LTFT, OOPs, IDT
These acronyms can seem shrouded in mystery and complexity. This article aims to shed some light on the varied options for training.
If you would like careers advice, your AES should be your first port of call.
This article will cover:
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Short term unpaid leave
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Employment break
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1. Less Than Full Time (LTFT) training
Applying
You can apply for LTFT training for any “well-founded” reason (see policy): https://www.hee.nhs.uk/sites/default/files/documents/LTFT%20FAQ%20Final%20.pdf
You need to think about this well in advance as applications must be completed 16 weeks in advance. As a trainee, the minimum you can work is 60%. Which sessions or days of the week you work will be up to you to negotiate with your trainer depending upon both your respective timetables. Applications must also have the support of the doctor's Training Programme Director. You then need to inform the trust where you will be working.
You can start by discussing it with the consultant(s) you’ll be working for. Especially if you are flexible on which days you work, you can base this around what works best with their job plan.
Then inform your rota coordinator and HR.
Your on calls and AL should also be calculated pro rata based on your percentage LTFT.
To adjust your CCT date on ISCP you will need to forward an email from the deanery to ISCP helpdesk. It is not compulsory to extend training. To check your CCT date on ISCP: Dashboard > training information
Pay
Read this useful article on pay:
Explaining pay for those working LTFT, including examples, weekend allowance, on-call, transitional pay and flexible pay.
https://www.bma.org.uk/pay-and-contracts/pay/ltft/less-than-full-time-trainees-pay-explained
Rota
One advantage of less than full-time training is that if you are off you cannot be allocated any additional unexpected sessions. The day off needs to be the same every week if your child goes to nursery as they will have fixed days. With travel time and late finishes, it is often easier to work one whole day instead of two half days. Generally, your day off will be when your consultant has no commitments.
As a consultant, it is also possible to negotiate your contract around your life so that you work fewer sessions, or cluster your sessions on certain days. Some hospitals have evening
clinics and theatre lists which mean that you can have a day off instead.
Your on calls and AL should also be calculated pro rata based on your percentage LTFT.
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Weekends:
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LTFT Weekend Frequency Allowance is based on proportion of weekends worked not a proportion of weekend days worked
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Working any part of a weekend makes that a weekend worked in terms of weekend frequency, with no clause making a distinction between FT & LTFT.
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Bank holidays:
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Bank holidays are paid statutory leave (and must be counted within the leave adjustment calculations for prospective cover of out of hours alongside annual leave and all relevant study leave entitlements)
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LTFT trainees are entitled to pro rata bank holidays (their training % of each day/full time total days over a given reference period.). So, a trainee working 60% is entitled to 0.6 of each bank holiday or 0.6 x the full time BH annual entitlement over the year/placement.
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When you get a day off for a BH you are paid for the whole day, and so it costs a whole day from your pro rata BH allowance (or combined pot)
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This entitlement is not impacted by the days of the week you work. (Ie. Not working Mondays does not reduce your entitlement to pro rata of all bank holidays).
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When you get a paid shift off as statutory leave this costs one day from your combined pot. Anything else will not use up leave as statutory holiday leave taken, but will instead become pro rata time off in lieu, including:
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Being rostered to work or be non-resident on call for any part of the 24h period.
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Being on an unpaid shift/rest/zero/non-working day on the bank holiday.
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Support
Each hospital will have a LTFT champion who you can contact for support
Discounts
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JCST - As LTFT, you can obtain a discount on JCST fees.
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BMA - applicable to those LTFT and earning <£50,000
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GMC - your “fixed” discount applies for your first four years post-registration regardless of LTFT/FT. Beyond this you can apply for an income discount if your income is <£34,000. You can only receive one of these discounts at once.
2. Out Of Programme (OOP) options
HEE offers Doctors in Training the opportunity to take a planned period out of their training programme, subject to agreement of their Training Programme Director and Head of School.
