Application Process

If you are considering or have made the decision to go LTFT/reduce your working percentage, discuss this with your Educational Supervisor (ES) and Training Programme Director (TPD) Find your TPD; they can guide you on the process and the TPD will also to take this into account for your future rotations (they may change).

Apply via the HEE/NHSE LTFT application portal HERE. There is a 16 week minimum notice period (even for urgent childcare reasons) to change to LTFT working (or change your WTE further if already LTFT) however this can happen faster if your application is processed and your employer/trust are able to accommodate - your TPDs are key.

Quoting from the HEE website: "From August 2022, all doctors in training across England in any specialty have the right to apply to train LTFT for any well-founded reason, including for their wellbeing or through personal choice."

HEE/NHSE no longer use LTFT categories (1, 2 & 3). Trainees now apply under one of a number of criteria:

Application criteria accepted at any time (no need for windows):

  • Trainees with a disability or ill health – This may include ongoing medical procedures such as fertility treatment.
  • Trainees (men and women) with caring responsibilities (e.g. for children, or for an ill/disabled partner, relative or other dependant)

Applications criteria that need to be made within predetermined 'windows':

  • Welfare and wellbeing – There may be reasons not directly related to disability or ill health where trainees may benefit from a reduced working pattern. This could have a beneficial effect on their health and wellbeing (e.g., reducing potential burnout)
  • Unique opportunities – A trainee is offered a unique opportunity for their own personal/professional development, and this will affect their ability to train full time (e.g., training for national/international sporting events, or a short-term extraordinary responsibility such as membership of a national committee or continuing medical research as a bridge to progression in integrated academic training)
  • Religious commitment – A trainee has a religious commitment that involves training for a particular role and requires a specific time commitment resulting in the need to work less than full time
  • Non-medical development – A trainee is offered non-medical professional development (e.g., management courses, law courses or fine arts courses) that requires a specific time commitment resulting in the need to work less than full time
  • Flexibility for training and career development with the option to train less than full time with flexibility that might enable development of a broad career portfolio

The Windows are determined by the month in which you rotate. If wanting to commence LTFT for a March rotation the window is usually during August, for September rotations it's usually during April. Dates for 2024: 

Rotation Month

LTFT Window Head of School Sign off HET Confirmation to Trainee Deadline TPD GRID Deadline
September 19/04/2024-03/05/2024 17/05/2024 20/05/2024


Trainees will remain LTFT unless they request a change (via the same application form). This can be reviewed if the application is to support a time limited activity.

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.

What Percentage WTE To Choose - Minimum of 50% WTE for Paediatric Trainees in London

% Weekly hrs No. of fixed days off Pay Rough Estimate Training extension for each 2 yrs worked
50 20-24 2.5 50% of FT 1yr
60 24-28 2 60% of FT 9 months
70 28-32 1.5 70% of FT 6months
80 32-36 1 80% of FT 3 months

Fast Tracking Training: Whilst it is true that paediatric training is competency based, all percentages of LTFT working mean that your training will be extended unless you fast-track. For example, working 2yrs at 80% WTE is equivalent to 19 months at full-time. Or, working 30 months at 80% is equivalent to 24 months full-time. To fast-track, you must prospectively agree this with your educational supervisor and TPD and prove at ARCP that you have met competencies early to progress. Discuss this early with your ES and TPD as it needs planning.

Types of LTFT Working Arrangement:

Slot share vs. reduced sessions in a full-time slot - LTFT trainees can be allocated to work 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  or
  • a single trainee working reduced sessions in a full-time post

Which arrangement you are in is controlled by NHSE/HEE. This is outside of your control; you can’t ask to be in one as a preference.

Slot share: you share a single full-time slot on the rota with another flexible/LTFT trainee. You need to cover the entire working week between the two of you. This may mean one or other of you will may have to change your non-working day (we know this can be tricky). No matter what your individual percentages you split the on calls 50:50. You may need to add in other short days to make up the required number of each shift type & total average weekly hours. Trusts will often not allow you to overlap on calls with your slot share partner. Why you usually can't overlap OOH shifts with your slot-share: The pay for OOH work comes from the trust. Most trusts cannot afford to pay 2 people for one on call. The pay for our standard shifts comes from HEE hence they will cover the increase in standard days.

