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Delivering greater flexibility

Giving trainees greater flexibility in their working lives.

Health Education England are working with partners to build greater flexibility in training:

Less Than Full Time 

HEE is committed to increasing flexibility in postgraduate medical training. As a part of HEE’s work to Enhance Junior Doctors Working Lives several initiatives have been developed with partners to increase flexibility within Post Graduate Medical Education. Feedback from trainees indicate that many trainees would appreciate the opportunity to pursue a more flexible approach to their training.

Less Than Full Time (LTFT) Training Category 3 allows trainees to request the opportunity to undertake a period of less than full time training for personal choice and was initially made available in Emergency Medicine, Paediatrics and Obstetrics and Gynaecology.

The LTFT Category 3 Guidance for each of these specialties can be found below:

- LTFT Category 3 Paediatrics Guidance

- LTFT Category 3 Obstetrics and Gynaecology Guidance

- LTFT Category 3 Emergency Medicine Guidance


If you require these documents in another format please email merp@hee.nhs.uk 


Expansion of Less Than Full Time Training to Higher Physicianly, Radiology, Psychiatry and ICM trainees

Following the success of Less Than Full Time Training, this opportunity is now being expanded to Higher Physicianly, Radiology, Psychiatry and ICM trainees.

Guidance and FAQs on this, including guidance for employers, can be found below.

LTFT (Less than Full Time) Category 3: Evaluation

RSM UK Consulting LLP (RSM) was commissioned by HEE in 2020 to conduct a three year longitudinal evaluation of the LTFT Category 3 initiative. The Year 1 Report explores the current profile of LTFT Category 3 trainees, and the perceptions of LTFT Cat 3 trainees, wider trainees, Champions of Flexible Training, educators and employers of the impacts of the initiative. This report also provides a series of further recommendations to enhance the ongoing development of the programme in Year 2 and beyond. The report can be downloaded from the “Related Documents” section at the bottom of this page.


LTFT (Less than Full Time) Training - A Guide

Below are 3 short videos which explain Less than Full Time training in more detail.




Your HEE local office will be able to advise on application windows and application information for each HEE local office can be found below:

East of England


Kent, Surrey, Sussex

Yorkshire and Humber

East Midlands

West Midlands


North East Lead Employer Trust Policies 

North East Education and Training Policies 

North West

Thames Valley

Severn Deanery 

Peninsula Deanery 


Out of Programme Pause 

Allowing trainees to step in and out of training, and to the have their learning during this period assessed on their return and potentially count towards their CCT. More information for trainees considered Out of Programme Pause (OOP-P) below. 


For further information, contact the team.

In 2017, Health Education ran a pilot that allowed higher specialty trainees in emergency medicine the ability to train at 50%, 60% or 80% of a full-time rota for 12 months, without having to meet the criteria set out in the Gold Guide.

Following the success of this we are now running a second pilot, which was open to applications from all existing higher emergency medicine trainees and run-through ST3 trainees in England, who are expected to progress to ST4.

These pilots have been developed in partnership with the Royal College of Emergency Medicine (RCEM) and the British Medical Association Junior Doctors Committee (BMA JDC), in response to concerns raised by junior doctors regarding inflexibility in their work patterns. It is hoped that this approach could reduce ‘burn out’ and attrition; boost morale; and aid recruitment in a high-intensity specialty.

The Academy of Medical Royal Colleges, the BMA, the General Medical Council, NHS Employers, NHS Improvement and the RCEM have expressed their support for piloting this approach to flexibility. We are working with partners to develop a detailed and robust evaluation process, before making further recommendations based on the pilot’s outcomes.

For further information contact the team.