1. South Thames Foundation Schoolwww.stfs.org.uk Less Than Full Time (LTFT) training for foundation doctors Christine Bridge STFS Manager

2. South Thames Foundation Schoolwww.stfs.org.uk Overview What is LTFT / Flexible training? Who can apply? What are the categories? How to apply – HE KSS & HE SL How do placements work? Funding Approval of programmes What are the pros and cons? Advice for foundation doctors

3. South Thames Foundation Schoolwww.stfs.org.uk What is LTFT training? LTFT (HEKSS) or Flexible (HESL) training is available for doctors and dentists who are unable to work and train full time for “well-founded” reasons. The scheme allows doctors to work less than full-time in posts that are fully recognised for training.

4. South Thames Foundation Schoolwww.stfs.org.uk Who is eligible to apply? Category 1 Disability or ill health - this may include those on in vitro fertility programmes Responsibility for caring for children Responsibility for caring for a sick or disabled partner, relative or other dependant

5. South Thames Foundation Schoolwww.stfs.org.uk Category 2 Unique opportunities for personal / professional development Religious commitment involving training for a particular religious role with a specific time commitment Non medical professional development (law, fine arts, complementary therapies) Other well founded reasons

6. South Thames Foundation Schoolwww.stfs.org.uk Approval priorities Category 1 applicants have priority HEKSS & HESL will support all Category 1 applicants, subject to available funds and training capacity. Access to Category 2 is dependent on individual circumstances and the availability of suitable training placements.

7. South Thames Foundation Schoolwww.stfs.org.uk Application process - HE KSS Application Form available from www.kss.hee.nhs.ukwww.kss.hee.nhs.uk complete electronically, print and sign. submit to LTFT Training Adviser at HEKSS incl Equality and Diversity Monitoring Form Curriculum Vitae (CV) – must be up to date Supporting Documentation – if applying on the grounds of either disability/ill-health or adult carer responsibilities

8. South Thames Foundation Schoolwww.stfs.org.uk Application process – HE SL email the Educational Resources team (ltft@southlondon.hee.nhs.uk) with ‘Eligibility Form request’ in the subject line and postal address in the body of the email. Paper form will be sent in the post.ltft@southlondon.hee.nhs.uk Once deemed eligible an Approval Form is sent to the applicant. Contact Foundation School Manager for additional information needed e.g. educational approval for your timetable.

9. South Thames Foundation Schoolwww.stfs.org.uk Types of LTFT Placement STFS are responsible for the allocation of doctors to F1 & F2 programmes. Where possible, slot shares are arranged by matching trainees to posts based on geography, e.g. for those with approved special circumstances. Alternatively, in reduced sessions placements.

10. South Thames Foundation Schoolwww.stfs.org.uk Slot sharing Two (or more) trainees share one full-time post and work between 50-80% paid by the Trust as an individual trainee on the basis of actual contracted hours they split out of hours between them The Trust receives funding in support of slot shares.

11. South Thames Foundation Schoolwww.stfs.org.uk How Slot Shares Are Funded – HE KSS HEKSS funding for slot shares currently provides the employer with surplus funds as an incentive to support the LTFT training placement. both trainees are paid for actual hours worked, subject to available funds, the employer will receive additional reimbursement Funding covers the WTE of trainees in post plus a surplus of 0.1 WTE to acknowledge the extra work involved in hosting these arrangements.

12. South Thames Foundation Schoolwww.stfs.org.uk HE KSS Example Trainee A works 70% (0.7) WTE Trainee B works 60% (0.6) WTE Trainee 1 + Trainee B = 1.3 WTE Trainee A funded at 1.0 WTE Trainee B funded 0.3 WTE + 0.1 WTE (LTFT budget) Total funding = 1.4 WTE

13. South Thames Foundation Schoolwww.stfs.org.uk LTFT funding - HESL Enquiries about the funding arrangements should be made to the Finance Team of the LETB: South London HEE Email lda@southlondon.hee.nhs.uk

14. South Thames Foundation Schoolwww.stfs.org.uk Reduced Sessions in a full time post Doctor occupies an established full-time post but works reduced hours, e.g. 60% wte. No additional funding as the post is already funded from the Educational Contract. the employer retains the surplus funds to support the LTFT arrangement at local level. e.g. A trainee works 60% reduced sessions and Trust retains 40% surplus funds.