    1. Example: 60% slot-sharing with 80%. Both work 50% each of every shift type. The 60% trainee will need to add short days to make their weekly average 24-28 hours. The 80% trainee will need to add short days to make their weekly average 32-36hours. This will leave the 80% trainee with a relative 30% loss in on call shifts (and less pay than if they were doing 80% on-call shifts) but will protect the non-working day

Reduced hours in a full time slot (will be called stand-alone in the rest of the guide): You work your FTE percentage of every shift type. This may mean you need to work on/into your non-working day (i.e. night shift) to ensure you work enough shifts. You will do your full FTE percentage of on-calls.


  • LTFT rotas can be challenging for LTFT trainees and departments alike. The key message is to work together and aim for mutual agreement

How are the requisite hours/shifts determined? HEE/NHSE guidance states: "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?

  • LTFT Trainees may wish to have regular fixed non-working days (NWD), i.e. for childcare as most nurseries, childminders, and nannies cannot offer varying days each week
  • Some trainees, i.e. 80% for work-life balance may be happy with reduced hours spread across the whole week and may not require/want/need a NWD
  • Generally speaking, trusts will ask LTFT trainees if they have a non-working day preference prior to commencing a new rotation
  • At present you are not automatically entitled to the NWD of your choice, it is a negotiation between you and the trust i.e. every LTFT trainee cannot requested be granted a Friday for obvious reasons. However, employers are usually able to facilitate individual preferences and should have good reason not to, especially for those with fixed caring responsibilities.
    • Make sure you check in advance when important clinics/teaching takes place to minimize loss of learning opportunities.
  • If in a slot-share, you will need to liaise with your slot share partner ASAP as you cannot both have the same NWD (the whole week will need to be covered)

How to make your rota: There is increasing use of self-rostering and AI software across London. This guidance is for the traditional rota with predetermined slots: 

  • For the full-time rota, count the number of each different shift type over the 6 months/26 week period (i.e. short days, long days, weekend days, nights).
  • Then either:
    • Stand-alone slot: Calculate your percentage per shift type of the FT amount. Do this for total weekends shifts also. You need to work your full percentage of every shift type if in a stand-alone shot. This may mean starting or finishing nights on your NWD.
    • Slot-share: If in a slot share you work 50% of the on calls. And work out how many additional short days you would need to work to make up the average hours for your percentage.
  • Decide on your preferred NWD(s): agree this with your slot share if applicable
  • Allocate the number of shifts you have calculated above over the 6 months. Try to follow the basic rota pattern for full-timers as much as you can. But you will have to remove some of the FT shifts or add in extra standard days (dependent on whether you are in a slot-share or stand-alone)
  • Send this to your to rota coordinator to check compliance
  • Once mutually agreed, you should receive a bespoke work schedule outlining your rota and pay for the period. This is MANDATORY and important to be able to check your pay accuracy

Lieu days: they are not a shift type. They are built into LTFT rotas to make the full-time version compliant. As a flexible trainee you do not include them on your rota. Ignore them essentially (see website FAQs for bank holiday questions and more LSP LTFT FAQs). See BMA good rostering guide for examples of different percentages in slot-shares and stand-alone slots

Proactivity from both parties: As per JD Contract, 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 is often huge challenge for LTFT rotas made from full-time-equivalent rota slots, which require negotiation and mutual agreement that can mean final rotas are not completed within the 6 week deadline. We recommend contacting your rota co-ordinator early. 

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

FAQ’s: Please also see our



HEE have also released some FAQs here

HEE Video - LTFT rotas:


Leave (Annual, Bank Holidays, Study):

Leave is taken AFTER your rota is agreed. It is not included in the hours calculations when building your rota.

Annual leave: In order to work this out you need to be clear on your starting amount of annual leave per year. If less than 5 years continuous service (maternity leave and OOPs included in the NHS count) it is 27 days, if 5 years or over then its 32 days. You then work out your pro-rata percentage of the total and halve it to give allocation per 6 months (round up to the nearest half day)

Bank holidays: can be confusing. You need to count the total bank holidays over the 6 months (working or not). You then work out your percentage of these, rounded up to the nearest half day. i.e. if there were 4 and you worked 80% this entitles you to 3.5 (3.2 rounded up). This is then added to your total AL requirement. Then the following applies:

  • If you work an on-call day on a BH, you work the shift. You don’t receive any day off in lieu as it is already in your leave allowance
  • If you are scheduled to work a non on-call shift on a BH and you don’t work the shift, you then use up a leave day. Or, if your department agrees, you can choose to work and keep the leave day
  • If you are not due to work the BH (it’s on your NWD or you are not on shift) then your leave allowance is untouched, i.e. all 3.5 days remain included

Study leave:

