The College has a strong commitment to helping all psychiatrists in training to reach their full potential and to enable all colleagues who are unable or who do not wish to train on a full-time basis, to promote career development and work/life balance for doctors training in the NHS.
The College is keen to recruit and retain colleagues, particularly those with child-caring or other caring responsibilities, health concerns or individual developmental opportunities, to continue in training. The recent NHS Long Term plan has a strong commitment to promote flexible NHS working.
The Gold Guide is clear that those in LTFT training must meet the same overall requirements in specialty training as those in full-time training, from which it will differ only in the possibility of limiting participation in medical activities by the number of hours worked per week; and that they will need to evidence the requirements on a pro rata basis.
Options for LTFT training
LTFT (less than full time) training allows doctors to work reduced hours in posts that are fully recognised for training. It covers any such arrangement with reduced working hours. Trainees will have the same balance of work as their full-time colleagues.
Day-time working, on-call and out-of-hours duties will normally be undertaken on a basis pro rata to that worked by full-time trainees in the same grade.
Trainees will normally move between placements within rotations on the same basis as a full-time trainee. For Core trainees this means that they will usually rotate every 6 or 12 calendar months; and for Higher trainees, they will usually rotate every 12 calendar months; and for both at the same rotation points as their full time colleagues.
LTFT can be 50%, 60% or 80% depending on the type of working LTFT. In exceptional individual circumstances, Postgraduate Deans have flexibility to reduce the time requirement for LTFT training to less than 50% of full-time.
However, doctors in training should not normally undertake a placement at less than 50% for a period of more than 12 months. The GMC position statement provides information on Less than full time training.
The types of working LTFT include:
Two trainees share a training slot, with each working from 50% 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.
As the training post is divided between two doctors, all duties of the full-time post are covered by the doctors. In a slot share the LTFT doctors are employed and paid as individuals (often for 50-60%) and work together. The doctors share the educational slot(s) but not a contract and may overlap sessions.
Slot-sharing sometimes has the advantage that you are likely to be able to spend at least some time with your slot share partner if both of you work 60% of a normal week. You'll therefore have the chance to share one day or one session, where you can carry out a proper handover.
It can allow for both slot-sharing colleagues to be seen in the department as seamlessly filling one full time equivalent (FTE )post. It also allows a department to manage service demand such as clinical workload, on call shifts, and daytime rotas.
However, many training rotations do not have trainees who can slot share, either because there are not enough trainees who want to work LTFT; or that any LTFT trainees are at different stages of their careers and have differing training needs. And slot share LTFT colleagues will usually have less flexibility as to which hours they can work in a week, which may not easily support their caring of childcare responsibilities.
Care is also needed to ensure that each LTFT colleague can achieve the required competencies across their period of training; eg psychotherapy competencies in core training.
LTFT training in a full-time slot:
The LTFT trainee usually works 50, 60 or 80% of a FTE. The trainee also does the same pro rata reduced percentage of the FTE on call as the percentage that they work in the day, ie 50, 60 or 80% of the on call rota. This can only be accommodated if the speciality can continue to provide the required service provision with a LTFT trainee.
This kind of working pattern and on call arrangements can lead to gaps in on call rotas, deficits in clinical services, and potential challenges for the LTFT to meet their training needs due to service pressures. This may be if the service requirements are too onerous or when expectations of trainers or other team members are based on the availability of previous full-time trainees.
Other colleagues should be asked to provide cover on the non-working days of the LTFT trainee, and this will need to be managed sensitively by all.
This can often be accommodated in mental health services, and be a good training experience, but requires for all to be aware that the trainee is expected to undertake the reduced proportion of clinical work, and reduced proportion of non clinical objectives.
The Health Education England (HEE) local office (previously named the Deanery), or NES, the Wales Deanery or NIMDTA, agrees to fund an additional training post for the LTFT training, and an additional training number where it is available and approved. Approval for a particular placement requires the employing Trust to pay additional money for the on call payments.
It is now the case that most HEE local offices/ deaneries are not able to offer supernumerary posts, except in specific and exceptional circumstances. This means that there may be restrictions in the areas where trainees can work LTFT.
But supernumerary funding is most likely to 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.
Supernumerary funded slots allow a LTFT trainee to be funded to work in a training post that best meets their training needs, if funding is available.