The London School of Paediatrics is keen to develop and support LTFT training. This page aims to signpost trainees and trainers on various aspects of LTFT training.

LTFT Overview Video: if you'd rather not read all the information below, watch this excellent overview:


Categories of LTFT training

Trainees may consider less than full-time training for various reasons that range from caring responsibilities, health and wellbeing concerns, professional development, or to ensure a healthy work-life balance. Based on the reasons, there are three categories of application with slightly varying processes:
Category 1: Health or caring reasons
Category 2: To avail unique opportunities for personal or professional development
Category 3: Any other reason

Please discuss with your program management TPD before you apply.

Detailed resource on LTFT training, mainly focussing on the new Cat 3 LTFT, is available at the link below: this link.

Video resources: LTFT Training – Applying

Pros and Cons of LTFT working

Although working LTFT has many benefits, there can also be challenges - however obviously the LTFT subgroup members feel the benefits win out overall! Nonetheless it is vital to plan working arrangements and patterns very carefully. Here is our take on the main pros and cons:

  • Pros:
    • work-life balance
    • may alleviate feeling overworked/exhausted and make work more enjoyable
    • ability to pursue other interests, professional or otherwise
    • if LTFT for childcare, spend precious time with your family
    • less of your salary is subject to the higher tax bracket (although obviously your salary is still lower overall!)
    • ability to join the LSP LTFT subgroup! (although full-time trainees may also apply)
  • Cons:
    • reduced salary (apologies for stating the obvious) - although locum shifts are allowed if extra cash / gap filling is required
    • lack of continuity at work: this is a common compliant and is to an extent unavoidable, there is extra effort and stress involved with getting 'back up to speed' with your patients after a non-working day
    • longer training time
    • extra admin headaches: agreeing rotas and ensuring correct pay can be challenging but we feel this is generally improving as more trusts become accustomed to increasing numbers of LTFT trainees
    • having regular non-working days can mean LTFT trainees miss educational opportunities falling on that day - be organised and plan in advance ways to minimise these issues where possible

Comprehensive information on LTFT eligibility for trainees, application, tips and resources is available here.

Application and Process

Trainees who want to apply, change the LTFT category, or the percentage of whole-time equivalent (wte) must communicate with their programme management TPD at least six months before the change. Applications for category 3 have specific application windows and have different minimum notice requirements to category 1 or 2 applications.  Key links are below:

Find your TPD
HEE LTFT application webpage

 

Rotas (issues, slot share, reduced hours in an FT slot and related FAQ’s)

This is an area that can cause potential conflict and provoke significant anxiety both for trainees and trainers. Most issues can be resolved by communication and understanding the perspectives of both the trainee and rota manager or department.

What percentages can I work? LTFT trainees work a minimum of 50%, but up to 80% of the whole time equivalent (WTE).

Slot share vs. reduced sessions: LTFT can be allocated to work either as

  • part of a slot-share - where the two trainees together may add up to more than 1.0 WTE providing extra cover for the specialty
  • a single trainee working reduced sessions in a full-time post

How are the hours/shifts determined? HEE guidance states that “Day-time working, on-call and out-of-hours duties should generally be undertaken on a pro-rata basis to that worked by full-time trainees in the same grade and specialty unless the circumstances which justify flexible training make this impossible and provided that legal as well as educational requirements are met”.

What about non-working days (fixed regular days off, i.e. 'I don't work Fridays')? The majority of trainees prefer working on fixed days each week with the same days off (non-working days). This can be particularly important when organising child care, as most nurseries, childminders, and nannies cannot offer varying days each week. Generally speaking, trusts will ask LTFT trainees their non-working day preference prior to commencing a new rotation. If there are challenges associated with trusts accommodating these, particularly for reasons such as childcare, further discussion may be needed including involvement of the TPD.

Proactivity from both parties: Trainees must be given adequate notice of rotas (6 weeks before starting), and working commitments as the organisation of child care and medical appointments often require substantial notice. This relies on trainees playing their part by contacting new teams and rota coordinators to discuss their rota well in advance of starting.

Slot Shares: When working with a slot share partner replacing a full-time post, the expectation is that between the two trainees, they will cover, as a minimum, all days/shifts of the full-time rota. In all cases, the trainees need to negotiate working patterns so that educational and personal needs can be appropriately balanced with service needs. This requires flexibility and professionalism on the part of the trainees to reach a workable compromise that suits all relevant parties, particularly where specific working days are needed by both partners, e.g. to accommodate child care needs or to attend medical appointments related to health concerns or disability. The School of Paediatrics cannot mediate between two trainees, both requesting the same days to work.

HEE guidance: Guidance for organising an LTFT rota is provided by HEE and can be accessed here.

FAQ’s: Watch this space for some new pending LSP LTFT FAQs. For now, see the below external links:

https://lasepgmdesupport.hee.nhs.uk/support/solutions/folders/7000009155
https://lasepgmdesupport.hee.nhs.uk/support/solutions/7000006974

Video: LTFT Training - Rota patterns

 

Pay arrangements

Pay is complicated anyway. It is more complex for LTFT and further complicated in slot sharing.

Who pays for what (HEE and NHS trusts):

  • FT trainees are paid 50% of their sociable hours/non-banded work by HEE via the Medical and Dental Education Levy
  • The trust bears the other 50% and OOH/banding costs

For example, a 70% wte trainee not in a slot share, has it relatively simply:

  • 50% of the base salary comes from HEE
  • The remaining 20% comes from the trust’s budget
  • The trainee works 70% of their sociable/non-banded hours and 70% of their OOH/banded hours therefore the trust only gets 70% of the work done, but it has 30% of its budget free to pay for, say, a locum. The trust is entitled to expect the LTFT trainee to work at least 70% of their sociable hours/non-banded hours.

For LTFT trainees in slot sharing positions, it is more complicated:

  • Both trainees cover a single slot in the rota as an advantage - there are no gaps
  • But if the wte of both trainees together goes over 100%, it gets difficult for the trust, creating a ‘cost pressure’ – potential expense for the trust that it hadn’t anticipated. It’s a particular problem for out of hours activity, as the trust has only planned one slot on the rota and one salary for this time, but if both trainees are 70%, they would hope for 140% of a rota slot between them, with commensurate pay. The trust does not have this money. As a compromise, we ask that trusts provide a minimum of 50% of out of hours work for each trainee in a slot share.

Video resource: LTFT Training – Pay

Further details on pay arrangements can be accessed at:
https://www.bma.org.uk/pay-and-contracts/pay#payslips
https://questionnaires.bma.org.uk/news/lessthanfulltimetrainees/index.html
https://www.nhsemployers.org/articles/pay-and-conditions-circulars-medical-and-dental-staff

External Links: 

Contact

You may wish to know more – so please get in touch. The LSP LTFT is the newest group of the trainee committee, formed in 2020. The TPD lead is Syed Mohinuddin, contactable at syed.mohinuddin@nhs.net.