NHS Structure

nhs

OVERVIEW

The general pathway is starting out as a foundation doctor, then specialising and finally becoming a consultant. Foundation training is 2 years long while specialty training ranges from 3 years (for GP) to 8 years (for many hospital-based specialties). Additional training after reaching GP or Consultant status is optional. Remember that all training posts are paid in the UK, so you will be working as a doctor every step of the way. 

There are several ways to walk this path and it can be confusing in the beginning, especially for an outsider. 

So let’s begin to explore each step.

The Structure

Training is organised in 3 levels: national, regional and local.

The local level is made up of hospitals. On the regional levels they are grouped into deaneries or LETBs (Local educational training boards). On the National level there are several organisations such as Health Education England (HEE), NHS Education for Scotland, NHS Wales Shared Service Partnership, Northern Ireland Medical and Dental Training Agency, and the Royal College of each specialty.

Once you are recruited by a hospital, you are appointed to a place of training run by a Local Education Training Board (LETB) or deanery. Health Education England (HEE) hosts the LETBs for England. Wales and Northern Ireland and Scotland host their own deaneries.

Here’s a link for 8 organisations you’ll encounter as a doctor in the UK at some point in your training. It is good to be familiar with them but don’t be overwhelmed; you will get to know them as soon as you start your foundation training.

The Pathway

Crossing the finish line in the UK training race means that you either become a Consultant (you become part of the Specialty Register of the GMC) or a GP (General Practitioner Register of the GMC). Depending on the specialty you choose there are specific ways to reach this goal.

FOUNDATION YEARS
First, you need to attain a Certificate of Completion of the Foundation Programme (CCFP). There are 3 ways to do this:

In terms of supervisors, you will have a clinical supervisor (CS) for each rotation you undertake and an educational supervisor (ES) for each year of training. They are both consultants. The CS is a consultant from the department you would be working in and they would guide you more closely and monitor you on a daily basis. The ES can be a consultant from any department in the hospital, not necessarily one you will be working in. The ES will help you with your portfolio, your overall plans and will be overseeing your progress. 

Tip: When choosing between available positions, it would be smart to pick rotations that are relevant to the specialty you wish to pursue (if you already know what you want to do). 

For all up-to-date information regarding the foundation programme and how to apply for it visit their  official website.

SPECIALTY TRAINING

Specialty training in the UK is the same thing as residency in other countries. As you know there are various options and some specialties (residencies) have a different pathway that you should be aware of from early on. Here’s how it goes. 

If you wish to do Cardiothoracic surgery, Neurosurgery, Obstetrics & Gynecology, Ophthalmology, Pediatrics, Radiology or GP then you have chosen a so-called run-through or coupled specialty. What does this mean?

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Run-through specialties
You go through the 2 years of Foundation Programme and/or once you get your CCFP you apply for the specialty you want directly. If successful, you get a national training number, often referred to as a “number”. You then progress through your years of specialty (ranging from 3-8 years, depending on the specialty), without having to re-apply for a position. Bear in mind, run-through specialties are usually very competitive. You also need to pass certain exams before progressing from one year to the next. For example, in neurosurgery you need to pass both parts of the (MRCS exam Member of the Royal College of Surgeons Part A & B) before progressing to ST3. To get an idea of the competition, most candidates pass their MRCS during their foundation years.

Un-coupled specialties
After the 2 years of foundation and/or once you get your CCFP you apply for core training. That is either core surgical training (CST) for most surgical specialties (except for the run-through ones outlined above) or internal medical training (IMT) for most medical specialties (except for the run-through ones). CST lasts for 2 years and IMT for 3 years in total. IMT replaced CMT (Core medical training) in August 2019. Once these 2-3 years are complete you have to re-apply for a higher specialty training position to become a registrar. The higher specialty training posts are limited and often competition is fierce. The main difference between coupled and un-coupled specialties is that you need to apply two times for the latter.

Acute Care Common Stem (ACCS)
For those of you who wish to enter higher specialty training in General Internal Medicine, Acute Internal Medicine or Anesthesia there is an alternative: the ACCS. This is a 3-year training programme that replaces IMT before applying to the afore-mentioned specialties. Important note: If your passion is Emergency Medicine (EM), then ACCS is the only core training programme before you enter higher specialty training in EM.

The Terminology

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* Previously, Stand-alone FY1 positions were available and medical school graduates with full registration had a chance to apply to these posts. Currently, the UKFPO have no plans to recruit to FY1 Stand-alone posts. If a doctor has full registration, they can check their eligibility to apply directly for an FY2 Stand-alone programme. ​

Other Resources

For more detailed information on the various roles of doctors in the NHS and how it works, we would recommend this website, which is addressed to international medical graduates mostly but a lot of it applies to European medical graduates too: 

How specialty training (residency) works in the UK: A complete beginner’s guide

This website is not an official UKFPO, GMC or NHS website. It was made by doctors who studied in the EEU and wanted to share their experiences, offer some advice and provide guidance as to where to look and what kind of information you will need to find out on your own. Read more here.

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