Guidance for Full Time and LTFT Doctors in Training
Prior to starting your GP practice placement, your supervisor should agree a work schedule with you. Below is guidance in compiled from the Severn Deanery School of Primary Care, RCGP, and the GMC-approved RCGP curriculum.
Click on the arrow heads below to show the answers to the FAQs. The subsections are titled to aid navigation.
Hours and structure of the working week
How many hours is a GP trainee/registrar contracted to work whilst in a GP training post?
40 hours per week at full time equivalent. For trainees working less than full time (LTFT) this is adjusted on a pro-rata basis (i.e. an 80% WTE trainee is contracted to work 32 hours per week).
How is the working week structured?
In theory, the 40 hour working week is divided into 10 x 4 hour nominal sessions (7 clinical and 3 educational) but this does not fit well with most GP working days (often 8.30am to 6.30pm) so it is easier to think about it in terms of hours. See below for more information.
What activities should be included in trainees’ contracted hours?
28 hours clinical activity, with 1 hour of clinical admin time for every 3 hours of patient contact.
- Clinical activity time includes: booked appointments, unscheduled care (duty doctor), any home visits. This works out to 21 hours direct patient contact and 7 hours clinical admin.
- Debrief time: during each session of direct patient contact, adequate debrief time should be included in the work schedule. As a guide: many deaneries use example GP training rotas (see here) which include a 30 minute debrief slot per session. However, the precise ratio of debrief to direct patient contact time is not stipulated in the 2016 contract, nor in the NHS Employers Guidance for work scheduling.It is expected to vary according to the experience of the Doctor in Training and should be agreed between the DiT and their supervisor.
12 hrs educational activity, split as follows:
- 4 hours external structured education (induction days, half-day release on Wednesdays, timetabled Education Provider Organisation [EPO] sessions). These are deducted from total study leave allowance (see here for further details on study leave).
- 4 hours practice based structured teaching (this includes supervisor tutorials, joint surgeries, practice based learning events, some induction activities).
- 4 hours independent educational activity/self-study. These sessions are not deducted from study leave allowance.
Not every week will be the same once study leave, annual leave and public holidays etc. are taken into account, so over a 12 month ST3 year there should be approximately:
- 44 x 4 hour External Structured Teaching Sessions – (deducted from study leave allowance)
- 44 x 4 hour Practice based structured education (2 of 4 hours protected)
- 44 x 4 hour Independent education activity sessions
- N.B. For ST1 or ST2 trainees on GP placements on a 6 month post – these numbers would be halved.
For trainees working Less Than Full Time (LTFT) please see below.
How is out-of-hours (OOH) work (i.e. Brisdoc shifts for Bristol patch trainees) accounted for in the contract?
Time worked during out of hours shifts should be deducted from the trainee’s clinical activity time and taken as leave by the trainee as time in lieu.
How this time in lieu is taken is decided by agreement between the trainee and their host practice. This may be taken back per shift worked (i.e. a 4 hour shift worked in OOH may be claimed back as a session of additional leave), or by taking a number of shorter working days over the course of several months (i.e. three 4-hour OOH shifts may be accounted for by the trainee working one hour less per week over a 12 week period).
There is no set minimum or maximum amount of OOH shifts a trainee can undertake. Doctors are not required to do a specified number of hours/shifts worked OOH – only that the UUSC exposure overall (both in-hours and OOH) should be sufficient.
The following page is up to date as of July 2023 and contains further detail on UUSC requirements: https://primarycare.peninsuladeanery.nhs.uk/about-us/gp-specialty-trainees/uusc/
See also:
https://primarycare.severndeanery.nhs.uk/training/trainees/uusc/
https://www.rcgp.org.uk/mrcgp-exams/wpba/urgent-unscheduled-care
Where can I find more information on the working week?
Less than full time (LTFT) working
I am a trainee working LTFT. How should the split of clinical and educational activities be adjusted according to my contracted working hours?
The work schedule for a LTFT GP trainee in a practice placement should reflect the same proportion of clinical and education sessions as a full-time work schedule.
The work schedule should ensure that LTFT trainees are able to receive the proper proportion of the intended training opportunities in the placement.
How is study leave allowance adjusted for LTFT trainees?
Per 12 month period, LTFT trainees have a pro-rata allowance which is calculated according to their % working time equivalent. For example, an 80% WTE trainee is allocated 24 days; a 60% WTE trainee is allocated 18 days.
What should trainees be doing if there is no external structured teaching (i.e. half-day release on Wednesdays) during the week?
For full-time trainees: you are not expected to be in clinic as it is your educational time.
As per the School of Primary Care website, activities may include:
- Teaching Programme Induction days
- Timetabled Education Provider Organisation (EPOs such as BGPERT, SGPET, GGPET)
- Topic Teaching
- AKT and CSA courses provided by local RCGP Faculty
- Careers Fair
- Attending ST3 practice for ST2 trainees
For less than full time trainees, this depends on the stage of training, your work schedule, and the proportionate split of clinical vs. educational time which has been allocated within your work schedule. See “How should LTFT trainees plan their attendance at half-day release” below for further information.
