Working LTFT in FY1/FY2

Working LTFT can be a great way to improve your work-life balance and is applicable to individuals in many situations. Obviously training takes a little longer and there are pros and cons to consider. If it’s something you’re considering I hope this article will provide a good overview of the eligibility criteria, processes involved in applying and pros and cons of working in an LTFT post.

Eligibility for LTFT training
There are two categories of eligibility criteria for LTFT training in the foundation programme, detailed below. However these categories are not exhaustive and trainees should discuss personal circumstances with their educational supervisor and TPD (training programme director). Each application is considered on its own merits.

Category 1: Trainees with health conditions and caring responsibilities
  • Personal ill-health or disability
  • Responsibilities for caring for children
  • Responsibility for caring for ill/disabled partner or other relative/dependent
Category 2: Trainees with unique opportunities or commitments outside of medicine
  • Doctors with unique opportunities for personal or professional development outside of medicine e.g. competitive sport on a national or international level, management courses, art courses etc.
  • Doctors with short term extra commitments e.g. serving on BMA committees/other national committee
  • Doctors training for a religious role which requires a certain amount of time commitment.
Applying for LTFT training
Most Deaneries require 3 months’ notice for an application to work LTFT. Applications are normally made via the deanery online portal and you are usually required to submit an application based on a particular percentage. The minimum time commitment you can give in foundation is 50%, up to a maximum of 80% of a full time post. The possible percentages may vary depending on deanery and you should refer to your local HEE/deanery office before making an application. As an example, I work at 70% which is 3 days/week and 100% of my share of weekends. Applications are usually considered quickly and will be either approved or declined by the deanery. If approved, the deanery should notify your trust that you have approval to work LTFT, however it is worth keeping the trust HR department in the loop so they are aware of your application and can chase approval from the deanery if necessary.

Types of LTFT post
In theory there are three types of LTFT post:
  • Slot share (usually 50% or 60%)
  • Part time in a full time post (50% - 80%, creates rota gaps)
  • Supernumerary
In reality most LTFT posts at foundation level are part time in a full time slot. Slot shares are difficult to come by as there are not that many LTFT foundation trainees, and there are a very small number of supernumerary posts which are reserved for trainees who need flexible training at short notice e.g. sudden onset of ill health or sudden increase in care needs of a dependent. Type of LTFT post will need to be discussed with your trust and department.

Determining your work pattern
Your work pattern will depend on what type of post you are in. If a slot share, usually one of you will work the first half of the week and one the second. Depending on % worked, this can give the opportunity for you to do a proper handover on a Wednesday which offers good continuity.

If part time in a full time slot, at foundation level you will usually be able to determine your work pattern, but it may depend on the rota of the department you are working in. Most people prefer to work consecutive days but there may be other factors to consider e.g. availability of childcare that contribute to determining your work pattern.

Progressing as LTFT
A quick note on progressing – Obviously if you work anything other than 50% you will complete FY1 out of sync with your full time colleagues. It is in theory possible to start an FY2 post at any changeover point (August, December, April) but this will obviously depend on job availability and you may find that you have to take a trust grade job or do some locum shifts to fill time before starting an FY2 post.

Pros and Cons of LTFT
Pros:
  • Better work-life balance
  • Opportunity to spend more time with your children/other dependents
  • Opportunities to pursue other interests you may not otherwise have time for
  • Better able to enjoy your work when you are there
Cons:
  • Lower take home pay (pay is pro-rata)
  • Longer training time
  • May have difficulty in completing portfolio requirements
  • Lack of continuity of care for patients
  • Takes longer to integrate with team and get to know ward staff
  • Handover issues with team
  • Can feel like you are always playing “catch-up”
 Top tips for succeeding at LTFT
  • Keep the lines of communication open with trust HR department. Make sure they always know what % you are working and what your hours are, and make sure they notify payroll – sorting out incorrect payment is a nightmare! It is worth re-confirming this before starting each new rotation.
  • Get actively involved in extra-curricular activities e.g. co-ordinating and presenting at journal clubs, QIPs and audits, teaching medical students etc
  • Invest time at the beginning of placements in getting to know your colleagues.
  • Ensure everything you do is documented clearly in the notes and on the handover list if you have one, especially before you go off for a few days.
  • Know what you are responsible for and what you are not – e.g. you are NOT responsible for finding cover for on call slots left empty on your non-working days.
  • Know what your e-portfolio requirements are – you should be completing SLEs pro-rata to your full time colleagues but some education departments will not be very experienced with LTFT trainees.
  • You will have an annual ARCP, just like full time trainees. Know what the requirements are for your ARCP when you are and are not progressing. E.g. you will need to complete a Form R every calendar year, but an educational supervisor end of year report need only be completed once at the end of your training year.
  • Make plenty of time for self-care. Balancing the many responsibilities that often come with working LTFT can take its toll.
  • Good luck!
References:
https://www.healthcareers.nhs.uk/explore-roles/doctors/career-opportunities-doctors/less-full-time-training-doctors#applying
Doctors in flexible training – Principles underpinning the new arrangements for flexible training

Dr Rachael Ward, FY1 East Sussex Healthcare NHS trust