities and workplace attitudes. Guidance has been published by NHS Employers and the GMC to enable TPDs and ESs to support their LTFT workforce.36,37 Additional guidance is provided in The Gold Guide which builds on the principles of this legislation in relation to training programmes.38
LTFT resident doctors should be able to access the full range of training opportunities to meet all areas of the curriculum. We suggest that resident doctors and their supervisors develop a job plan that reflects the full-time equivalent to enable all training needs to be met. Flexibly working resident doctors and consultants should not be disadvantaged in applying for management, leadership, research or educational posts.
There should be strategies employed to ensure LTFT resident doctors can access the same training opportunities as their full-time counterparts, without impacting their non-contracted days. This, for example, may mean more flexibility from the Trust to allow LTFT resident doctors to use offsite training opportunities (Box 3). It would be beneficial to resident doctors to have a list of all regional training opportunities with location, time and contact details to aid organisation and completion of competencies.
Box 3. Example of offsite training provisionA LTFT resident doctor works 60% on Wednesdays, Thursdays and Fridays and needs to attend a movement disorder clinic but the local clinic is on a Tuesday. It would be preferable for them to arrange to attend a clinic in a different hospital on one of their clinical days rather than be expected to attend the local one on their non-contracted day. |
Many LTFT resident doctors and consultants work fixed days each week. This allows them to accommodate and plan other fixed arrangements around regular working days (such as childcare). Teaching, training days and departmental meetings are also often on set days. This puts people who do not usually work on those days at a disadvantage as they cannot attend. As attendance at these sessions is required for the annual review of competency progression (ARCP) and appraisal process, some people will give up their non-contracted day in order to attend.
In theory, resident doctors can claim this time back in lieu, but in reality, they rarely do. This may be due to other commitments, on call requirements, or the guilt of taking more time off. Giving up a non-contracted day also relies on flexibility in commitments outside of work which may be a challenge, especially if people rely on paid childcare.
We encourage training programmes and departments to plan the way they deliver meetings and teaching to accommodate the needs of flexibly working colleagues. The COVID-19 pandemic has made virtual learning commonplace and we encourage these practices in the long term. We encourage local rota coordinators to take the burden from the resident doctor and automatically re-allocate a non-contracted day if a resident doctor has used this time to attend mandatory training (Box 4).
Box 4. Example of good practice for study leave allocationA LTFT resident doctor works 60% on Mondays, Tuesdays and Thursdays. All regional geriatric medicine teaching falls on Fridays. 80% attendance at teaching is required at ARCP to pass each year. The Training Programme Directors recognise this and change the teaching day each month to allow more attendance. They also ensure teaching is recorded and made available for resident doctors to watch at a later date. The same resident doctor has to attend a mandatory Advanced Life Support course before next ARCP. The only one available locally is on a Wednesday. They arrange alternative arrangements for their caring responsibility outside of work and book the study leave. The rota coordinator acknowledges the study leave falls on a non-contracted day and automatically gives them the following Thursday off in lieu. |
LTFT for nurses and AHPs
Line managers should support all colleagues working in nursing and allied health professions to work less than full time when possible if this is desired. All employees have a legal right to request flexible working from day one of their employment with an organisation and there is no limit to the number of flexible working requests they are able to make. This is often referred to as a ‘statutory application’. However, rules in Northern Ireland are different so employees should ensure that they are following guidance relevant to their nation. Managers have a duty to consider all flexible working requests fairly and in line with the requirements of the service. All applications for flexible working should be dealt with by employers in a ‘reasonable manner’ as advised by the ACAS Code of Practice on Flexible Working (2024).39 There is a statutory requirement for the process to take no longer than two months from the formal request to a decision, including escalation and appeal, if necessary.10 If employers are deemed to not have dealt with the application in a reasonable manner, employees can take them to an employment tribunal. Guidance for individuals wishing to work flexibly and line managers is available from NHS Employers10 or through individual employers’ flexible working policies. Unions and professional bodies such as the Royal College of Nursing40 and the Chartered Society of Physiotherapy41 also provide guidance on working flexibly.
