The 'Improving Quality of Training for Postgraduate Doctors Working Group' met in March 2016 to discuss non-contractual matters relating to education and training that had been raised through postgraduate doctor contract negotiations. Access to less than full time (LTFT) training was discussed, in particular the possibility of allowing all postgraduate doctors the opportunity to work LTFT should they wish to, not just those who meet the existing criteria under A Reference Guide for Postgraduate Specialty Training in the UK, 2016 (more commonly known as the ‘Gold Guide’). Accordingly, Health Education England (HEE), the Royal College of Emergency Medicine (RCEM) and the British Medical Association (BMA) are implementing a pilot to explore the impact of allowing more flexibility within higher Emergency Medicine (EM) training.

It is thought that a more flexible approach may reduce ‘burn out’ and attrition, improve morale and aid recruitment.

This is one of a number initiatives being developed and implemented by HEE to enhance the working lives of postgraduate medical and dental trainees.

The pilot permits all higher EM postgraduate doctors (ST4+), and current ST3 run-through trainees expected to progress to ST4 in August 2018 to apply for LTFT training, without needing to meet Category 1 or 2 of the Gold Guide (2016).

The pilot is an England-only initiative under Health Education England, and involves all HEE Local Offices.

This pilot is not applicable to trainees who are Out of Programme or undertaking Acting Up placements.

NIHR Academic Clinical Fellows and Clinical Lecturers in higher EM are included in the pilot.

In this pilot, trainees can apply to reduce or increase their hours to 50%, 60% or 80% of a full time post.

Trainees within the pilot will not be able to choose which days they wish to reduce their hours; however this does not apply to LTFT trainees who meet the Gold Guide criteria as they may negotiate with their Employer as usual regarding meeting the responsibilities for which they have LTFT status. Working hours/days will be agreed with the Employer/Host Organisation.

The LTFT training arrangement is an agreement between the Trainee, Employer and HEE Local Office/School. By approving the initial application, HEE and the School have agreed to the Trainee reducing their hours for a 12 month period (or less if specified in advance); this will need to be conveyed from the HEE Local Office to any new Employer/Host Organisation as part of any subsequent rotation.

If a Trainee changes HEE Local Office through the Inter Deanery Transfer process, the receiving HEE Local Office will undertake the normal processes to re-confirm the Trainee’s LTFT status. As this is an England-only initiative, organisations outside of England have no obligation approve LTFT training under this pilot via the Inter Deanery Transfer mechanism.

Higher EM trainee doctors approved through the pilot may undertake periodic locum shifts with their employing/host organisation in the first instance. Should the employing/host organisation not require the services of the postgraduate doctor on a locum basis, the postgraduate doctor may undertake occasional locum shifts elsewhere. The postgraduate doctor should clarify in the first instance whether their employing/host organisation requires their services.

Additional locum work by trainees approved by the pilot should be periodic and not frequent. This should normally be up to a maximum of 8 hours, or one shift per month. Trainees who wish to regularly undertake locum shifts will have the percentage LTFT reviewed and increased to account for this. This could result in a return to full time training status.

Locum shifts may only be undertaken with the approval of Educational Supervisors in advance and all locum shifts should be declared to the Educational Supervisor in real time. As part of the evaluation process, trainees approved under the pilot will be asked to declare where any locum shifts were undertaken (employer or other organisation), and the frequency of such shifts.

The Educational Supervisor and Trainee must notify the Head of School/local HEE training lead on a regular basis (at least 3 monthly) about locum shifts undertaken during the pilot. In accordance with revalidation requirements, all locum work undertaken must be declared on the Trainee’s Form R (Part B). Trainees who feel pressured to undertake additional locum work should discuss with their Educational Supervisor and Head of School.

If there is high demand for LTFT training, individuals who meet the Gold Guide (2016) Category 1 or 2 criteria will be given priority. HEE Local Offices may explore the use of a waiting list if necessary. Whilst every effort will be made to support all LTFT training applications, approval may be subject to exigencies of the service; this will of course require careful consideration. This aspect will require close monitoring and will form part of the evaluation process.

Ultimately, the Employer has a responsibility to approve/agree that the Trainee can be accommodated to train LTFT (this is part of the existing process which is already in place). Alternative training locations may be explored if an Employer feels unable to support a LTFT working pattern due to exceptional circumstances (i.e. exceptional workforce issues creating potential risks to patient safety).

Trainees wishing to apply for LTFT should consider carefully the implications this may have on their future pension provision and may wish to seek independent financial advice. Further information is available on the NHS Business Services Authority webpage: http://www.nhsbsa.nhs.uk/Pensions/4206.aspx