South West Paediatric Less Than Full Time Training Guide

Authors:

Dr Sian Ludman Consultant Paediatrician
Dr Alexandra Childs Paediatric Registrar
Dr Esther Morris Paediatric Registrar

This is a guide for Paediatric trainees who are looking to convert to less than full time training (LTFT) or who are already LTFT and looking for a source of information. It includes information for anyone wishing to pursue LTFT training for whatever reason, but does also include extra information specifically related to pregnancy and childcare advice.

It has been compiled to be a source of reliable information for Paediatric Trainees who work throughout the South West in both the Peninsula and Severn regions. The aim is to promote the importance of equality and provide support, whilst also maintaining high standards of care and training.

Introduction
Flowchart to outline application for LTFT training
The application process
LTFT: different options, how much is LTFT?
Salary and banding
Locums
Induction
Study leave, annual leave and bank holidays
Placements and SPIN modules
Work based assessments
Advice regarding working during pregnancy
Maternity leave and KIT days
Returning to work
Helpful courses

Appendix

Links to forms and contacts
Checklist prior to leaving for period of absence
Maternity pay
Tips for childcare


Introduction

Flexible working and Less Than Full Time (LTFT) training is well supported within Paediatrics, particularly in the South West. We hope this guide will help direct you through the application process, legislation surrounding LTFT working and logistics of continuing training part time. This guide is intended to be a single point of reference to make this process more transparent and easy to follow.

Whatever your reasons for applying to LTFT training we hope you will find this guide useful. Due to the fact the vast majority of applications are due to having children, there is additional information and advice regarding working during pregnancy, maternity leave and childcare.

Dr Sian Ludman (Consultant Paediatrician, Royal Devon and Exeter Hospital) is the Peninsula LTFT trainee advisor, Dr Marie Wheeler (Consultant Paediatrician, Gloucester) is the equivalent for Severn. Should you feel that any questions you have are not included in this guide, please contact one of them via the contact details listed so that it can potentially be included in the next revision of this guide.

sian.ludman@nhs.net
marie.wheeler@glos.nhs.uk


What to do if considering LTFT training

 

LTFT guidance flowchart

  


Application Process

  • All doctors in training are eligible to apply to LTFT training and each application should be treated positively.
  • Those that apply should show that continuing in full time training would not be practical for them, based on well-founded reasons. Reasons for application are divided into 2 categories, as set out by GMC guidance to trust/employers and classified as below:

Category 1 Those doctors in training with:

    • Disability or ill health (this may include those on in vitro fertility programmes)
    • Responsibility for caring (men and women) for children

Category 2 Those doctors in training with:

    • Unique opportunities for their own personal/professional development, for example training for national/international sporting events, or short term extraordinary responsibility, for example a national committee.
    • Religious commitment – involving training for a particular religious role which requires a specific amount of time commitment.
    • Non-medical professional development such as management courses, law courses, fine arts courses or diploma in complementary therapies.

  • Other individual reasons which are well founded maybe considered within the capacity of the specialty and particular situation.
  • Applications for LTFT training should be processed and completed normally within 3 months, in line with Improving Working Lives Best Practice.
  • Once approved, posts would be taken up promptly, subject to a reasonably agreed start date. In exceptional circumstances this maybe deferred with appropriate liaison between the employing trust and Postgraduate Dean.
  • Where an application is rejected there should be an independent, transparent and fair appeals process.

What constitutes LTFT?

Trainees are required to undertake at least 50% of full time training. Only in exceptional cases may the Postgraduate Dean reduce the time further. The absolute minimum is 20% of full time training, with the expectation that trainees should not work at this level for more than 12 months.

Two LTFT trainees working at F6 will achieve 120% of whole time equivalent (WTE). The trust traditionally only fund 100% and the Postgraduate Deans LTFT budget funds the remaining 20%  Hence the centralised application process and the need for clarity on how many days you will work, to ensure the extra funding is available to pay for it.

