Pros and cons of LTFT training
- Working LTFT has many benefits and has become a requirement for many within the modern workforce. For doctors:
- LTFT working can reduce fatigue and allow greater enthusiasm for work by providing a better work-life balance.
- It facilitates a wider variety of experience within the system and helps retain a diverse cross-section of doctors in training who might otherwise have been lost from the workforce.
- Working LTFT allows trainees who otherwise may not be able to continue in training, to continue working, progress in their career, and to provide valuable mental health services.
- LTFT work allows a trainee to dedicate time to other pursuits, family and/or children while caring for oneself. There is a positive work life balance with training often being less intense with respect to shift pattern and pro-rata on-calls, allowing more time to reflect and learn.
- While remaining in a training post for more calendar months than if training full time, it provides opportunities to get as much experience as a FTE colleague, but also to see the longitudinal course of mental disorder and recovery, and to have time to complete audits and other quality improvement projects.
- Work placed based assessments are pro-rata to FTE colleagues, there is more opportunity to do WPBA spreading over more time.
- However, regardless of the reason, the practicalities of working LTFT can be difficult due to the following factors:
- Balancing work and personal commitments can often be demanding and exhausting, and deficiencies in rota design and rostering can exacerbate feelings they are not achieving as they might wish in either area.
- Identifying individual needs, facilitating flexible working patterns, and providing consistency and stability (with sufficient notice for changes) are key to underpin the process of good rota design and rostering for LTFT doctors, allowing them to be effective team members in helping meet service needs.
- Trainees who work LTFT describe the training journey is not straight forward but achievable.
- Trainees often describe feeling that they are perceived as ‘not as good as’ FTE colleagues; and that this even sometimes experienced as negative discrimination, feeling bullied or looked down on.
- LTFT trainees often feel that their FTE colleagues and trainers have little understanding of LTFT working. And that there is a negative perception that they see fewer patients and are ‘not available’ as much as FTE colleagues.
- There are the obvious financial implications of working LTFT and extended length of training time. And there are often complications with pay banding and structures that can be time consuming to clarify.
- Some LTFT colleagues also describe challenges of ensuring that they can obtain posts in particular specialties, and challenges of obtaining endorsements as Higher Trainees because of the need to remain in a specialty post for longer than a single calendar year in order to obtain a 12 month equivalent time in that specialty.
- LTFT trainees also describe that they often feel that they are ‘left behind’ as their FTE colleague cohort progress more rapidly, and achieve CCT and consultant practice a long time before them.
However, most LTFT trainees report that the opportunity to work LTFT allows them to complete their specialty training and continue to work positively in their chosen field.
They report that Psychiatry as a specialty is supportive of working and training LTFT. But that there is a significant additional burden in achieving this.
LTFT trainees describe their requirement to have more assessments, ARCPs, and costs of professional subscriptions over more calendar years than their FTE colleagues; and for each ARCP administrative requirements to be accommodated in less working hours than FTE colleagues.
There are helpful reduced fees for some professional subscriptions, including GMC and Royal College of Psychiatrists, but these sometimes only equate to training at less than 50% FTE, which excludes most LTFT colleagues.
In addition there are additional burdens of each new LTFT placement requiring a new application, setting weekly time table and HEE, or other educational provider, approval. And a need to clarify all of this significantly before each training post is approved.