Box 5. Example of good practice training and staff meetingsA service rotates their in-service teaching and staff meetings to be on different days of the week or offer staff the option to change their non-contracted day for that week to an alternative day to enable their attendance. For those not able to move the whole non-contracted day, the option of moving half a day would be offered. Staff are also given the chance to join teaching and staff meetings remotely and the meetings are routinely recorded. |
Nurses and allied health professionals are required to undertake continuing professional development (CPD) as part of revalidation for nurses or to renew registration for AHPs. Nurses need to revalidate every three years and need to undertake 35 hours of CPD during those three years.42 AHPs need to renew their registration every two years and need to meet the Health and Care Professions Council’s CPD standards in order to renew.43 These requirements remain in place, regardless of whether a nurse or AHP works full time or less than full time.
Box 6. Example of accommodating commitments outside of workA Trust employs an AHP who is a semi-professional athlete. This individual’s non-contracted hours were adapted each month depending on their competition dates and times and training and recovery needs. This was done in a scheduled way to enable effective resource management. |
External training events
Those working flexibly may face issues with attending external courses and conferences. Many national conferences are held on the same days each time which can mean that people who do not normally work on these days are consistently unable to attend. The BGS is aware of these issues and in recent years has introduced online attendance for conferences and made session content available for six months after the event, so that delegates can view at a time of their own convenience. However, online events should not mask the difficulties that LTFT workers face. Online events should be considered a working day and staff who attend these events should be granted study leave and given time back in lieu if they occur on their non-contracted days. As the BGS strives to do, we encourage other event organisers to consider the needs of flexible workers.
Language and attitudes
The BGS LTFT survey conducted in 2019 showed that more than half of resident doctors (53%) had experienced negative attitudes towards LTFT working, some of which can be considered discrimination (Box 5).44 A culture shift to normalise LTFT working must include a change in the language used.
Box 7. Examples of discrimination towards LTFT workers‘When I announced my pregnancy, a male consultant said something to the effect of ‘female doctors only get pregnant so they can work less.’ ‘A consultant who emailed the other consultants in the department after SpR Ward allocations were sent out to say that she didn’t want me to be on her ward because I was LTFT and they needed a full-time SpR.’ |
Negative attitudes to LTFT and flexible working may often be under the radar, as opposed to outright discrimination, but they are widespread. Comments such as ‘enjoy your day off’, or ‘it seems like you are never here – what days do you work again?’ lead the individual to feel as if they are not pulling their weight and are not considered as part of the team. Comments around attendance at training events due to fixed day working, such as ‘can’t you just swap your caring day’ are unhelpful and perpetuate negative attitudes.
The language we use to describe non-working days is important. Language needs to be easy to understand but not encourage people to think negatively of people who work LTFT. People who work LTFT may use phrases like ‘off-days’ as they are easy to understand but they should not be considered as days off. Even the concept of a ‘non-working day’ does not do justice to the variety of activities that people undertake when they are not in their primary place of work. There is no one phrase that should be used to describe time when LTFT staff are not working in their medical role. We suggest that for official purposes the term ‘non-contracted days’ should be used, but that for all other purposes, staff should use a term that adequately describes their use of the time, e.g., parenting day, caring day, writing day, sporting day, etc. Terms such as ‘flexi-time’ are also widely used by some organisations – we consider this to be appropriate, as long as everyone involved understands what is meant by this term.
Hints and tips
Box 8: Tips for Trusts and Human Resources
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Box 9: Tips for LTFT individuals
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Box 10: Tips for TPDs, Educational Supervisors and line managers
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Box 11: Tips for full-time colleagues
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Conclusion
As LTFT and flexible working becomes normalised in the NHS, as supported by the NHS People Plan, it is important that this is embraced across the system. LTFT resident doctors and consultants need to be supported to undertake their training and work within their designated hours. We hope that this document will help LTFT staff to understand the support available to enable them to undertake their work with confidence. We also hope that TPDs, educational supervisors, commissioners and full-time colleagues will find this document useful in helping them to understand how they can help those working flexibly.
*At the time of publication, an updated workforce plan was due to be published imminently.