Less than full time training: examining the impact on the workforceBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h238 (Published 19 January 2015) Cite this as: BMJ 2015;350:h238
- Carolyn Evans, LTFT adviser1,
- Anna Fowler, LTFT anaesthetics programme director NE/NC London2,
- Carolyn Johnston, consultant anaesthetist3,
- Seema Randive, locum consultant anaesthetist 4
- 1Royal College of Anaesthetists, London, UK
- 2Royal National Throat, Nose and Ear Hospital, London
- 3St George’s Healthcare NHS Trust, London
- 4Mid Essex Hospital Services NHS Trust, UK
Carolyn Evans and colleagues look at the impact of less than full time training on the anaesthetics workforce
Requests to take up less than full time (LTFT) training continue to rise in all specialties,1 and the General Medical Council, the Academy of the Medical Royal Colleges, the BMA, and other national organisations have sought to promote LTFT training as part of building a diverse and sustainable workforce. The Shape of Training review recommended that future training models should be more flexible to allow trainees to move in and out of training, to achieve a better work-life balance, and to pursue outside interests or research, teaching, or leadership responsibilities.2
There is little objective evidence, however, about the influence of the different structures of training on the medical workforce. Our own literature search and the evidence scan that fed into the Shape of Training review found only surveys and studies based on subjective satisfaction ratings and reflections of trainees and trainers.
With support from the Royal College of Anaesthetists, we sought to answer some fundamental questions—and also to dispel some myths—about LTFT training. We looked at training outcomes for more than 1200 anaesthetic trainees who had been awarded their certificate of completion of training between January 2009 and December 2011. We were able anonymously to link trainee records with consultant advisory appointment committee information held by the royal college and with other data gained from surveying these trainees.
Of the 1247 anaesthetists awarded a certificate of completion of training between January 2009 and December 2011, 14% had trained LTFT for at least six months at some point in their training. Of those that had trained in this way, 84% were women, compared with 26% of those who trained full time. A 2010 national survey of anaesthetic trainees working LTFT showed that 92% had requested this to care for children.3 Among respondents to a 2014 survey of LTFT anaesthetic trainees in the west of Scotland, 100% reported they had requested to work LTFT for childcare reasons.4
LTFT trainees were as successful as full time trainees at obtaining consultant jobs: 95.6% secured a substantive consultant job, compared with 95.7% of full time trainees. LTFT trainees were more likely to take up LTFT consultant jobs, but the magnitude of this variation was small: 3.4% of the LTFT trainees took up LTFT consultant jobs, and 1.75% of the full time trainees did so. We calculated that the degree to which LTFT training contributes to reducing whole time equivalent consultant numbers is equivalent to the loss of one whole time equivalent consultant a year across the whole specialty.
Time in LTFT training
Trainees usually chose LTFT training for specific periods of time, rather than for the entire duration of the programme. The average time spent in this training was 39 months, and trainees change between LTFT and full time training at different times throughout the training programme. The average length of training for LTFT trainees was 10 years, 8 months, and 23 days, while for full time trainees it was 8 years, 5 months, and 6 days. Of note, the extra time spent in training for those who became LTFT consultants was not related to time spent in additional training as part of a recommendation for intensified supervision or repeated experience (record of in-training assessment E or annual review of competence progression 3).
Despite concern expressed by the Royal College of Anaesthetists on how the specialty would meet the demands of 24/7 working, there has been a reduction in overall anaesthetic training numbers since 2012, informed by work from the Centre for Workforce Intelligence.5 Deanery allocated funding that was specific to LTFT enabled provision of supernumerary posts. It also offered some flexibility around funding the percentage of LTFT to meet training needs. This has been lost with the disappearance, or considerable reduction, of deanery allocations of money to underpin LTFT. The fixed 50% now offered by some local education and training boards has unforeseen consequences, such as the requirement for additional training time, for LTFT in a craft specialty such as anaesthesia where 60% is recommended as a minimum.6
Provision of LTFT training
The change from slot sharing to offering LTFT only in a full time slot has become the norm across large parts of the UK, especially in Scotland.7 This creates gaps that departments attempt to fill with locums, but provision of internal locum cover can precipitate conflict as the LTFT trainee is bound by guidelines set out in an NHS Employers document and can offer only short notice additional duties.8 The financial implications for employers of funding locum cover for rota gaps or supporting LTFT requests for slot shares greater than 50% can make departments reluctant to offer any increase in secondary care LTFT placements.
As consultant job plans change to increase the proportion of direct clinical care delivered and extend working hours beyond the traditional working week, this may also have an effect on those who currently opt to move from LTFT training into a full time consultant post. Our outcome data have shown the 7.5:2.5 professional activity 2003 consultant contract, with a flexible approach to delivery of supporting professional activities’ time, enabled LTFT trainees to move to full time posts. It is important that trainees’ views are sought on the impact that changes to their contracts may have on their career plans, as demonstrated with 9:1 contracts in Scotland and the move south of post-certificate of completion of training anaesthetists.9 A change in job structure that leads to LTFT trainees choosing LTFT consultant posts has a huge impact on workforce planning.
Competing interests: We have read and understood BMJ’s policy on declaration of interests and declare the following interests: None.