Introduction

Less than full time (LTFT) trainees are a broad church. They include those who train LTFT for: caring reasons, to pursue academic interests, mental or physical health reasons, simply work-life balance, or other exceptional opportunities such as representing their country for sport or national leadership positions. The majority (90%) are women, but a growing number of men are requesting to work flexibly.  The proportion of female higher specialty trainees specialising in gastroenterology is rising every year ² and there is an increasing need to accommodate flexible working patterns.

The BSG supports flexible working as demonstrated by the recently published position statement, published by Dr Shairoz Samji and Dr Matthew Cowan.

In order to support and optimise LTFT training in gastroenterology and promote equal opportunities for all, we recommend all those involved in Gastroenterology training to read this page. It also contains information about returning to training after a period of absence from clinical work such as OOP or parental leave.

What are the Principles of LTFT Training?

• All trainees have the statutory right to request to train flexibly. Training Program Directors (TPD), educational supervisors, and trainees should be empowered to facilitate LTFT training arrangements and the process for LTFT training approval should be streamlined as far as is practicable. It should be noted that requests to undertake LTFT training cannot be guaranteed and will be dependent on the capacity of the program.
• LTFT trainees should be offered the same opportunities as full-time trainees on a pro-rata basis.
• LTFT trainees should be offered the same amount of subspecialty training as proportional to their LTFT status and as such, some attachments may not be restricted to a calendar year within reasonable limits.
• LTFT trainees should complete their subspecialty training at similar stages of training to full-time trainees and at similar progression. All educational supervisors should undergo education in the principles of LTFT working and training. This may include courses accessible through the Online e-learning for Health website or SuppoRTT courses (in England).
• The ARCP process expectation of the number of assessments/curriculum goals to be achieved is on a pro-rata basis and should be spread evenly.
• It is preferable to offer LTFT trainees working between 50-60% slot shares when practically possible.
• Ideally, there should be an LTFT representative on all regional Gastroenterology Specialty Training Committees.
• Trainees should take ownership of their training to identify opportunities and be proactive in discussions with their TPD. They should familiarise themselves with the advice in the Gold Guide, national LTFT guidance⁴ and the policies of their Deanery/School.
• Trainees and trainers should set clear aims at the start of placements and document them in their e-portfolio. Trainers and employers should hold to the learning agreement, with reasonable notice of any changes and a recognition that those with caring responsibilities may be more flexible about some aspects of their training than others.
• It is appreciated that in some circumstances, training opportunities may not be accessible within the standard working time of some LTFT trainees. If this occurs, the trainee should be offered time-off-in–lieu. (TOIL)

How do I apply for LTFT Training?

Doctors in training should first contact their TPD to discuss their reasons for wishing to train LTFT, and how this will impact upon their training. There will be a notice period before a new working pattern can be instituted, although this may be flexible in exceptional circumstances such as health problems. Detailed information about the process of applying for LTFT training is given here.

Reasons for wishing to train LTFT are traditionally divided into those named “category 1”: health reasons and caring responsibilities (including childcare), and “category 2” which consists of any other unique opportunity that carries a regular commitment that reduces the time available to train. A recent pilot has introduced the concept of a “category 3”, which is defined as the opportunity to train LTFT for personal choice. At the time of writing (winter 2021), the pilot is being rolled out, and the LTFT period is restricted to four months of 80% training within a twelve month period.

What are the impacts on rotas, annual leave, study leave, and bank holidays?

The BSG supports the document “Good rota design and rostering recommendations for LTFT doctors”  May 2018 ⁴ and respects the terms and conditions of the junior doctor contract.

Who to ask for help when things are not going to plan

Junior doctor training is complex because of interactions between your trust as your employer and your deanery who is responsible for your training. It isn’t always clear at first glance whether challenges to LTFT trainees face relate to their employment or their training

Don’t despair there are many people you can ask for help. If you are having difficulties with your rota or your pay (in England), you could approach your Flexible Champion of Training or Guardian of Safe working. For all four nations, you could ask your union for assistance, your local negotiating committee via the Junior Doctor Forum. Your educational or clinical supervisor might be helpful with rostering or job share issues as well.  If you are having issues accessing equitable training, you could – and should – approach your training programme director and educational supervisor.

You will also have junior doctor reps (via your union) in your local hospital and trainee reps linked with your deanery in gastroenterology who you can approach too. 

What is the provision for return to clinical training after a period of absence?

Any trainee who has not been undertaking clinical activity for a period of 3 months or more should meet with either their TPD or next educational supervisor prior to their return to work. An action plan should be made for their return to training, including an agreement about future working hours and a detailed plan of any aspects of the curriculum that may need particular attention or extra support. Other forms of support could include BSG mentoring, regional SuppoRTT courses (in England), utilising Keep in Touch (KIT) or Shared Parental Leave in Touch (SPLIT) days, and coaching at local/deanery level.

Trainees should also be encouraged to continue to attend Regional Gastro Training Days as study leave in this period in order to help them maintain their knowledge.

Accessing support courses in your region

If you are returning to work after a period of absence of greater than 3 months for whatever reason (eg OOP or maternity leave) then do start the SuppoRRT (Return To Training) process in your deanery. Details can be found on your local deanery website. Health Education England provides lots of funding for a range of courses in your local region to help you back into work. Examples include simulation courses about scenarios found on the acute medical take to returning to work LTFT.

If you are returning back to work after maternity leave you should make use of your KIT days to access these courses and complete other mandatory training as well as attending your regional gastroenterology training days in order to help maintain your gastro knowledge whilst you are taking time out of work.

Accessing the RCP Flexible working toolkit

This toolkit looks at opportunities for physicians to work flexibly, as an alternative to leaving the NHS.

This toolkit follows discussions at the ‘Stopping the exodus, solutions!’ conference, which took place on 16 September 2019 at the Royal College of Physicians (RCP). It provides some tried and tested examples of flexible ways of working as well as top tips for doctors at different stages of their career.

Find out more

About the authors

Dr Shairoz Samji is BSG Workforce Lead, and was previously LTFT representative to the BSG Training Committee. Dr Samji is a newly qualified Consultant Gastroenterologist and Endoscopy Training Lead in East Kent. She trained LTFT for childcare reasons and won the BSG TS Leadership and Management Prize 2019. 

Dr Matthew Cowan was the Chair of the BSG Training Committee 2021-2023. Dr Cowan is a Consultant Gastroenterologist in Surrey who also works less than full time.

Further information

References

1. General Medical Council. Training environments 2018. Key findings from the national trainee surveys. GMC/NTS2018KF/1118
2. Royal College of Physicians. Census of consultant physicians and higher specialty trainees 2018-19. www.rcplondon.ac.uk/census
3. (https://www.copmed.org.uk/images/docs/gold_guide_8th_edition/Gold_Guide_8th_Edition_March_2020.pdf ) and 2005 NHS Employers document Principles Underpinning the New Arrangements for Flexible Training
4. GMC LTFT training position statement Nov 2017 https://www.gmc-uk.org/-/media/documents/Less_than_full_time_training_position_statement_Nov_17.pdf_72374278.pdf
5. NHSE BMA Good rota design and rostering recommendations for LTFT doctors May 2018

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