This guide provides a very useful summary:
There are six main types of time taken out of programme:
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Out of Programme Training (OOPT): Time out of programme for approved clinical training in a post which has prospective approval from the GMC
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Out of Programme Research (OOPR): Time out of programme for research a post which will not count towards the award of a CCT
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Out of Programme Experience (OOPE): Time out of programme for clinical experience in break related to personal circumstances or other requirements
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Out of Programme Career Break (OOPC): Time out of programme for a planned career similar patient facing work in the UK which can be assessed upon return and may count
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Out of Programme Pause (OOPP): Time out of programme to undertake NHS work or similar patient facing work in the UK which can be assessed upon return and may count towards the award of a CCT.
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Acting up as a Consultant (AUC): Time out of programme to act up as a consultant.
Below is some more detail on some options:
Out of programme Research (OOPR)
A higher degree can be a brilliant option for Academically minded trainees. Read this BMJ article on research options for trainees: https://www.bmj.com/content/345/bmj.e6858
Top tips:
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Planning
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Before you start an MD/PHD you will need to come up with a University, a topic, a supervisor and an application.
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Grants:
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There are several grants specifically for clinicians, such as NIHR research fellowships and more speciality specific organisations such as the AO, National societies, the RCS.
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Pay
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Any trainee on the 2016 pay contract completing a PHD after foundation years is entitled to the academic flexible pay premium of £4288 per annum
pro rata every year from the completion of their PHD until they CCT. -
More information can be found on this BMA page: https://www.bma.org.uk/pay-and-contracts/pay/other-doctors-pay/medical-academics-pay-scales
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Application:
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You need to inform your TPD and the Deanery of your expected OOPR time and your proposal 6 months prior to commencing.
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Three months before the end of your time out you need to inform the TPD and deanery once again
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Collaboratives:
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This is a fantastic way to meet others and build research partnerships, as well as embedding yourself within the academic community.
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They can also be used to facilitate National projects, or expand the reach/number of sites in your project.
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Some are trainee led, which also provides an opportunity for developing managerial skills.
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Academic life
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Be prepared for a slower pace of life in academia, things take time.
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This is often hard coming from a fast-paced trauma service, and can add considerable time to your targets.
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Ethics applications, sponsor approvals, capacity and capability assessments for trusts to allow commencement of a study, take a long time so plan for this
and have other projects/grants/etc that you can be getting on with whilst waiting.
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Maintaining clinical skills
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It is important to maintain your clinical skills and as this will make the transition much easier when you return to clinical work.
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If you can, agree with your supervisors some dedicated clinical time
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Some fellowships may limit this eg. The NIHR doctoral research fellowship
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If you are undertaking your OOPR in another deanery, you will need to liaise with the TPD of that region to agree this, as well as getting an honorary
contract with the trust. -
Bear in mind that you will not get paid for these clinical sessions if you are on an honorary contract
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Out of Programme Experience (OOPE)
Fellowships:
https://www.fellowshipfinder.org.uk/
Leadership Fellowships:
BOA Future Leaders Programme:
https://www.boa.ac.uk/learning-and-events/courses/boa-future-leaders-programme.html
Faculty of Medical Leadership and Management:
https://www.fmlm.ac.uk/services-programmes/clinical-fellow-schemes
Chief Registrar Post:
https://www.rcp.ac.uk/improving-care/resources
Volunteering:
Overseas experience can enrich and enhance your clinical practice. It provides an opportunity to develop your clinical skills, learn how to work with limited resources, see other parts of the world and meet amazing people. However, it can be difficult to coordinate alongside registrar training. Taking time out is possible at any stage of training, as you will be able to offer different contributions.
Short-term trips (1-2/52):
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You can either go on short-term training camps, where you travel with a team to run an educational training course or run a surgical camp for example. These are usually1-2 weeks and can be taken as SL, AL or a mixture of the two.
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There are several charities who run trauma/surgical courses. WOC (World Orthopaedic Concern, the charitable arm of the BOA) run several projects throughout various low and middle income countries.
Longer term trips (>4-6/52)
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Longer term trips, >4-6weeks is usually arranged as an OOPE necessitating TPD and deanery approval.
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These must be requested at least 6 months in advance.
