Less Than Full Time Training
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Support Service please telephone: 020 7245 0412 or
(LTFT) training is becoming an increasingly popular way of
achieving a positive work–life balance. The demand for such
training, from both men and women, has been steadily increasing
despite the reduction in trainees’ working hours brought about by
the introduction of the European Working Time Directive. In
response, NHS Employers, deaneries and medical Royal Colleges have
made a commitment to meet this demand, with the underpinning
principle that LTFT training will be integrated into mainstream
full-time training. This is achieved by all posts being available
for any combination of part-time or full-time training and by
guaranteeing equality of access to study leave, out-of-hours
working and other employment rights and protections.
Psychiatry has an
admirable record in relation to LTFT training, with psychiatrists
working part time in Oxford as far back as 1966, 2 years before the
formal introduction of flexible training into the National Health
Service. The number of LTFT trainees in psychiatry rose from 173 in
2008 to 315 in 2010. The latest GMC survey identified 11.7% of
Junior doctor workforce trained flexibly. 16% of Psychiatry
trainees are working flexibly, reflecting the commitment within
psychiatry to support LTFT training.
This type of training
is not a bar to a very successful career in psychiatry – Baroness
Sheila Hollins and Dame Fiona Caldicott are notable examples.
Who can apply for LTFT training?
Any doctor can apply
for LTFT training if they fulfil certain eligibility criteria,
which fall into two categories.
If a doctor experiences
ill health, has a disability or is responsible for caring for
dependent children (up to age 16 or 18 if the child has a
disability) or other relatives, they are likely to be offered LTFT
If a doctor wishes to
work LTFT for other reasons (e.g. personal reasons, professional
development, religious commitments), the merits of their individual
situation will be considered before LTFT training is offered.
Anyone wishing to train
less than full time first has to obtain a National Training Number
(NTN) in open competition with all other applicants. Once
successful, application for LTFT training can be made by
approaching the appropriate deanery. Approval for an application
can take up to 3 months so some forward planning is required.
Look before you leap
Before applying for
LTFT training, due consideration should be given to the impact this
will have on various aspects of training and lifestyle. The minimum
amount of time compatible with training is 50% of full time; this
doubles the time spent as a trainee so full-time peers will
progress more rapidly.
Every year or job
change approval for continuing LTFT training has to be
agreed and each training post has to gain educational approval.
Considerable negotiation between the trust, the training consultant
and the deanery may be involved. Flexibility and willingness to
compromise is needed on all sides. Each case will be taken on its
merits in deciding whether LTFT training continues to meet the
training needs of the individual and whether suitable posts are
available. Although deaneries have attempted to reduce bureaucracy
and streamline the process, it can nevertheless be time consuming
and planning ahead is essential.
Certain career choices
may be more difficult to accommodate than others (e.g. very few
academic trainees are working LTFT). Similarly, obtaining an
endorsement in a particular specialty may present problems to the
training scheme if the length of time taken by the LTFT trainee
limits opportunity for other trainees as such a person would be in
the post for up to double the length of time. Career choices and
training needs can be discussed with educational supervisors and
training programme directors.
Trainees are required
to rotate into different posts over the course of their training so
it may, at times, be necessary to change the days of the week
worked to facilitate training needs. Flexibility will be needed to
accommodate the changing work demands.
trainees are paid pro rata, with the main salary coming from the
deanery and the trust paying for on-call duties.
is possible but it requires planning and timely discussion with
educational supervisors and training programme directors.
Types of LTFT training
Two trainees share a
training slot with each working up to 60% of a full-time equivalent
(FTE). The deanery tops up the 20% shortfall in the full-time
salary. On-call duties are shared 50:50. In reality, the
practicalities of finding a suitable slot-share partner mean that
this option is uncommon.
LTFT Training in a Full-Time
This is the most usual
situation but can only be accommodated if the service requirements
can be met. Difficulties may arise for the trainee if the service
requirements are too onerous or when expectations of consultants or
other team members are based on the availability of previous
full-time trainees. Colleagues will be asked to provide cover on
the non-working days of the LTFT trainee, who may have to deal with
this issue sensitively.
The deanery agrees to
fund an additional training post for LTFT training with an
additional NTN. The employing trust has to approve extra funding
for on-calls. In practice, there is little funding available for
supernumerary posts and few of these posts exist outside
will favour different solutions to requests for LTFT training
depending on the availability of slot shares, the percentage of
time the LTFT trainee wishes to work and the availability of
funding for supernumerary posts. Occasionally, a training scheme
may not be able to meet the individual trainee’s needs in LTFT
posts and permission to train less than full time may not be
How does it work?
