Less Than Full-Time Training
Many surgeons make the decision to train less than full time (LTFT) as either a temporary or a longer term measure. This decision is based on personal circumstances and may be to facilitate a healthier work/life balance than full time training. Child care commitments, care of a dependent and health optimisation are some of the reasons for trainees choosing to train LTFT.
Application and assessment
Before you start the application process, gather as much information as you can. There are many useful websites (see references) out there and finding another surgical trainee who is LTFT can be invaluable in giving you advice specific to your local area and hospital trusts.
You cannot start preparing too early. For example, if you are pregnant and already know you want to train LTFT after you return from maternity leave then start the preparation now.
Contact your current assigned educational supervisor (AES), and explain why you wish to go LTFT. Then contact the LTFT administrator at your LETB/Deanery, and ask what paperwork you need to complete.
You will not be able to commence LTFT training until you have written confirmation of acceptance of your application. Also it may not be possible to start LTFT immediately due to rota changes etc which is another reason for applying as far in advance as possible.
Eligibility for LTFT training
Any trainee in a substantive training post can apply for LTFT training. Trainees of either sex can apply but they must have well founded reasons which they are able to articulate as to why they are unable to train full time.
Reasons for applying for LTFT training have been agreed nationally and are divided into two categories. The needs of trainees in category 1 will always take priority and LETB/Deanery will endeavour to support all category 1 applicants subject to available funds and training capacity.
Those in category 2 will be considered, but permission will depend on the capacity of the specific training programme and availability locally of resources.
Category 1; surgeons in training who themselves have:
- Ill health
- Responsibility for caring for children
- Primary carer for ill/disabled partner, relative or other dependent
Category 2; surgeons in training who themselves have:
- Unique opportunities for their own personal/professional development (example training for national/international sporting events)
- Short term extraordinary responsibility (for example a national committee)
- Religious commitment – involving training for a particular religious role which requires a specific amount of time commitment
- Non-medical professional development such as management courses, law courses, fine arts courses or diploma in complementary therapies.
Other well-founded reasons may be considered by your local LETB/Deanery but this would be dependent on the particular situation and the needs of the surgical specialty in which you are training.
Where an application is refused by the LETB/Deanery, the applicant has a right of appeal, but, the overall training capacity of a training programme and service commitment will have to be taken into consideration.
What are the rules on percentage of work I can undertake?
The GMC Postgraduate Board issued a position statement in Nov 2017 (see references) re-establishing the minimum time requirement for LTFT trainees. That is that the minimum percentage for surgeons in LTFT training should be not less than 50% of full-time training. This revises the GMC 2011 statement and sets out conditions to make sure that the duration, level and quality of LTFT training, is not less than that of continuous training.
For the small number of trainees who experience exceptional difficulties, it has been agreed that Postgraduate Deans should have flexibility to reduce the time requirement further. The absolute minimum would be 20% of full-time training, with an expectation that trainees should not undertake a placement of less than 50% for more than 12 months.
LTFT training pattern should be decided locally and be approved by the Postgraduate Dean. The pattern of the work schedule approved should assure that the standard of training is maintained regardless of the exact details of the training pattern.
The GMC position statement states that conditions for LTFT training should ensure surgeons maintain current competences and continue to develop capabilities to progress, maintain an appropriate presence in the training environment and cover the required aspects of the curriculum.
Trainees in academic training programmes are also eligible to apply for LTFT training and trainees should discuss this on an individual basis with the Postgraduate Dean. Under normal circumstances, an academic training placement done at less than full time should be a minimum of 50% of full-time training and the programme should ensure the surgeon in training is able to develop both clinical and academic competences, as required by their curriculum and assessment system.
Many LTFT trainees have found sharing a post with a similar LTFT can work extremely well. Many LETB/Deanery (e.g. Health Education Thames Valley – see references) will facilitate this by providing an uplift of up to 20% of basic salary to allow both trainees to work up to 60%.
In practical terms this can mean both trainees working together at some point in the week thus facilitating comprehensive and safe hand-over of clinical issues.
However sometimes, especially in LETB/Deaneries with a small numbers of surgical trainees, slot sharing is not feasible. Also slot sharing arrangements can be quite short lived if one of the trainees circumstances change meaning the percentage which they wish to work may change
Changing percentage working and moving Trusts
LTFT trainees usually need to complete an additional form if they wish to change the percentage which they are working and also each time they rotate to a new Trust. It is advisable to contact the rota organiser and your new clinical supervisor (and new AES if applicable) in advance of arriving to start in a new Trust to ensure they are aware you are going to be LTFT. This can be very helpful to both trainee and supervising Consultant especially if the LTFT trainee has capacity to alter their days at work to fit in with the new schedule in the new post.
All LTFT placements must have the approval of the Postgraduate Dean. They should meet the needs of the surgeon in training, both in terms of provision for attainment of competencies but also the trainee’s wider educational needs. The LTFT placement must be appropriate for the Department in which they are working, ensure safety and continuity of training and making best use of resources. Involving your Educational Supervisor early in the process is key to ensuring education value for your placements and prompt escalation if the educational potential of the placement is not fulfilled.
Annual Review of Competence Progression (ARCP)
Decisions to grant LTFT training should be subject to regular review to ensure appropriate progression during the period. LTFT trainees will be required to continue to engage with the annual appraisal cycle of ARCP to meet statutory revalidation requirements. Expectations around training and competency progression will be pro-rata according to the level of less than full time training. (GMC position statement – see references)
Length of training
Training programmes will be extended accordingly to ensure they are of equivalent overall duration to full-time training and to comply with any minimum duration requirements.
However, it may not be necessary to extend the training programme on a full pro-rata basis, depending on the progress in achieving learning outcomes by the surgeon in training.
The expected end date will be decided by the Postgraduate Dean and confirmed at the trainee’s ARCP and the relevant regulatory bodies will be involved in this decision to ensure all requirements are met.
LTFT and other issues which affect time in training
It is important to clarify that LTFT training arrangements are separate from arrangements for career breaks, out of programme training, maternity and paternity leave, parental leave or other statutory absences from training.