Less Than Full Time (LTFT) Training FAQs for Geriatric Medicine Trainees

Any trainee in a substantive HEE approved post can apply for less than full time training on the basis of the following criteria:

Category 1

• Disability or ill health (this may include those undertaking in vitro fertility programs)
• Responsibility for caring children
• Responsibility for caring for ill or disabled partner, relative or dependent.

Category 2

• Unique opportunities for personal professional development, for example, training for national or international sporting events, or short-term extraordinary responsibility such as national committees
• Religious commitment
• Non-medical professional development, such as management courses, law courses, fine art courses or diploma in complementary therapies.

Category 3

• This is for personal choice. It was initially offered as a pilot in a few specialities but between August 2021 and August 2023 it will be rolled out fully to all postgraduate specialties. The full model implementation for Geriatric Trainees is within the August 2022 roll out.

NHS Employers report that all requests should be treated positively but overall training capacity and service provision also needs to be considered. Therefore Category 1 applicants will have priority although all applications are welcomes and will be supported where possible. If an application is refused the applicant does have the right of appeal. Category 3 applicants should be advised that the move to LTFT will be encouraged to take place at a rotation date.

LTFT is integrated into local rotas but either reduced sessions or “job-sharing” posts. Most deaneries are currently not offering supernumerary posts except in specific and exceptional circumstances due to the additional complexity both to the individual’s training and the local rota. The NHS Employers review of LTFT training ‘Principles underpinning the new arrangement for Flexible Training[i]’ suggests that a supernumerary posts should be available for ‘those who need flexible training at short notice, for example those in ill-health, and those with dependents who suddenly need increased care’. These are designed to be for a limited time only.

Job-sharing is regularly seen as advantageous due to the individual and the trust as there is usually overlap or a “shared session” to enable safe handover between trainees.

It is worth being aware that rarely job-sharing will occur between trainees in two specialities who may or may not share work on the GIM rota. This is purely a financial arrangement and should not disadvantage the trainee.

This is an individual decision, although your local TPD should provide you with support. They are able to help you understand what is likely to be both most beneficial to you as well as discussing what your options are for local training depending on the options taken (eg if another trainee is also looking for a job-share partner).

Although there is some flexibility at a local level, it is usual that job share partners are working an equivalent of a 50-60% split. It is also usual that on-call requirements are at a 50:50 split and this has salary implications it is important for trainees to recognise.

Therefore overall it is typical that trainees working 70,80 or 90% of full time are working reduced hours on a full time post, whereas those at 50 or 60% are job sharing.

An excellent resource is already available via HEE here 

LTFT training applications must be submitted a minimum of 12-16 weeks in advance of the planned start date, depending on deanery. This can sometimes be expedited in extenuating and emergency situations. This is to provide time for HEE and your local deanery to both determine eligibility and make arrangements for your training plan that is neither disadvantageous to you or your colleagues.

To apply for LTFT training you will need to fill out an application form and send to the relevant person in your deanery, along with any required supporting documentation.

Good rostering guidance indicates that LTFT work schedules should be agreed collaboratively between the trainee, the TPD and the employer with requests for set working days to be facilitated where possible, taking into account service provision needs. While requested days ‘off’ cannot be guaranteed, discussion should take place taking into account the individual’s needs, training and service requirements. Once a work schedule has been implemented the agreed rota should remain the same unless there is an agreed change from all parties with adequate notice given.

LTFT trainees can do additional paid work, including locums.  This will not count towards their training time and must comply with the terms of their contract. Additional work will form part of their practice, so it must be declared on your Form R. The trainee should not feel pressurised to do additional work and has a professional duty to maintain patient safety and a healthy work/life balance.

LTFT training is normally supported in placements at 50%, 60%, 70% or 80% of full-time contracts. Other patterns of work may be supported depending on the individual’s situation. Day time working, on call and out of hours work should all be undertaken on a basis pro-rata to full time trainees in the same grade and specialty. Trainees will either slot share or occupy a full time slot dependant on the capacity of the programme.

Changing your percentage training is possible on discussion with your Deanery and may require resubmission of LTFT application paperwork. This again requires a 12-16 week notice period except in emergency scenarios.