Less than full time training may be undertaken in one of three ways listed below:

Slot-Sharing

  • Two trainees occupy one full time post and manage the out of hours work between them, generally at 50% out of hours split between them at their discretion.
  • Each trainee must work 50% or above but if funding is secured from the deanery then each trainee can work up to 60% WTE.
  • Flexibility will be required where specific working days are required. Typically slot-sharers will work separate days of the week with overlap on one day or more. These generally tend traditionally to be "ends of the week" to improve the patients and trainees' continuity on the ward or in clinic.
  • Any trainee supernumerary or part time in a full time slot will be required to slot-share should the opportunity arise.

Part Time in a Full Time Slot

A trainee occupies an established full time post but works reduced hours and may work up to 90% when part time in a full time slot. However, should there be a requirement to slot-share the trainee will be required to reduce their working hours, unless funding has been secured for more than 120% WTE for two trainees.

Supernumerary

These posts are in addition to the usual complement of training. Supernumerary placements will only be considered where slot-share arrangements or having a part time trainee in a full time slot is not practical. Examples would be those in ill health and those with dependents who suddenly need increased care.

The Postgraduate Deanery LTFT budget will provide the educational component of the salary up to F6 (60% whole time equivalent). Any additional hours and banding supplement will be agreed and paid for by the employing Trust.

Salary and banding

Less than full time training is counted in the same way as full time work, it just takes longer to complete. The table below is an aide to understand the time taken to train and working hours, comparing LTFT to WTE. For example 60% of whole time equivalent (F6) will take 5 years to do a 3-year rotation. A calculator has been produced to help calculate duration of training:

Percentage of WTE

Average hours/wk

Duration of training

Full time

Over 40 hours

6 Months

12 Months

18 Months

24 Months

30 Months

36 Months

F5 (50%) 

20-24

12 Months

24 Months

36 Months

48 Months

60 Months

72 Months 

F6 (60%) 

24-28

10 Months

20 Months

30 Months

40 Months 

50 Months 

60 Months 

F7 (70%) 

28-32

9 Months

17 Months 

26 Months 

34 Months 

43 Months 

51 Months 

F8 (80%) 

32-36

9 Months

15 Months 

23 Months 

30 Months 

38 Months 

45 Months 

F9 (90%) 

36-40

7 Months

13 Months 

20 Months 

27 Months 

33 Months 

40 Months 

 

Salary

In 2005 NHS Employers published national guidance on the salary of LTFT employees entitled, ‘Equitable pay for flexible medical training’. The system which it uses is where the basic salary is determined by the actual hours worked, derived from the rota and checked with monitoring.

Added to this is the banding supplement is a proportion of the basic salary, reflecting the intensity of out of hours duties.

Banding is currently under debate, as is annual salary increments.

Supplements for intensity of unsociable hours worked:

Banding

Supplement

Unsocial hours working

FA

50%

High intensity and at the most unsociable times

FB

40%

Less intensity and less unsocial times

FC

20%

All other trainees with duties outside 0800-1900, Mon-Fri.

Locums

  • Covering shifts at short notice is as much part of being a LTFT trainee as it is a full time trainee.
  • Covering shifts for sickness or other absence is not only the responsibility of full time trainees.
  • Aim for childcare that is flexible enough to cover colleagues.

Induction

  • The Induction process in all hospitals has become more vigorous and structured over recent years. Many have it as a legal requirement that you complete the hospital induction prior to any working.
  • Induction is compulsory whether it falls on your regular working days or not. Should the latter be the case you can then take the days you attend as days in lieu.
  • There may then be departmental specific induction which again may not fall on your usual working days. Contacting departments well ahead of time to find out induction dates to book extra childcare can be helpful.

Study Leave and Annual leave

LTFT trainees study leave is allocated on a pro-rata basis (e.g. 0.6 x 31 = 19.2 over a year period). This is also the case for a study budget; however this is then carried forward into the full time equivalent (e.g. £560 over 18 months).

Appropriateness and eligibility for study leave is subject to the same criteria as for full-time trainees.

Attendance at deanery study days is compulsory, as it is for full time trainees. A minimum of 70% attendance is required to be signed off at ARCP. However for LTFT trainees this is pro-rata (e.g. for a trainee working 60%, 0.6x0.7=0.42% i.e. 5 study days a year).

