Less than full-time training

The only requirement to be permitted to train less than full-time is a well-founded individual reason. However, LTFT training is not guaranteed.

Categories have been created to identify which trainees will be prioritised. The needs of trainees in Category 1 will be prioritised. Applications under Category 2 are usually for a fixed period.

As of 2021, there are pilot schemes to introduce a third category which would allow trainees to enter LTFT training by personal choice rather than by providing a reason. It is hoped that this will improve wellbeing and reduce attrition rates by providing an alternative to leaving training. As this is still in the pilot stages, there are large variations across the four nations, but it s expected to be implemented across all specialties in all areas.

An application for LTFT training can be made when applying for entry into a training programme or at any time after being accepted onto a training programme. The process for appointing candidates to training posts should not be affected or influenced by an application for LTFT training. Approval for an application can take up to six months so some forward planning is required.

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 are 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 speciality may present problems to the training scheme if the length of time by the LTFT trainee limits opportunities 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. 

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.

The Royal College of Psychiatrists stipulates that LTFT trainees should have the same opportunities to work in a range of clinical settings, as with full-time trainees.

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 education supervisors and the employing trust.

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. 

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 leave basis, with a successful outcome being achieved by the presentation of evidence of training proportional to the time worked.

Rotation between 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 RCPsych’s requirement for a job to be of six months’ duration to qualify for training and examination purposes has now been addressed. So, although an LTF trainee may only have worked in a post pro-rate for four or five months, this will be considered adequate for training purposes.

NHS England (NHAE), Local offices, NHS Education for Scotland (NES), Health Education and Improvement Wales (NEIW) and Northern Ireland Medical and Dental Training Agency (NIMDTA), which were previously called deaneries, have websites with information about LTFT training. Local trusts may have an LTFT training lead or champion who can provide more information.

The College has a lead for LTFT training who sits on various committees and provides a link between the College, the deaneries, the BMA’s Junior Doctors Committee, Medical Women’s Federation, the LTFT Forum and the Intercollegiate Improving Working Lives Committee, thereby representing the needs of LTFT trainees.