  • You should receive a pro rata percentage of the study leave allowance given to full time trainees (round up to nearest half day)
  • The cost of the study leave should be reimbursed in full the same as a FT trainee
  • If a course falls on your NWD you can take another standard day back in Lieu

Locum work

  • You are entitled to locum as a LTFT trainee. However, if you locum so often it increases your total weekly hours to the next band then your trust or TPD may legitimately ask you why you are not working the percentage above your current
  • Locum work >40hrs/week should not be included in your pensionable pay. Trusts will often, however, give you a separate assignment number for staff bank/locum work and will automatically enroll you in the NHS Pension scheme on this assignment too. With previous limits on pension pots for total career earning, it was sensible to opt-out of pension payments on your locum work. With recent changes this is more nuanced. If wanting to opt out, complete an SD502 form (google this) and either post it directly to SBS payroll, or send it to your HR department who will forward it on to SBS.


Pay, especially on the 2016 contract can seem dauntingly complicated. But once you've worked through our pay calculation guide you'll get the hang of it and be able to claim back significant underpayments and avoid being contacted about overpayments down the line.

Visit out 'Pay' subpage for details on how to check your individual pay


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 trusts usually provide 50% of out of hours work for each trainee in a slot share.

Further details on pay arrangements can be accessed at:


The following FAQs have been created with trainee and TPD input to provide information for trainees, educational supervisors and employers. They are for guidance purposes only. If your LTFT question isn't answered below please feel free to get in touch with us (see contacts information) for further support and possibly to inspire a new addition to the FAQs. Enjoy!



Can I apply for LTFT just ‘because’?
Yes, but if you do not have a reason relating to a direct caring responsibility or a disability/ill-health, you will need to apply within specified application windows throughout the year. The following two quotes coming directly from HEE:
"Criteria 3: Welfare and wellbeing – There may be reasons not directly related to disability or ill health where trainees may benefit from a reduced working pattern. This could have a beneficial effect on their health and wellbeing (e.g., reducing potential burnout). "
"From August 2022, all doctors in training across England in any specialty have the right to apply to train LTFT for any well-founded reason, including for their wellbeing or through personal choice."

My circumstances have changed and I need to go LTFT urgently. What do I do?
You are able to apply outside of set application windows to process an 'urgent' application to change to LTFT working if your reason for this is parental care, caring responsibility or disability/ill health. In these situations, we would always recommend speaking with your educational supervisor/college tutor/TPD ASAP. Technically HEE have a 16 week notice period to change to LTFT working, however if they process and approve your application, the start date of your LTFT working depends on agreement with your employer (whose agreement you need to provide to HEE in writing), therefore you may be able to change to LTFT sooner than 16 weeks. Lastly, if applying on health grounds you will need to provide a supporting letter from your GP or occupational health department.

I previously worked LTFT and am about to return from parental leave/TOOT; do I need to apply for LTFT again?

No you don’t need to reapply, you will be assumed to be returning at the percentage you were working at prior to taking time out. You only need to reapply again if you want to change your percentage


What is the maximum LTFT percentage I can work in London? The maximum is 80%

What is the minimum LTFT percentage I can work in London? The minimum is 50%

I work 80%, how many hours should I be working per week?
The average FTE hours are a maximum of 48 per week. In reality, most full-time rotas are a slightly less than this. LTFT doctors are contractually entitled to work a pro-rata equivalent of each shift type as compared to the full-time rota (as specific in the generic work-schedule). The absolute maximum that a LTFT doctor can work if their full-time colleagues were working 48hrs per week would be:
- 80% = maximum 38hrs per week on average
- 70% = maximum 34hrs per week on average
- 60% = maximum 29hrs per week on average
- 50% = maximum 24hrs per week on average
Trainees should expect these hours to be spread across a pro-rata reduced number of all shift types (nights, long days, short days etc.), i.e. if a full-time trainee works 20 night shifts over 6 months, a 50% FTE trainee should expect to work 10 night shifts over 6 months
The number of any fixed non-working days (if requested by the trainee) may vary based on the local rota. i.e. a 50% trainee may have Monday & Tuesday as non-working days then work their required 50% of all shift types across the remaining days (Wednesday-Sunday). Another example is a 70% trainee with one non-working day who works their required 70% of shifts across the other 6 days. It is very rare for LTFT trainees to be scheduled to work half days.

I’m a 60/70/80% LTFT trainee and I’ve been put into a slotshare, is this OK?
Generally speaking, if using the increasingly outdated slot-share rota method, LTFT trainees are often put into slotshares unless there are rota-gaps.

