Higher Emergency Medicine LTFT Pilot


The junior doctors' contract negotiations highlighted wider, non-contractual concerns around flexibility in medical training. Health Education England (HEE) is exploring innovative solutions and developing new approaches to postgraduate training to improve morale and provide greater flexibility for junior doctors and dentists. 

The higher Emergency Medicine less than full time (LTFT) pilot will explore the provision of more opportunities and wider access to LTFT. It is that a more flexible approach may reduce 'burn out and attrition, improve morale and aid recruitment. This pilot is designed to improve the working lives of higher Emergency Medicine trainees by offering an opportunity for improved work-life balance. 

This pilot is supported by the Department of Health, HEE, NHS Employers, NHS Improvement, the General Medical Council, the British Medical Association Junior Doctors Committee and the Royal College of Emergency Medicine. 



What is the application process?

Who can apply for the pilot?


• Higher Emergency Medicine trainees (ST4, ST5, ST6).

• Run-through ST3 Emergency Medicine trainees who are expected to progress to ST4 in August 2019


How do I apply to train less than full time as part of this pilot?


• Applications for the pilot can be submitted from today (18th March 2018) up until 12.00 on 18th April 2019, with a view to commencing LTFT training from August 2019 onwards

• You must first discuss your intention to apply for LTFT training via the pilot with your Training Programme Director (TPD) and medical staffing/HR at your employing Trust to ensure safe local service provision and workforce stability could be maintained were your application to be approved by HEE

• To apply you should fully complete and submit the LTFT Pilot Form available to download from the bottom of this page (please save the form locally on your desktop before completing)

Where did the idea of an Emergency Medicine LTFT training pilot come from?

The 'Improving Quality of Training for Junior Doctors Working Group' met in March 2016 to discuss non-contractual matters relating to education and training that had been raised through junior doctor contract negotiations. Access to less than full time (LTFT) training was discussed, in particular the possibility of allowing all junior 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.

Why have a pilot and why in Emergency Medicine?

Whilst there is recognition of the potential benefits for junior doctors in allowing a more flexible approach to LTFT training, there is a degree of apprehension as the impact and popularity of a more flexible approach is not known.

A pilot provides an opportunity to identify the benefits, and address obstacles and risks of having a more flexible approach.


RCEM volunteered to participate in the pilot. As a high intensity specialty which has experienced workforce issues in a number of areas, it was agreed that a pilot in EM would provide an excellent opportunity to identify any particular obstacles and to evaluate the benefits and issues.

Which trainees can apply to have their hours reduced as part of the EM LTFT training pilot?

The pilot permits all higher EM junior 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.

Are CT1-3 trainees eligible to apply for the pilot?

CT1-3 trainees in Emergency Medicine are not eligible to apply. However ST3s who are in run-through training who are expected to progress to ST4 in August 2018 may apply.

Can higher EM trainees choose which percentage they wish to work at and which days they want to work?

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.

What happens after the window has closed?

HEE Local Offices will manage applications and will be in touch with trainees directly to convey the outcome. Please be aware that where demand for LTFT training is high, a waiting list may be introduced.

What are the key dates for this pilot?
18th March 2019

 Pilot information to be sent to:

  • HEE Local offices via PG Deans and Managers
  • HEE Less Than Full Time Forum attendees
  • EM Training Standards committee
  • Trust Medical Directors
From 18th March 2019 HEE local offices to send information about the pilot for higher EM trainees. 
From 18th March 2019 Application window opens for English higher EM & O&G trainees and current ST3 run-thorugh EM trainees who are expected to progress to ST4 in August 2019. Trainees apply to their local office, quoting "category 3".
Midday 18th April 2019 Application window closes.
August 2020 The pilot formally ceases. 


What is the duration of the proposed pilot and how long does a Trainee’s LTFT training request last?

The pilot will last for a minimum of 12 months. Trainees who have increased or reduced their hours will have the opportunity to work at the agreed level for 12 months. Pilot LTFT training arrangements agreed as part of the pilot will cease in August 2020 and are subject to service requirements and consideration by the Training Programme Director or Head of School.

If a Trainee under the pilot wishes to increase or decrease their hours at any stage, this should be requested via the relevant HEE Local Office. It is recognised that an increase or decrease may not be accommodated at short notice and will be subject to local approval.

What would happen if a Trainee changes Employer/placement during their training? What about Inter Deanery Transfers?

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.

How would this affect a Trainee doctor’s Tier 2 visa?

Tier 2 applicants need to liaise with their HEE Local Office and UK Visas and Immigration (UKVI) to ensure that any proposed reduction in working pattern (and therefore reduction in pay) does not compromise their visa requirements. This is the responsibility of the Trainee.

Are higher trainees in EM who have reduced their hours as part of this pilot able to undertake locum shifts?

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 junior doctor on a locum basis, the junior doctor may undertake occasional locum shifts elsewhere. The junior 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.

How will the pilot be evaluated?

An evaluation will take place involving feedback from all higher EM trainees (those training full-time, LTFT and part those involved in the pilot), BMA officials, organisations with LTFT trainees through the pilot, RCEM officials and HEE officials (including Heads of Schools).
It is a mandatory requirement for trainees accessing LTFT training under the pilot to contribute to the evaluation process.

If there is high demand for less than full time training under the pilot, and an organisation feels unable to support a Trainee moving to LTFT training, what happens?

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).

What effect will training less than full time have on my pay?

Training and working LTFT will result in a proportional reduction in pay (including pensionable pay) when compared to that paid to full-time colleagues. This will be calculated differently, depending on which contract trainees are employed:

2002 ‘New Deal contract’
Pay will be calculated according to the number of hours worked (in 5 bands F5-F9 set out below) plus a supplement as applicable based on the working pattern (FA – 50%, FB – 40%, FC – 20%).

  • F5 is 20 or more and less than 24 hours of actual work a week and attracts 0.5 of FT basic salary
  • F6 is 24 or more and less than 28 hours of actual work a week and attracts 0.6 of FT basic salary
  • F7 is 28 or more and less than 32 hours of actual work a week and attracts 0.7 of FT basic salary
  • F8 is 32 or more and less than 36 hours of actual work a week and attracts 0.8 of FT basic salary
  • F9 is 36 or more and less than 40 hours of actual work a week and attracts 0.9 of FT basic salary
  • The full details on calculating pay for doctors training less than full time are set out in the NHS Employers guidance: 'Equitable pay for flexible medical training

2016 Contract for doctors and dentists in training
Pay for trainees working LTFT will be apportioned as follows:

  • basic pay (and the value of any applicable flexible pay premia) will be calculated pro rata to their agreed proportion of full time work
  • the on-call availability allowance will be calculated pro rata, based on the proportion of the full time commitment to the rota that has been agreed in the doctor’s work schedule
  • unsocial hours enhancements will be paid according to the working pattern detailed in the work schedule
  • weekend allowance will be paid pro-rata based on the proportion of full time commitment to the weekend rota. For example, if the LTFT doctor contributes 60 per cent of the FTE weekend rota, they will receive 60 per cent of the cash sum.
Will working and training less than full time have an impact on my pension?

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

Will other specialties join the pilot?

Discussions are ongoing with a number of Colleges and Faculties to explore a range of approaches to increasing flexibility. Qualitative and quantitative feedback from the pilot will be shared widely.

Tuesday, 19 March, 2019
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Tuesday, 19 March, 2019