15. South Thames Foundation Schoolwww.stfs.org.uk Out of Hours LTFT timetable should give equivalent experience but need not necessarily include exactly the same hours or shift pattern of full-time trainees. Precise hours worked need to be negotiated and then agreed with the supervising consultant. pro-rata evening, night and weekend work & include time for handovers, annual leave Overall rota approval by STFS

16. South Thames Foundation Schoolwww.stfs.org.uk Foundation – LTFT Approval Form The form should detail all rotations/posts within the programme. NB unconfirmed rotations will not be approved To be completed the form must be Signed by foundation doctor Approved and signed by responsible finance representative at the Trust Approved for educational content by the Foundation School Director

17. South Thames Foundation Schoolwww.stfs.org.uk Training Duration and Approval Foundation training is time and competence based Approval lasts for - duration of each grade in HEKSS - financial period in HESL

18. South Thames Foundation Schoolwww.stfs.org.uk LTFT Training Trainee Pay & Funding Guidance Trusts are responsible for establishing pay and supplement levels for LTFT Trainees where the Trust is the employer of the trainee*. - in line with the National guidance ‘Equitable pay for flexible medical training’. See http://kss.hee.nhs.uk/education-and- training/specialty/support/ltft/trainee-pay-funding/

19. South Thames Foundation Schoolwww.stfs.org.uk Pay Basic pay calculated based on hours worked Intensity supplement –Based on % of hours worked outside 7am and 7pm / at weekends

20. South Thames Foundation Schoolwww.stfs.org.uk Extension needed? If the approval is due to expire before the end of the training date contact the LTFT Training Team for advice. Eligibility may need to be re-assessed and an ‘Extension Application Form’ may be needed.

21. South Thames Foundation Schoolwww.stfs.org.uk Locum Shifts Trainees should not normally be permitted to engage in any other paid employment whilst undertaking flexible training. However, there will be occasions when short notice additional duties are required in order to deliver a service to patients. In this case LTFT Trainees may undertake extra duties to assist colleagues, as this is professional behaviour; this should be the exception and not routine.

22. South Thames Foundation Schoolwww.stfs.org.uk Practicalities for foundation doctors Advise STFS ASAP – contact the Foundation School Manager Decide a start date - allow 3 months for application process Choose a WTE Whole Time Equivalent 50% 2.5 days 60% 3 days 70% 3.5 days 80% 4 days

23. South Thames Foundation Schoolwww.stfs.org.uk Organise your working week FIRST talk to the Foundation School Manager about options Apply for Special Circumstances if required Contact your slot share partner asap. Meet up if you can! Decide on the days of the week you are each going to work Consider teaching, clinics, meetings Agree on how to split the Out of Hours Complete the LTFT training forms and get them signed off Follow up the forms and keep copies Submit in good time!

24. South Thames Foundation Schoolwww.stfs.org.uk Rota & timetable -requires negotiation between all parties! Find out how many hours full-time trainees are contracted to work per week and what they do. e.g. proportion spent covering ward work, clinics, theatre, emergencies etc. The hours of the full-time post must be covered by a slot share arrangement.

25. South Thames Foundation Schoolwww.stfs.org.uk Pro’s Opportunity to spend more time with children as they grow up / pursue a special interest / fulfil your caring role Improved work / life balance Appreciate time at work Slower pace Con’s Training longer Less pay More difficult to become integrated in medical team Less continuity of care Approval forms, splitting rotas Pressure to manage same training requirements as full time trainees Feel you are falling behind your peers Reduced confidence Guilty you are not working on days at home

26. South Thames Foundation Schoolwww.stfs.org.uk Working LTFT has many benefits! For doctors, part time working can reduce exhaustion and allow more enthusiasm for work and a better work-life balance, and it will help to retain doctors in training who might otherwise have been lost from the workforce. Trainees’ tales of less than full time training Authors: Rosa Topley, Gemma Ashwell, Jessica Webb, Alexandra Brightwell, Ros Roden, Oliver J Corrado http://careers.bmj.com/careers/advice/view-article.html?id=20008522

27. South Thames Foundation Schoolwww.stfs.org.uk Working LTFT has many benefits! Once you start training LTFT, try not to worry about falling behind your peers in terms of career development. A medical career needn’t be a rush to a final end point; it is an important journey that may be as effective, perhaps more effective, if taken at a slower pace. Trainees’ tales of less than full time training Authors: Rosa Topley, Gemma Ashwell, Jessica Webb, Alexandra Brightwell, Ros Roden, Oliver J Corrado http://careers.bmj.com/careers/advice/view-article.html?id=20008522

28. South Thames Foundation Schoolwww.stfs.org.uk Tips on how to make the most of being a LTFT Be proactive Try to organise your working week to maximise you educational opportunities and aid the department at busy times Get involved in your department Try to be flexible

29. South Thames Foundation Schoolwww.stfs.org.uk HEKSS Specialty support team specialtysupport@kss.hee.nhs.uk Specialty Training Manager: Kevin Hand Specialty Support Advisors: Kent –Jackie Keith Surrey – Joseph Okorafor Sussex – Jessica Tollerfield Contact telephone: 020 7089 7512 HESL Educational Resources Team LTFT@Southlondon.hee.nhs.uk Contact telephone: 020 7862 8607 020 7862 8605

30. South Thames Foundation Schoolwww.stfs.org.uk Any Questions? “A medical career needn’t be a rush to a final end point; it is an important journey that may be as effective, perhaps more effective, if taken at a slower pace.”