"I'm a 70% LTFT trainee but my new trust have asked me to slotshare with another LTFT trainee. They have told me I will only do 50% of out of hours shifts. Is this OK?"
Contractually, LTFT trainees are entitled to work a pro-rata percentage of all shift types. However, funding for out of hours shifts is provided by trusts rather than HEE/NHSE therefore a trust may only be prepared to pay 100% of out of hours pay for one slot. This may mean that when all slots on a rota are full, a 60/70/80% trainee may be rostered to work 50% of FTE out of hours shifts (so that the OOH is shared equally between slotshare partners). This results in a reduction in the proportion of 'on call' shifts. Often trusts will make up the difference with ‘in-hours’ shifts.

"I'm an 80% trainee but I only want to work 50% of out of hours shifts - this is what a friend in another trust is doing, can I do the same?"
As stated above, a LTFT trainee should be prepared to work the same percentage of all shift types. Any requests to reduce out of hours shifts would have to be agreed locally and then from placement to placement. We have some 50% LTFT trainees saying "I'm happy to go up to 80% in-hours if I can stay 50% out of hours", this is not a typical arrangement and again would need to be agreed locally.

My non-working day is Tuesday, am I allowed to work a Tuesday night? How do nights work on LTFT rotas?
The way in which LTFT rotas are made varies from trust to trust. It is strongly advisable that a trainee is involved early on in building their rota, for example (if using slots) by choosing a ‘pro-rata’ number of each shift type from a FTE rota slot. However the rota is made, when satisfying the requirement to fulfil the necessary pro-rata-reduced numbers of each shift type (i.e. short days, weekend long days, nights), it may be the case that a LTFT trainee is requested/decides to work a night shift that runs into or starts on their non-working day. i.e. this doctor may elect to work night shifts on Tuesday but avoid Monday nights so they can be awake/rested for their non-working day. Therefore, it is critical for trainees with fixed non-working day requirements to be involved very early on with discussing their needs with rota-coordinators.

  • Also see the following from the Junior Doctor Contract: NHS-doctors-and-dentists-in-training-eng-tcs-v9_0.pdf ( Page 34, Clauses 18 and 19. "When requested by a doctor, all reasonable attempts should be made to facilitate set working day patterns.... provided that service needs can be met." & "Unless agreed, no shift should be rostered on a non-working day in a fixed working pattern"

I work 80% and have an agreed work schedule with a non-working day of Thursday. My rota co-ordinator is now asking me to work a Thursday day shift, is this allowed?

This answer applied to the previous 'category based' application system and needs updating:
This depends on your category of LTFT training.
For category 1 &2 we defer to the following statement from the junior doctor contract "Unless agreed, no shift should be rostered on a non-working day in a fixed working pattern"
For category 3: During the LTFT application process, category 3 applicants are informed that they cannot necessarily expect to have a fixed non-working day. In reality most departments will find it easier to set fixed non-working days however this relies on mutual agreement.

Non-working day: “I am starting at a new trust, can my employer refuse my requested non-working day?”
This is a tricky area, the junior doctor contract stipulates that “all reasonable attempts should be made to facilitate set working day patterns, in line with their statutory right to request flexible working provided that service needs can be met”. In other words, any non-working day arrangements are mutually agreed between an employer and the junior doctor. In practice, the majority of trainee non-working day requests are accommodated by employers but we recognise that sometimes this is not the case. Consider a department with 15 LTFT registrars and all of them ask for Friday NWD - this is not possible and needs negotiation and compromise to reach 'mutual agreement'. Ultimately, this is a local employment issue therefore your TPD/HEE cannot stipulate set working days for trainees to trusts. Therefore we encourage LTFT trainees to make early contact with college tutors and rota coordinators to discuss their individual needs. Furthermore, if you are in a slot share, between you the whole slot will need to be covered and you will not both be able to have the same days off. This needs to be negotiated between slot share partners. We are very aware that this is not an ideal scenario.

Should I get a day-in-lieu if my full-time equivalent rota slot is marked as an off-day but it falls on my non-working day?
No, by working pro-rata of each shift type, LTFT trainees will naturally be allocated the correct number of off-days. You do not get a day in lieu in this scenario.