When trainees wish to return to full time training this will be facilitated by the local deanery. As this depends upon the availability of training capacity and funding, there may be a delay in transferring back to full-time training.

The basic ARCP requirements do not change whether a trainee is full or less than full time. The GMC requires that all trainees working in a training post have an ARCP each year. This is only not held if you are on Maternity Leave or Long-Term Sick Leave.

It is recommended that LTFT trainees should have an annual ARCP. ARCPs must be no more than 15 months apart to comply with re-validation requirements. LTFT trainees will be required to demonstrate that their competencies and capabilities are at a level appropriate for their level of training as described in the curriculum. Assessments are reviewed on a pro-rata basis but must be spread evenly throughout training programs.

Additional ARCPs may be required at less than a year if the trainee is at a critical progression point in training.

Your post will be longer than the full time equivalent, so your overall training programme will be extended.

You should speak with your deanery or LETB to discuss how long your training will be extended for.

The length of your training will depend on the successful completion of competency based annual reviews. Your expected CCT date will be reviewed as you progress through your programme.

The joint royal colleges of physicians training board provide a tool to work out your CCT date.

Yes. Full time trainees can apply for a period of up to 3 months to act up as a consultant prior to reaching their CCT date. For LTFT doctors this period will be pro-rate of the three months.

However it is important for trainees to be aware that the Period of Grace (POG) is 6 months irrespective whether the doctor in training is full time or less than full time. This period is designed to enable trainees time to secure a consultant or other post following attainment of CCT.

You can get support from your Clinical Supervisor, Educational Supervisor, TPD and your peers. In addition, each trust should have a LTFT or flexible working champions. Please also contact us as your LTFT BGS council reps and we will be happy to offer advice and support.

• Consider what your aims for LTFT training are both at a personal and a training level. It is important for LTFT trainees to work at an appropriate level when they are in work but should not be expected to come in on their non-working days for additional training or educational needs. This is particularly important with the rise in remote teaching, LTFT trainees should not be obligated to watch remote teaching on their non-working days.
• However, local and deanery teaching is often on similar days in the week or month. If you have flexibility in your work schedule this may be worth considering.
• You are more likely to need to be pro-active with regards to audit and QIP, journal clubs and local teaching as your ad hoc availability is less
• Clear documentation becomes even more important when working LTFT as you are less likely to be around to clarify your documentation if it is later misunderstood.
• Invest time in meeting and engaging with colleagues both within medicine and the MDT. Good rapport with colleagues is always important but becomes crucial when you are a less consistent member of the team
• Ensure you understand what you are and are not responsible for with regards your rota. It is not your responsibility to reduce your rota to be LTFT (although some individuals do prefer the flexibility this gives them) nor are you responsible for finding cover for your non-working shifts. Do not feel pressured into this additional work.
• LTFT trainees frequently report feeling “looked down on” or other workplace bullying or harassment. This is clearly unacceptable. Raise concerns early and remember that you are as important as any other trainee.

1. Gold Guide -https://www.copmed.org.uk/images/docs/gold_guide_8th_edition/Gold_Guide_8th_Edition_March_2020.pdf

2. BMA - https://www.bma.org.uk/advice-and-support/career-progression/training/flexible-training

3. GMC Position Statement. This sets conditions for doctors in LTFT training who are working towards a CCT. It should be read with other legal obligations, for example the Equality Act 2010 - https://www.gmc-uk.org/education/standards-guidance-and-curricula/position-statements/less-than-full-time-training

4. HEE -          https://www.hee.nhs.uk/our-work/doctors-training/delivering-greater-flexibility

https://lasepgmdesupport.hee.nhs.uk/support/solutions/7000006974

5. NHS Careers - https://www.healthcareers.nhs.uk/explore-roles/doctors/career-opportunities-doctors/less-full-time-training-doctors

6. NHS Employers - https://heiw.nhs.wales/files/less-than-full-time-training/nhs-principles-underpinning-the-new-arrangements-for-flexible-training/

7. BGS position statement - https://www.bgs.org.uk/resources/flexible-working-in-geriatric-medicine