Less than full time (LTFT) training is no longer unusual — it's a mainstream choice. Roughly 20% of UK medical trainees now work LTFT, up from single digits a decade ago. The reasons range from childcare and caring responsibilities to disability, health conditions, and the increasingly recognised category of "unique opportunities" (research, sport, other professional commitments).
Despite its prevalence, the process of applying for LTFT is poorly signposted and surrounded by outdated stigma. Here's the clear picture.
Who's eligible
Since 2019, the eligibility criteria have been significantly broadened. The current categories (Health Education England guidance):
Category 1: Disability or ill health (yours or a dependant's). Category 2: Caring responsibilities (childcare, eldercare). Category 3: Unique opportunities (not covered by other categories — sporting commitments, significant non-medical activities, religious commitments).
In practice, most applications are approved. The shift in policy has been toward supporting flexible training rather than gatekeeping it. If you have a legitimate reason and can articulate how LTFT training will work practically, approval is likely.
How to apply
Step 1: Speak to your Training Programme Director (TPD) informally. This isn't required but it smooths the process and helps you understand any programme-specific considerations.
Step 2: Submit a formal LTFT application to your local HEE office / deanery. The form requires: your category of eligibility, the percentage of full-time hours you're requesting (most commonly 60%, 70%, or 80%), your proposed start date, and supporting evidence (for Category 1: medical evidence; for Category 2: evidence of caring responsibilities; for Category 3: a personal statement).
Step 3: The deanery reviews and typically responds within 4–8 weeks. Approval is usually granted for a defined period (often 12 months, renewable).
The practical reality
Training duration extends pro-rata. If you train at 80%, your training takes 20% longer. A 3-year GP training programme at 80% LTFT takes approximately 3 years 9 months. A 5-year surgical training programme at 60% LTFT takes approximately 8 years 4 months. The curriculum requirements don't change — you just complete them over a longer period.
Your rota changes. You'll work fewer sessions per week, including proportionally fewer on-calls and weekends. The exact rota arrangement is negotiated with your department and should reflect your LTFT percentage fairly.
Pay is pro-rated. 80% LTFT = 80% of full-time salary. However, because of progressive taxation, the take-home reduction is less than 20% — typically 12–15% reduction in net pay for a 20% reduction in hours. This makes LTFT one of the most tax-efficient working arrangements in medicine.
Pension accrues at the reduced rate. Your pensionable pay (and therefore pension accumulation) reflects your LTFT salary, not the full-time equivalent. Over a full career, this matters — though the extended working years partially compensate.
Exams aren't extended. Your exam deadlines may or may not adjust for LTFT — check with your Royal College. Most colleges give some additional time but not a full pro-rata extension.
The stigma question
Let's address it directly: there was historically significant stigma around LTFT training, particularly in surgical specialties. The culture has shifted substantially, but pockets of resentment persist — usually from full-time trainees who feel LTFT colleagues get "the same training with better hours" or from consultants who trained in a less flexible era.
The response: LTFT trainees complete the same curriculum, pass the same exams, and achieve the same CCT. They take longer to do it. That's the trade-off, and it's a legitimate one. The evidence shows no difference in clinical competence between full-time and LTFT-trained doctors.
If you're hesitating because of what colleagues might think, consider that 20% of your cohort is already doing it — and the percentage is growing every year.
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