Annual leave: How much do I get?
- Pro-rata reduced amount according to your FTE percentage
- 5 years of continuous NHS service means 32 days
- <5 years of continuous NHS service means 27 days

Study leave: How much do I get?
You are entitled to a pro-rata amount of study leave. Full-time entitlement is 30 days per year

Bank holidays, how do they work?
The classic LTFT rota question! The total annual bank holidays number is 8, so for example if you are 60% you should get 5 days per year pro-rata
Best practice is for your trust to allocate you this pro-rata number of days (i.e. 5 in the above example) as additional annual leave days. So that:-
- If you work an on-call day on a BH, you work and no day off in lieu is given, as it is already in your leave allowance.
- If you would ordinarily have been scheduled to work a non on-call shift on a BH and have the bank holiday off, one day is deducted from the total leave allowance (which includes the pro-rata additional BH days). If however you chose to work this shift (locally agreed) then your leave allowance remains untouched.
- If you are not due to work the BH (it’s on your non-working day or you are not scheduled to work) then your compensatory leave allowance is untouched


How will it affect my pay?
Your pay will obviously be reduced overall compared to full-time working in the same post, however for more senior trainees you may pay less tax as a proportion of your overall earnings. This is because the 40% ‘higher rate’ income tax rate applies to annual earning above £50,271 (the rate of income tax below this threshold is 20% rather than 40%). There is also an additional flexible training payment of £1000 annually (or &83.33 per month) in the 2016 contract (often appears as ‘flex PT trans 2019’ on your payslip)

How will I know if I am being paid correctly?

In our experience, LTFT pay is usually wrong. We cannot advise strongly enough that you check your pay using our resources (see Pay Accuracy page) and look our for our 'LSP Lay & Working Lives' fora

What about pension?
In 2022 the pension T&Cs changed so that LTFT doctors no longer pay full-time contributions. Success! Your pension payments (the money you get when you retire) on the latest pension scheme is calculated based on career-average earnings so it will be lower if you work LTFT.


What about maternity leave?
Your maternity pay is calculated based on average weekly earnings for the 8 weeks up to and including the 15th week before the expected week of childbirth. This will usually be an average of the 2 monthly payslips before week 25 of pregnancy. Therefore, as you would expect, maternity pay will be reduced compared to a full-time equivalent. However, any adjustments made to your working pattern during pregnancy (i.e less out of hours work), legally cannot result in reduced pay


Can I do locum shifts whilst working LTFT?
Yes, but if you are doing an excessive amount of locum shifts, the college advise that you discuss your LTFT status with your ES/TPD. You also need to declare locum work that you do on your ARCP form-R


Does going LTFT always mean more training time?

YES!! This is a common misconception for London trainees. If you work LTFT, your CCT will be delayed unless you prospectively plan and compete the necessary fast-track paperwork. Part of the confusion is generated by other schools having varying approaches to this.

What is the FTE Training extension for every 2 yrs?
- 50% 1yr
- 60% 9 months
- 70% 6months
- 80% 3 months
Going LTFT will delay your CCT date regardless of your FTE percentage (even if working 80% - the max LTFT % in London). Having said this, training is competency based therefore you may be able to accelerate. This must be discussed prospectively with your educational supervisor and TPD so competency can be properly assessed. Applications to fast-track training need to be made 6 months in advance and submitted for consideration at ARCP.

I am a current LTFT trainee, I don’t know how progress+ will affect me, help!
This is tricky and individualised. If in doubt, discuss with your Educational Supervisor, TPD and see our resources from the Progress+ information evening.

I am a ST5(C4) Trainee. What competencies do I need to meet given that I have already had level 1 signed off?  

There is a specific document from the RCPCH (attached below) that covers this for this group of trainees. Both the table of required WPBAs and the list of key capabilities have changed- please read carefully and target these areas in your ST5(C4) year in order to progress.

I am a ST5(C4) Trainee. Is there a minimum amount of time I need to spend on the tier two rota before I can progress to the new ST5?

Paediatrics is a competency-based training programme as such there is not a minimum amount of time set in stone. However the RCPCH gives an indicative 12 month WTE to complete this phase of training. All LTFT trainees will be allocated 3 x 6 month blocks ( 0.5 WTE may be allocated 4 x 6 month blocks). Should you feel you are on track to progress faster please discuss a fast track form with your ES and submit for this to be considered at ARCP.


What if I want to go back to full-time?
You can change back to full-time working but only when this can be accommodated within the programme. This is also very likely to affect your future placements. At the point of wanting to return to full-time, if your current trust can accommodate a change to full-time, great! If they can’t, you will probably need to wait for the next changeover after the minimum notice period (16 weeks) from submitting your change form.


  • Firstly please have a look through the information page
  • HEE have also recently published some FAQs
  • RCPCH is also developing LTFT resources on their webpage

Please get in touch with us with any further queries, perhaps your AQ will become a FAQ!

Other Useful External Links: