GP School Policies and Organisation.

Health Education England working across Yorkshire and the Humber adopts a unified approach to all trainees wishing to train less than full-time. HEYH offers support to all trainees who, for well founded personal reasons, are unable to complete their training programme on a full-time basis. View the policies section to see the LTFT Policy is for trainees and trainers and provides full details of eligibility etc.

If you are considering LTFTT, please bear in mind that General Practice Specialty Training (GPST) at three years (full time equivalent) is shorter than any other specialty training programme. It is therefore important that the focus of the time in training should be on covering the breadth of the General Practice curriculum rather than restricting prolonged periods of study to narrow fields of special or personal interest. There is plenty of scope for General Practitioners to pursue an area of special interest after they have been awarded a Certificate of Completion of Training (CCT).

For trainees who have been granted an extension to training and want to complete this on a Less Than Full Time basis, approval must be sought from the Postgraduate Dean. Trainees should in the first instance discuss this with their Training Programme Directors, who will then approach Health Education with a formal request.

 Health Education England working across Yorkshire and the Humber welcomes applications for Out of Programme Experience because trainees do now have the opportunity for time out to gain wider experiences. However, trainees must weigh the decision to take OOP very carefully. OOP can be undesirable for trainees for the following reasons:

• The duration of GP training is short compared with training for hospital specialty training. At the end of their three years’ training, GPSTRs will have the opportunity to take time out without risking disruption to their learning and will have the qualifications and experience to make them more valuable to their host employer. So think about taking a sabbatical AFTER GP training.
• Continuity and integration of learning are important in order to assimilate the various and varied components of learning. This is made harder if there is a break in training.
• Permission for OOP is dependent on the trainee making satisfactory progress, so there is a risk that permission may be withdrawn if the trainee is not making satisfactory progress.
• Unlike other specialties, out of programme experience is not likely to count towards the issue of the CCT.

If you are comfortable with the above constraints, then do think about applying for Out of Programme Experience. If you are well on top of the requirements for demonstrating that you are progressing with your competencies development then the added experience of working in a different environment can make you into an even better doctor.

In practical terms this means that when you apply for OOP your eportfolio should be clearly showing that you are progressing, and you should have strong backing from your training program director, educational supervisor and clinical supervisor.

Health Education England working across Yorkshire and the Humber offer built-in OOPE posts working for a year between ST2 and ST3 in Whanganui in New Zealand. Whanganui is an attractive small city on the beautiful west coast of the North Island in easy reach of excellent walking, skiing and water sports and close to the capital, Wellington. This is a great opportunity to gain experience of working in the New Zealand healthcare system in a range of posts relevant to general practice (medicine, obstetrics and gynaecology, A&E, paediatrics). In addition to a competitive salary, you currently will receive reimbursement of half return air fares from the UK to Whanganui at completion of the 12 month contract.

Remember that, even after you have obtained permission for an OOP, you must still be making good educational progress before you can go. Health Education England working across Yorkshire and the Humber expects that your eportfolio will show good progress towards demonstrating your competencies and that you have made a reasonable attempt at the Applied Knowledge Test component of the MRCGP. The biggest risk is that you may have to cancel your OOP arrangements late in the day if you cannot prove that you are making good educational progress. 

During your OOP you will be expected to maintain contact with your TPD and use your eportfolio. You are required to report on your experiences to your TPD.

The Application Process

• Applications will not be accepted until trainees have demonstrated satisfactory progress in their ARCP at the end of ST1
• Because of the long notice required this means the only time that OOP can be arranged is after the end of ST2.
• Written permission and confirmation from the Training Programme Director and Educational Supervisor must be obtained
• A panel will consider ALL applications and will advise which requests can be allowed
• Further guidance notes and an application form can be found in the right hand column (resources section)
• If for any reason the GP trainee concerned is not making satisfactory progress during their training then permission will be withdrawn.

This may seem like a whole pile of red tape for no purpose but there are good reasons for insisting that OOP is only taken after the end of ST2. Getting through GP specialty training is difficult in three years. Risking disruption to GP training is hazardous. The summative assessments – CSA and AKT – are difficult and trainees must prepare adequately for them. Successful demonstration of competency in the Workplace Based Assessment means that regular high quality reflective entries have to made in the eportfolio.

You need to have a successful track record before you apply for OOP so you do not risk not completing your GP training satisfactorily and to be reasonably sure that you will still be making good enough progress when the time comes to start your OOP.

The long period of notice is required so that Training Programme Directors can cover any gaps in the service that you have left by taking your OOP. Vacant posts can only be satisfactorily filled by re-assigning them to new trainees and this can only be done in the small time frame before the recruitment round starts at the end of August.

Training Programme Directors - what you need to ensure for approval of OOP

1. Has the trainee provided a job description / brief outline of the OOP which you have reviewed and discussed with them?  Y/N 
2. Is the trainee applying for OOP which starts after the end of ST2 Y/N (VERY UNLIKELY TO BE ACCEPTED IF NOT)    
3. Will the OOP provide appropriate educational opportunities for the trainee?     Y/N    
4. Is the trainee currently making satisfactory progress in their training?        Y/N    
5. Are you satisfied that the OOP can be accommodated without unreasonable detriment to the service rotas? Y/N   (THIS IS IMPORTANT - review carefully: it is important we maximise training capacity and that we do not have unfilled gaps)  
6. Is the proposed start date acceptable? If no please state your recommendations.          Y/N    

Requests for Out of Programme Experience

General Practice Specialty Training (GPST) at three years (full time equivalent) is shorter than any other specialty training programme. It is therefore important that the focus of the time in training should be on covering the breadth of the General Practice curriculum rather than restricting prolonged periods of study to narrow fields of special or personal interest. There is plenty of scope for General Practitioners to pursue an area of special interest after they have been awarded a Certificate of Completion of Training (CCT).

Unlike other specialties, GMC requires General Practice Specialty Training Registrars (GP StRs) to complete their training within a seven year window in order to apply for a CCT. The seven year window is not extended for those training on a Less Than Full Time Training (LTFTT) basis. This can cause problems obtaining a CCT if individuals need to take prolonged or repeated career breaks for family or health reasons.

For these reasons Health Education England working across Yorkshire and the Humber has decided that it will only grant approval for out of programme experience in the following circumstances:

1. For statutory reasons: e.g. maternity leave or ill health
2. For those who defer entry into training in order to study for a higher degree, who have signalled their intention at recruitment in accordance with the National Guidance and current policy on GP recruitment.

Resources

GP OOP Guidance

GP OOP Application Form

To claim back any expenses trainees should contact their lead employer and adhere to their Trusts policy.