In the United Kingdom, Republic of Ireland, and parts of the Commonwealth, consultant is the title of a senior doctor who has completed all of his or her specialist training and been placed on the specialist register in their chosen specialty.
A doctor must be on the Specialist Register before he or she may be employed as a substantive consultant in the National Health Service. This usually entails holding a Certificate of Completion of Training in any of the recognised specialties, but academics with substantial publications and international reputation may be exempted from this requirement, in the expectation that they will practice at a tertiary level. “Locum consultant” appointments of limited duration may be given to those with clinical experience, with or without higher qualifications.
A consultant typically leads a “firm” (team of doctors) which comprises Specialty Registrars, and Foundation House Officers, all training to work in the consultant’s specialty, as well as other “career grade” doctors such as clinical assistants, clinical fellows and staff grade doctors.
The time required to become a consultant depends upon a number of factors, but principally the specialty chosen. Certain specialties require longer training, or are more competitive, and therefore becoming a consultant can take longer. Other specialties are relatively easy to progress through, and it is possible for a doctor to become a consultant much earlier in his or her career. After Modernising Medical Careers came into operation (in early 2007), the length of training was fixed for the majority of doctors, at about nine years.
Most consultants work on a long-term contract with one or more hospital trusts, and these posts are known as substantive consultant positions. Various titles (such as senior consultant, clinical director, medical director, etc.) exist for consultants who have particular responsibilities for the overall management of the hospital.
Other doctors – some without a CCT, a few who have only just obtained that qualification, and others who have retired from substantive appointments – may be employed as locum consultants, who have the same clinical responsibility, but are not responsible for management or training of junior staff, and are typically on fixed, short-term contracts.