How should LTFT trainees plan their attendance at half-day release?
For ST3s there are, broadly speaking, two possible approaches. This should be decided upon in agreement with their educational supervisor. Whichever their approach, the minimum attendance expected at half-day release education sessions is 70% for that particular training year.
- ST3s can attend every half-day release over a 12 month period.
This may be preferable to many trainees, as attending half-day release from August to August keeps trainees within one peer group throughout.
As described in the study leave section, this roughly amounts to 15 days study leave over the 12 months.
There may be some variation in this figure according to when the DiT takes annual leave.
Upon completion of the initial 12 months, a LTFT trainee may need to transition to either performing clinical activities on Wednesday afternoons (the usual time for half-day release) OR independent educational activity/self study for the remainder of their ST3 training, with the agreement of their educational supervisor. This decision will be determined by the structure of their work schedules and which activities, up to that point, had been disproportionately affected by their half-day release attendance.
This is based upon the GMC-approved RCGP curriculum which states that ST3 training should be 12 months duration at whole time equivalent.
See: https://www.rcgp.org.uk/your-career/qualifying-as-a-gp/cct-guidance/training-guidance - Alternatively, ST3s can attend 30 half-day release sessions over the total duration of their training year or rotation, amounting to a total of 15 days of their total study leave allowance.
For example:
An ST3 working at 60% WTE described above would attend approximately 30 half-day release education sessions over the course of the total 20 month ST3 GP placement.
If this approach is taken, then the Wednesday afternoons when the ST3 has elected to not attend teaching will either need to include an alternative form of education session (e.g. independent self-study), or may need to include some sessions performing clinical activities. This decision should be made in consultation with their educational supervisor, with the aim to achieve the best proportionate split between clinical and educational activities, considering the trainee’s work schedule across the full ST3 training year.
How should rest breaks be accounted for in the working day?
Trainees now get a paid 30 minute break for every period of work over 5 hours. This is often allocated as a lunch break.
Practically speaking, this should be deducted from the clinical activity, or the educational activity, depending on the particular structure of that working day. This is in order to prevent the working day from being inappropriately extended to allow for breaks.
Where can I find more information on Less Than Full Time working?
Annual Leave
Is the practice responsible for monitoring a trainee’s annual leave or is it the Lead Employer?
It is the responsibility of the trainee to keep track of their annual leave and ensure you take only what you are entitled to, but it is recommended that practice also keeps a separate record of your annual leave, as it does for its other staff.
Is it better to calculate leave in hours or days
As all days are not equal length (some trainees may choose to work 4x 10-hour days, others 5×8 hour days, but both work 40 hours weeks and are entitled to the same amount of annual leave), it makes sense to record annual leave in hours – 27 or 32 days (depending on length of service) x 8 hours = 216 or 256 hours.
How should I account for taking time off in lieu (TOIL) after I have done an Out Of Hours (OOH ) shifts?
It should be a straightforward conversion. If you do a 6-hour OOH clinical shift you are entitled to take 6 hours off from your standard rota clinical hours. If your shift is entirely observing another clinician, with no direct clinical work, then the time should be deducted from the educational time in the week.
How do I account for my educational sessions if I take several days leave?
It is important to remember to include your educational time in your leave calculations e.g. if your 4 hours of independent study time is on a Thursday morning, and you are taking a Wednesday and a Friday off as leave, then your practice will assume that you are also taking off your 4 hrs of study time as leave too. If this is not the case, then this will need to be explained to your practice in advance of your leave, with a clarification of what work you are doing during your study time (your practice may ask for verification of this afterwards).
If I overrun in my clinic, can I claim for toil/hours back?
You cannot claim for TOIL/hours back, but discuss with supervisor re: appointments, time management, your clinic/surgery structure, work schedule and so on. It is important to ensure that your supervisor sits down with you and you jointly agree on a work schedule at the start of their placement.
How much notice do I need to give for annual leave?
This needs to be agreed with the practice. Many expect to be given at least 6 weeks notice. Although you’re supernumerary, you need to give advanced notice of any type of leave, depending on how the practice is run.
Does a trainee’s annual leave allowance carry over from a previous placement?
A trainees annual leave allocation is proportional to the length of their placement. For example, a 6 month placement would have 50% of their annual leave allocated. This is also easier when calculated in hours
What if there are any issues or disagreements?
Communication, respect and mutual flexibility between trainee and practice is to be encouraged. If the issue cannot be resolved then it should be taken to your supervisor, then the lead employer (for Severn trainees, this is Gloucester Hospitals NHS Foundation Trust).
Page last reviewed: 29 January, 2024