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It’s often taken as OOPE, as getting the posts approved for training is challenging given the need for ISCP approval, consultant trainers etc but that doesn’t negate from the wealth of clinical experience you will gain whilst away
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Some examples:
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Cure international – an American children’s charity that provides orthopaedic and neurosurgical services in resource poor settings. Some hospitals have UK consultants practising there, who are a good port of call if you’re interested in spending a longer period of time (3-12months) working.
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World Orthopaedic Concern (WOC) – have well-established links with many of their partner countries and will be able to assist in finding a suitable hospital/clinic/country for periods of 3-12months.
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BSSH LION fellowship – A 5 year partnership between the BSSH and the Lilongwe Institute for Orthopaedics and Neurosurgery (LION) in Malawi. This is an opportunity to spend 6 weeks -12 months working alongside a UK consultant and hand therapist, to help the local Malawians to develop and deliver a hand surgery service. The fellowship is fully funded (though there is no basic salary) - all travel, accommodation and most your subsistence costs are covered.
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Whether you travel with an organisation, or arrange your own overseas experience, there are some universal hurdles:
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Funding - some organisations fully-fund trips, while others will part-fund. National societies and local deaneries often have charities than can also subsidise your travel costs. Be prepared to approach them, and also be prepared to raise your own funds.
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Leave plenty of time and headspace for arranging these well ahead of your trip.indemnity all need reviewing depending on where and how long you are going for
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Logistics such as medical certification, visas, immunisations, insurance, medical between the UK/resource rich settings is vast.many centuries of inequality and economic deprivation, so the healthcare disparity
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Limitations of provision - Low and middle income countries have suffered from principles of the any trip/course/fellowship you are undertaking and critically assessdetrimental impact on the local economy, health service and community. Look at the sustainability of projects is key to ensure continued success and minimise empower the local individuals and enhance their practice. The long-term
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Sustainability and local impact – the goal of all global outreach work should be to whether they align with these core principles, and whom they benefit.
Out of programme pause (OOPP)
NHS work or similar patient facing work in the UK which can be assessed upon return and may count towards the award of a CCT. OOPP allows doctors in training to step out of the rigours of formal training for up to 12 months. Doctors in training can undertake an NHS or other patient facing UK based non training post, having any capabilities gained assessed upon their return to the training
programme.
Who should apply?
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Trainees who wish to take a break from training and expect to receive either an outcome 1, 10.1 or 10.2 at their most recent ARCP.
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Trainees who feel it would be beneficial for their wellbeing.
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Trainees who want to step out of training and also use the opportunity to gain additional competencies as a consequence of the impact of COVID.
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Time out of programme on OOPP will not normally be agreed until you have been in a HEE approved training programme for at least one year of training (unless at the time of appointment, deferral of the start of the programme has been agreed for leave on statutory grounds).
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This pilot initiative also gives trainees the opportunity to have any competencies gained whilst out of training assessed upon their return. This may allow trainees to minimise the impact on the time out of programme has on their CCT date.
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Applications for OOPP will be processed on a first come first served basis and trainees will need to identify the OOPP post at time of application. Trainees will need to provide a minimum of three months’ notice of the start date of their OOPP to meet Code of Practice and ensure the employer is provided with the contractual notice period. However, there will be discretion to allow a shorter notice period provided the Deanery and Employer agree.
3. Other Leave Types
Short-Term Unpaid Leave
Short-Term unpaid leave may be granted for a variety of reasons such as:
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A period of study not covered by paid study leave
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To visit relatives or travel/work abroad
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Family illness or domestic problems extending beyond the provisions of the Emergency Leave policy and procedure.
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Voluntary work
Unpaid leave should only be taken when no other policy exists which is more relevant to the circumstances. The advice of your Human Resources Department should always be sought in the application of unpaid leave. If you have outstanding unplanned annual leave this should be used before taking unpaid leave. Short-term unpaid leave is defined as up to 3 months in any 12 month period. Unpaid leave will not count as a break in continuous service. Unpaid leave in excess of one month will not count as reckonable service as defined in your contract of employment for purposes of annual leave, sick leave, entitlement to redundancy pay or incremental credit. If you are a member of the NHS Pension Scheme contributions will normally be expected to continue during unpaid leave which may result in payment of contributions in arrears. Periods of unpaid leave may affect your entitlement to State Benefits (e.g. Statutory maternity pay, unemployment benefits, state pensions) and therefore you are advised to make enquiries with your local Benefits Office.
