In the United Kingdom, Ireland, and parts of the Commonwealth, consultant is the title of a senior hospital-based physician or surgeon who has completed all of their specialist training and been placed on the specialist register in their chosen speciality. Their role is entirely distinct from that of general practitioners, or GPs. Consultants accept ultimate responsibility for the care of all the patients referred to them, so the job carries significant personal responsibility. A physician 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 specialities, 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.
Responsibilities
A consultant typically leads a "firm" which comprises Specialty Registrars and Foundation Doctors, all training to work in the consultant's speciality, as well as other "career grade" doctors such as clinical assistants, clinical fellows, Speciality Doctors, Associate Specialists and staff grade doctors. They also have numerous other key roles in the functioning of hospitals and the wider health service.
Training
The time required to become a consultant depends upon a number of factors, but principally the speciality chosen. Certain specialities require longer training, or are more competitive, and therefore becoming a consultant can take longer. Other specialities are relatively easy to progress through, and it is possible for a doctor to become a consultant much earlier in their career. After Modernising Medical Careers came into operation, the length of training was fixed for the majority of doctors, at about nine years.
Contracts
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 exist for consultants who have particular responsibilities for the overall management of the hospital or some part thereof. In the UK all doctors including consultants have the right to undertake private medical work. Some make a career out of private medical practice. For others it is used to supplement their work for the NHS. Other doctors - some without a CCT, a few who have only just obtained that qualification, others who have retired from substantive appointments, and others who wish to use some of their annual leave to generate additional earnings - may be employed as locum consultants, who have the same clinical responsibility, but are typically on fixed, short-term contracts.