The Royal College of
Psychiatrists (2009) stipulates that LTFT trainees should have the
same opportunities to work in a range of clinical settings as
Most trainees choose to
work 50%, 60% or 80% of an FTE trainee and will therefore have
access to pro rata clinical experience, personal development,
audit, teaching and other experiences. The proportion of relevant
experience per post may vary depending on the training needs at the
time. For example, a requirement to attend an MRCPsych course may
call for a higher percentage of time to be apportioned to
education, which can be compensated for in subsequent posts. This
will need to be discussed with the educational supervisor and
approved by the training programme director. Training or other work
activities undertaken on non-working days should be compensated by
time off in lieu, which will again require discussion with the
clinical and educational supervisors and the employing trust.
The specific hours
worked by a trainee will depend on a combination of individual and
service needs and educational opportunities. The pattern can be
varied in different posts depending on changing needs so that core
clinical experience is gained from each post. The best fit will be
achieved by early discussion with the educational supervisor.
On-call commitment is
usually on a pro rata basis, although where an LTFT trainee is
occupying a full-time post, they may sometimes be asked to do the
same number of on-call duties as a full-time trainee.
Trainees may be asked
to be on call on days that they would not normally be at work,
especially if they work a full shift pattern. They may be expected
to make arrangements to facilitate this. If a trainee has
particular needs with regard to their hours of work, they will need
to discuss the situation with their educational supervisor and the
Workplace-Based Assessments (WPBAs)
assessments should be completed on a pro rata basis, although this
should be considered a minimum rather than an absolute number.
Progression Through Training
Training progression is
achieved on a pro rata basis. A trainee working 60% of full time
will move from one year of training to the next after 20 months.
However, an annual review of competence progression (ARCP) will
still take place on an annual basis, with a successful outcome
being achieved by the presentation of evidence of training
proportional to the time worked.
clinical posts generally takes place at the same time as for the
full-time trainees, except in cases of supernumerary posts where
the situation allows more flexibility. The problem previously
encountered whereby LTFT trainees did not satisfy the College’s
requirement for a job to be of 6 months’ duration to qualify for
training and examination purposes has now been addressed. So
although an LTFT trainee may only have worked in a post pro rata
for 4 or 5 months, this will still be considered adequate for
A LTFT trainee can act
up for a period of three months, can request a period of 6 months
grace, and can apply for consultant post six months before their
trainees have the same entitlement to study leave as full-time
trainees on a pro rata basis. The exception is mandatory training
which will need to be undertaken at the same rate as full-time
trainees. Where training requires attendance on non-working days,
time should be taken back in lieu. This will need to be discussed
with the educational supervisor and the employing trust.
Annual Leave and Bank Holidays
Annual leave is pro
rata, as are bank holidays. A trainee working 60% of full time is
therefore entitled to have 60% of bank holidays included in their
Networking with other
LTFT trainees can provide an invaluable source of support,
opportunity for information-sharing and may help to find job-share
partners. Some trainees may seek a mentor and the deanery lead for
LTFT training may be able to make useful suggestions in this
Each deanery’s website
has information about LTFT training as well as the name of the
person responsible for LTFT training. The College has a director of
LTFT training who sits on various committees and provides a link
between the College, the deaneries, the Junior Doctors Committee,
Medical Women’s Federation, LTFT Forum and the Intercollegiate
Improving Working Lives Committee, thereby representing the needs
of LTFT trainees. The deanery leads or the director of LTFT
training for the College can provide information, give guidance
with any difficulties encountered by trainees and generally offer
Useful sources of information include:
- Doctors in Flexible Training: Principles
Underpinning the New Arrangements for flexible Training by NHS
- ARCP for Less Than Full-Time & Academic
- The Gold Guide –
A Reference Guide for Postgraduate
Specialty Training in the UK
- Deanery websites, which contain practical
advice on how to apply for LTFT training
Royal College of Psychiatrists (2009)
Specialist Training in Psychiatry (Occasional Paper OP69). Royal
College of Psychiatrists.
This information guide is intended for a
trainee psychiatrist considering or currently working less than
full time. The information can be used as a guide only and is not a
substitute for professional advice. If you need further advice and
support, please contact the Psychiatrists’ Support