Bank Holidays

Bank holidays (BH) should be considered. The consensus reached by the LTFT college committee is that you are entitled to a pro rata number of bank holidays. e.g. F6 is entitled to 8x0.6 = 5 days a year.

Often the two LTFT split the ends of the week; one trainee will naturally be in a position to have less BH on a working day. Therefore, if the Monday-Wednesday LTFT trainee works no BH in 12 months they must pay back three days of annual leave i.e. be allocated three less days of leave elsewhere. If the Wednesday-Friday LTFT trainee does not work Good Friday and no other BH falls on a Thursday or Friday they are to be allocated four more days of leave elsewhere.

If however a trainee works a BH then they are due a day in lieu as per normal guidance.

Placements and SPIN modules

Less than full time trainees take part in the post preference application process in the same way as full time trainees. If you have a period out of training (such as for maternity leave, or OOP), unfortunately there is no guarantee that you will return to the placement which you left.

The deanery is guided by TPDs on placements for all trainees and where possible thos returning from maternity leave are placed in the same trust they went on maternity leave from, but this can change for a multitude of reasons. Furthermore if you had a post lined up for the next academic year and then went on maternity leave, you need to go back through the post preference system for reallocation, even if you are on maternity leave at the time of the allocation process.

There is a move for training to be competency-based. The RCPCH training guide, as found below, specifies the expectations at each level of training. Whilst you may be able to "speed" up your training in one particular level having met all the competencies at ARCP, it would be unacceptable to have taken the minimum time in each level specified.

View the training pathway on the RCPCH website. 

Special Interest (SPIN) modules are an excellent option if you are less than full time and restricted on where you need to be geographically, limiting your time available to train in tertiary centres. They are usually 12-months full time and can be extended pro rata for LTFT.

Work completed up to 3 years before the completion date can be accredited towards the module is you have prospective agreement. There is a good range of SPINs available in the Peninsula and Severn deaneries. Excellent advice and information is available on the college website.

Work-based assessments

RCPCH expects full time trainees to aim for 20 SLEs (supervised learning events) per training year (pro-rata for LTFT trainees). This includes all types of SLEs. Someone working 60% would need a minimum of 12 SLEs per year.

Work-based assessments can be challenging for those LTFT for whom continuity of work can be difficult. It is important to be aware of what assessments are required and take every opportunity to accumulate them throughout your job.

As per college guidance, all relevant curriculum items must be fulfilled during the full duration of training.

Advice regarding working during pregnancy

Pregnancy is a unique situation and there are some laws, some guidance, and lots of varying advice. How much and how long you work will depend on how you feel, and is a balance between safety for you, the baby and your work. Each trust will have a maternity policy.

Here are the main rules:

  • The employer has to be notified in writing about the pregnancy (this can be by email, but keep a copy of the email for your records). At the very latest this should be by the end of the 15th week before the expected week of childbirth. (i.e. before 26/40) There is a MATb1 form provided by the midwife that needs to be given in.
  • The trainee must also inform their clinical lead (CL) as soon as is reasonably possible, so that an initial risk assessment can be done. Ideally this should be by 20 weeks into the pregnancy. Additional assessments may be required at 28 and 34 weeks.
  • Should the risk assessment highlight any health issues, or if the trainee has concerns regarding the outcome of this assessment, then either the trainee or CL must contact Occupational Health to discuss further.
  • Factors to consider in Risk Assessment:
  • Potential impact of physically demanding work
  • Prolonged standing
  • Long hours
  • Shift work or night work
  • Hazards such as radiation exposure, chemicals/ anaesthetic gases etc.

Trainees should try to continue to carry out their normal duties whenever possible during pregnancy. Many trainees are contracted to work up to 48 hours a week. There is no automatic right to cease night shifts or long shifts at any gestation simply because a particular gestation has been reached. Where practical and appropriate it may be sensible for the trainee to swap their longer shifts to an earlier stage in their pregnancy.

