Application Process

Doctors usually need to give at least 3 months notice to change their working hours. The application process is outlined in the main guide here and on the NES website. We have advised resident doctors to contact their rota masters in advance of when their LTFT status is confirmed in order to give plenty of notice for rostering.

Finding out whether incoming doctors are LTFT

A rotation report created by MED is available on the LOTH Rotations and Inductions teams channel 2-3 months in advance of the August rotation date. This has the details of the incoming resident doctors for the year, including their LTFT% if applicable (column K). TPD's also have access to this information and there should be a list available to you on TURAS. Assume that LTFT doctors expect to work a pro-rata % of out of hours unless you have been informed otherwise by the resident doctor themselves or their TPD.

Average weekly hours

These are pro-rata of that which a full time resident doctor works (calculated by the compliance team using the Riddell formula and documented on the "rota template" for the role). Therefore in a 48 hour rota, aim for a 70% resident doctor to work (0.7*48) = 34 hours per week on average. In a 44 hour rota, aim for a 70% resident doctor to work (0.7*44) = 31 hours per week on average.

Often this is achieved by 1 fixed non-working day per week for LTFT 80% and 2 non-working days per week for LTFT 60%. Resident doctors working at uneven percentages (50/70/90%) may agree with their department to vary their working pattern alternative weeks (e.g. if at 70% to work alternate 3 and 4 day weeks) rather than take half days.

It helps if the average weekly hours for the LTFT resident doctor are displayed on their rota, because a lot of problems LTFT doctors have with rotas is due to lack of transparency, rather than a problem with the rota itself.

On call commitments

The frequency of long days, weekend shifts, twilight shifts and night shift should be reduced pro rata, but they should do these in full blocks (unless agreed for other reasons such as health). This means if the rota usually schedules 4 nights for full time doctors, LTFT doctors would also expect to do their nights in blocks of 4 but less frequently.

If full time doctors work 1 in 4 weekends, an 80% doctor would work approximately 1 in 5, a 70% doctor approx. 1 in 6, a 60% doctor approx. 1 in 7.

In exceptional circumstances, a resident doctor will plan to undertake 100% of OOH shifts. This may be for educational reasons or with prior agreement with both department and TPD for service provision. These individuals should contact you themselves to inform you of this working pattern.

Fixed non-working days

Requests for fixed days off from LTFT resident doctors should be accommodated where at all possible. Resident doctors really value a fixed day off each week. This may be due to fixed childcare arrangements, which can be difficult to change at short notice (waiting lists for Edinburgh nurseries are often over a year long). Alternatively, resident doctors may have other commitments, such as a second job e.g. medical research or education, or a fixed health commitment e.g. a regular counselling group, infusions.

Some resident doctors may have less strong preferences and may be flexible with their non-working day. In this case, non-working days should be evenly distributed across a rota rather than concentrated on a particular month.

Unless agreed, a normal day, long day or twilight shift should not be rostered on a non-working day. Night shifts or post on-call days may occur on a non-working day. As long as the average weekly hours remain correct (i.e. pro-rata) no further time in lieu days are required. Giving plenty of notice may help resident doctors make alternative arrangements when they are required to work (or be post on-call) on their non-working days.

Fridays

If the resident doctor elects to take Friday as their regular non-working day, they may be required to work a Friday evening as part of "weekend working" on occasion, although many departments will not find this to be a practical arrangement.

Multiple LTFT resident doctors on a rota

With the growing popularity of LTFT working, this is an increasingly common scenario. NES is working towards appointing to posts based on whole time equivalency, but this is not currently practiced outwith a small number of specialities.

Requests for fixed days off from LTFT resident doctors should be accommodated where at all possible. If multiple LTFT doctors wish to take the same fixed day off and this cannot be accommodated by the service, this should be negotiated with the individuals in question. For a resident doctor, changing a fixed day off can be challenging but is easier to arrange in advance of the intended change.

LTFT doctors expect to work approximately pro-rata of OOH shifts, but full time doctors should not be expected to work excessively more to fill this gap. A degree of flexibility from LTFT and full time resident doctors is required and an acceptance that staff bank or locum doctors may be required to fill gaps. Some resident doctors may have already agreed to work 100% OOH which may help to fill the rota - making contact in advance with LTFT doctors who will be rotating into your department may help you to establish this.

Study leave entitlement

LTFT resident doctors have access to a pro-rata number of study leave days, which for a full time doctor is 30 days per year from FY2 onwards. Full time doctors have access to up to 5 days for private study leave before exams - the availability of this to LTFT doctors is at the discretion of the TPD. All study leave taken on a non-working day should be compensated for with a day (or half day) in lieu.

Study leave budget

The study leave budget is administered by the TPD. There is no absolute requirement for the study leave budget to be reduced pro-rata for LTFT resident doctors, although many TPD's will choose to do this to ensure equity across the training programme.

Annual leave (AL)/public holiday (PH) entitlement

AL and PH leave is combined (pro-rata) to give the LTFT resident doctor an annual AL/PH allowance, rounded to the nearest half day.

As a reminder, full time doctors are entitled to:

28 days of AL (if they have worked for the NHS for less than 5 calendar years) or 33 days (if they have worked for the NHS for 5 or more calendar years) AND 8 public holidays.

So a LTFT 60% who has >5 years NHS service would expect to have (33*0.6)+(8*0.6) = 19.8+4.8 = 24.6 = 25 days.

Any public holiday falling on a date the LTFT doctor does not usually work does not require the resident doctor to use a day from their AL/PH allowance. A LTFT doctor who would otherwise be working the day the PH falls would need to "spend" a day of their AL/PH allowance to take it off. A LTFT doctor who works the PH retains all their AL/PH allowance to be used at their discretion.

LTFT training advisor

LTFT is complex for resident doctors, trainers and rota managers. Consider appointing a Consultant in your department as a LTFT training advisor or champion who can help resident doctors and trainers with queries.