To apply, you should discuss with your AES at the earliest opportunity Your departmental lead and rota coordinator may approve unpaid leave of up to 5 days. Applications for unpaid leave in excess of 5 days and up to 1 month should be directed to your “line manager” (AES, departmental lead) and approved in discussion with the relevant senior manager.
Employment Break
An employment break is an extended period of unpaid leave from the organisation with a guarantee of returning to employment with the organisation. It ensures that employees do not lose their place within their career and the organisation does not lose trained and skilled staff.
An employment break may be taken for a variety of reasons such as:
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Care for dependants
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To do voluntary work
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Travel
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Out Of Programmes (see above)
You should have at least one years’ continuous service with the organisation to be considered for an employment break. An employment break will be a minimum of 3 months and up to a maximum of 1 year (For breaks of less than 3 months please refer to short term unpaid leave). The period of leave will be unpaid but your contract of employment will not be terminated. This means that all pay and benefits will be suspended from the start of your employment break, e.g. Annual leave, sick leave, maternity benefits, and will be reactivated again on return to work. Absence due to an employment break will not regarded as a break in service, although the period of the break will not count as reckon-able service. During employment breaks longer than 3 months, pension contributions will not be payable
and will therefore result in a break in pensionable service. To formally apply for an employment break you should discuss with your AES and TPD. And compile a covering letter stating your reasons for the break and the ideal duration. You should give at least 3 months’ notice of your intention to take an employment break.
Employment breaks will be considered in light of the following selection criteria:
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The likely benefits to be gained by you and the organisation
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Your length of service with the organisation
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The demands of the service
If your application for a break is successful you will receive confirmation of this in writing stating the duration of the break, the dates and that you have a commitment to return to
work with the organisation for a minimum period equal to the period of the break, subject to a maximum commitment of 1 year. If your application is declined your manager should confirm this in writing stating the reasons for the refusal. Employee can appeal against the decision not to approve an employment break by using the organisation’s Grievance Policy.
Other things to note about taking an employment break:
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Maintaining contact whilst you are on employment break - It is important that contact with the organisation, colleagues and your profession is maintained whilst on your employment break. You must leave a contact address before beginning your employment break and should notify your manager of any changes to this during your break. Newsletters and appropriate literature will be sent to you by your manager to keep you in touch and aware of organisational changes and work development.
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You will be expected to maintain any professional registration
What happens if I need to end the employment break earlier than planned?
In exceptional circumstances it may be necessary to terminate your Employment Break and return to work earlier than expected. Such circumstances could include for example, long term illness or crisis in a country you are visiting. In cases such as this you would be advised to contact the TPD at the earliest opportunity to discuss the situation. They would have discretion as to when you return, and the notice periods outlined above apply but the organisation will try to reduce the notice period to support you if feasible to do so. It may be likely that someone would have been employed temporarily to cover your post whilst you were away so it may not be possible to put you back into your substantive post straight away but suitable alternative employment will be found for you in the interim.
4. Useful links / articles
Check out this website:
https://www.boa.ac.uk/careers-in-t-o/parenthood-orthopaedics/flexible-training-and-working.html
This BOA article provides a useful summary on flexible training.
Read this article: https://www.bmj.com/content/337/bmj.a1555
Training doesn’t mean forfeiting your dreams, this article dispels the myths and offers advice. Join this Facebook group: https://www.facebook.com/groups/852147548274259
A huge number of useful documents and sources of advice.
5. Edits / updates / improvements?
These support / welfare articles require constant updating to reflect the changing world of the modern Orthopaedic trainee.
If you have any edits / updates / improvements for this article please email them to:
Wins@bota.org.uk
Thank you for your support.
Original article by Robyn Brown.
Adapted for BOTA by Florence Shekleton.