Depending upon the nature of the specialty, some women will wish to continue to work their usual hours, whilst others may seek to reduce their hours. Any decision to reduce working hours should be made on an individual basis, and is likely to be influenced by the trainee’s past medical and obstetric history. It is not unreasonable for employers to request that a GP or obstetrician provide a medical certificate stating that nights or long (12 hours) shifts must not be worked. If this is the case then suitable day work should be provided (or a trainee suspended from work on paid leave) as long as is necessary to protect the health and safety of the mother and/or child. i.e. if a trainee is not working nights they must offer day shifts in return and are not entitled to the compensatory rest time post nights that would be written in to the rota.

A trainee is entitled to continue to be paid at her usual banding and for her normally contracted hours if she has been medically advised to alter or reduce her working hours.

The earliest date any woman can start maternity leave is the beginning of the eleventh week before the baby/babies’ due date (29/40). They must complete the maternity leave notification form stating the date of when they would like to start and end maternity leave.

On returning to work, there should be reasonable provision made for expressing if necessary and consideration of flexible working if still breast feeding. European legislation allows exemption from on-call if breast-feeding. This needs to be discussed with departments prior to returning to work.

Maternity leave and KIT days

There are two main questions which you need to decide on when it comes to maternity leave. The first is how much you wish to take and the second is when you want it to commence. Both of these choices are very individual and may also depend on health.

Many people have great ambitions of completing projects and undertaking additional educational opportunities whilst on maternity leave. Whilst some do manage this, many do not and having realistic expectations is important.

You are entitled to take up to 52 weeks of maternity leave plus annual leave accrued over that year. You can take as little of that as you wish, however 2 weeks of maternity leave are legally mandatory. Furthermore recent legislation means that the leave can be distributed between both parents should you wish.

Many of your annual fees can be frozen during your time away or reduced to a retainer fee. It pays to make a list and work through them discussing with each organisation the options (e.g. RCPCH, BMA, MDU etc.) When it comes to KIT days (further details to follow) you should be supernumerary. Remember if you are asked to do anything more you are not covered if you have suspended your indemnity policy. Don’t forget to restart all of them prior to going back to work.

KIT days are a great way of staying in touch and you are entitled to 10 paid days over the year. They can be used in any way that is work relevant (within reason!). For example, courses including life support courses, study days, conferences, educational supervisor meetings, sitting in on clinics and observing ward rounds. If you are returning to a new hospital following maternity leave they can be a way of orientating yourself. If you are beginning paid maternity leave from your previous hospital they will have to be billed for any that you complete, wherever they are held.

KIT days must be taken prior to the start of your accrued annual leave, once you are back on "annual leave" you are not entitled to extra payment. Importantly, for purposes of calculating time in training, your time in training starts from the date your annual leave starts and not the date when you return to work.

Returning to work

Try to work with the School and hospital as much as possible by giving plenty of notice. This not only helps with post allocation and regional job planning but also with planning induction and integration back into work. Trainees may return to work at any point during a rotation.

Many trainees are understandably nervous about returning to work after a prolonged absence. To help with this, utilise the KIT days on offer and look at the helpful courses and resources section. If your NLS or APLS are coming up for renewal in the period prior to taking time out, defer them until you are about to come back. Peninsula and Severn Deaneries are currently in discussion regarding a formal return to work program. They are also working with college tutors on allocation of Educational Supervisors 3 months prior to your return to work day, therefore giving you time to book a meeting with them in advance to discuss any concerns or specific requirements on returning to work. This meeting can take place on a KIT day. The Academy of Royal Medical Colleges has produced a guide for returning to work after periods of absence and has some helpful information.

Helpful courses and resources

  • Bristol Medical Simulation Centre: Step up to registrar course and COPE courses
  • Step back Neonatal Emergencies Course
  • RSM study days on different specialties
  • Paediatric care online – RCPCH website resource
  • Paediatric Pearls (UK-based monthly blog newsletter with answers to commonly asked questions from paediatric trainees
  • RCPCH News and Campaigns Sign up for RCPCH press cuttings - a daily summary of the most important Child Health news topics delivered directly to your e-mail inbox.
  • RCPCH yearly conference
  • NLS and APLS- revalidation in time for return to work.

 

Appendix

Links to important documents

  1. Peninsula deanery LTFT policies and guidelines
  2. Peninsula deanery LTFT applicant guide  
  3. Peninsula LTFT application part 1   
  4. Peninsula LTFT application part 2  
  5. GMC position statement on LTFT training  
  6. A Reference Guide for Postgraduate Specialty Training in the UK. The Gold Guide. Edition 6. 2016 
  7. NHS employers: Equitable pay for flexible medical training 
  8. NHS employers: Principles underpinning the new arrangements for flexible training
  9. Return to practice guidance. AoMRC. 2012

Checklist prior to going on prolonged period of absence

  • Know when rotation preference requests will be occurring and ensure you complete this whilst you are away
  • Have you contacted RCPCH, defence union, BMA etc. to request deductions or suspension of payments?
  • Contact HR and deanery to plan anticipated date of return
  • Ensure you complete or know when you LTFT application forms are required
  • If relevant, who will be paying your maternity pay and do you need to apply to local job centre? Payroll should advise
  • Consider applying to accumulate childcare vouchers (for you and your partner) whilst on maternity leave

Maternity pay

To be entitled to NHS Occupational Maternity Pay (OMP) you must have 12 months’ continuous service within the NHS by the 11th week before the Expected week of childbirth. Furthermore you must intend to return to work for a minimum of 3 months or you will be required to pay back your NHS OMP.

OMP is made up of:

  • 8 weeks of full pay
  • 18 weeks of half pay
  • Remaining 26 weeks of unpaid leave

How much you are paid is calculated in your pay cheques for the 15th-20th ?or 25th weeks of your pregnancy, if you have deductions such as childcare vouchers you may wish to put them on hold during this time.

To qualify for Statutory Maternity Pay (SMP) an employee has to have been in 26 weeks continuous service with the current (one) employer by the beginning of the 15th week before the expected week of the childbirth.

SMP consists of:

  • 6 weeks of 90% of their normal pay
  • 33 weeks of flat rate SMP (or 90% of average weekly earnings, whichever is lower)
  • Remaining 13 weeks of unpaid leave

Employees who do not qualify for SMP whether due to the statutory continuous employment rule or because of another aspect of eligibility, may be entitled to claim Statutory Maternity Allowance (SMA). HR can help guide you on this but it maybe through your local job centre.

If you qualify for both SMP and OMP this will consist of:

  • 8 weeks of Full pay less any SMP/SMA receivable.
  • 18 weeks of half pay plus the SMP/SMA
  • 13 weeks of SMP/SMA

Often trainees will find they are eligible for OMP and the SMA will start at the end of OMP and provide a small income for another few months.

Tips for childcare

There is no perfect to solution to childcare. Each option has pros and cons and you are very likely to need back up options. Medical training necessitates arrangements that are flexible and we suggest you consider the following:

  • Out of normal office hours (early mornings, late finishes and night shifts)
  • The need for additional days for educational opportunities that may not be on your regular working days
  • School or nursery holidays
  • Child sickness
  • Child carer absence through sickness and holiday entitlements
  • Cost of childcare
  • The needs of other family members (partner etc.)

Try to build in some time each month when you have childcare organised but are not necessarily at work. This will allow for other educational opportunities like teaching sessions, meetings, audits and presentations. Building in daytime hours to do this so can be really beneficial.

You need to have back-up plans for child sickness etc. so that you can fulfill your duties as a professional. Departments will understand a domestic crisis, but significant absence is not acceptable to employers. If you have no family members nearby or don’t know anyone you could rely on in this situation, there are agencies that specialise in emergency childcare that may be used.

Unless you are fortunate enough to have a family member on hand, you will find childcare expensive. It is worth paying for reliable childcare to enable you to work in the knowledge that your child is being looked after well. There is a financial cost and may be an emotional cost to leaving your children. It is an individual choice but most people find a balance.

There is a childcare voucher scheme within the NHS which enables employees to help pay towards childcare pre-tax and national insurance contributions. The amount you are entitled is based on your income and tax contributions. There is further information on this scheme on the NHS employers’ website and your hospital’s HR department can give you the specific person to contact to set up within your trust.