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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 a general practitioner.
The primary objective of a consultant is to use expert knowledge and skill to diagnose and treat patients while retaining ultimate clinical responsibility for their care. [1] A physician must be on the Specialist Register before they may be employed as a substantive consultant in the National Health Service (NHS). This usually entails holding a Certificate of Completion of Training (CCT) 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.
The term consultant may also be prefixed to other non-medical high specialist leadership roles in UK Healthcare settings such as Consultant Nurse, Consultant Dietician, Consultant Paramedic and Consultant Pharmacist. These are roles undertaken by Non Medical Practitioners in posts agreed by the Department of Health. [2]
In South East Asian countries, practitioners who have at least post graduation degree like Doctor of Medicine and more than 10 years of clinical experience in treating patients are labelled as consultant.
The Central Consultants and Specialists Committee (CCSC), which is a Standing Committee of the BMA, agreed the following as a very broad description of the role of consultants: [1]
"Primarily as the delivery of expert clinical care usually within a team, including the ability to recognise and manage the more complex end of the specialty spectrum (diagnosis, management decisions, difficult cases, including apparently simple cases which have a high incidence of complications in more inexperienced hands) but also involved in running departments, managerial decisions, teaching, training, researching, developing local services – generally being involved in the wider management and leadership of the organisations they work in, and the NHS generally." [1]
This report from 2008 describes how most consultants work now and it describes what the 2003 contract was intended (by BMA negotiators at least) to remunerate and develop (a consultant-based service).
Cohn mentions that "the consultant should try to support the referring physician and comfort the patient." [3]
A consultant typically leads a "firm" (team of doctors) 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, [4] [5] 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.
In terms of patient care, consultation times are controversial ground, with quality of communication is key over quantity of time spent with the client. [6]
Domain-specific challenges for consultants exist. [7] In palliative medicine consulting, emotions, beliefs, sensitive topics, difficulty communicating and prognosis interpretation, or patients expectations despite critical illness are some of the challenges faced by the consultant. [8]
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 (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, lead consultant etc.) 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. [9]
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.
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Consultants in the NHS start £88,364 (Threshold 1) to £119,133 (Threshold 8) with additional "Clinical excellence awards" available. [10]
The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. It does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The BMA has a range of representative and scientific committees and is recognised by National Health Service (NHS) employers alongside the Hospital Consultants and Specialists Association as one of two national contract negotiators for doctors.
Kamran Abbasi is the editor-in-chief of the British Medical Journal (BMJ), a physician, visiting professor at the Department of Primary Care and Public Health, Imperial College, London, editor of the Journal of the Royal Society of Medicine(JRSM), journalist, cricket writer and broadcaster, who contributed to the expansion of international editions of the BMJ and has argued that medicine cannot exist in a political void.
Acute medicine, also known as acute internal medicine (AIM), is a specialty within internal medicine concerned with the immediate and early specialist management of adult patients with a wide range of medical conditions who present in hospital as emergencies. It developed in the United Kingdom in the early 2000s as a dedicated field of medicine, together with the establishment of acute medical units in numerous hospitals. Acute medicine is distinct from the broader field of emergency medicine, which is concerned with the management of all people attending the emergency department, not just those with internal medicine diagnoses.
A Senior Registrar was a grade of doctor in the United Kingdom or Ireland before being superseded during reforms in the 1990s. The senior registrar post still exists in Australia, whilst in the US, the title of “Senior Registrar” might be applied to a Senior or Chief Resident in Surgery.
A nurse-led clinic is any outpatient clinic that is run or managed by registered nurses, usually nurse practitioners or Clinical Nurse Specialists in the UK. Nurse-led clinics have assumed distinct roles over the years, and examples exist within hospital outpatient departments, public health clinics and independent practice environments.
A foundation doctor is a grade of medical practitioner in the United Kingdom undertaking the Foundation Programme, a two-year, general postgraduate medical training programme which forms the bridge between medical school and specialist/general practice training. Doctors in the first year of the programme are known as Foundation Year 1 (FY1) doctors, and those in the second year are known as Foundation Year 2 (FY2) doctors. Being a foundation doctor is compulsory for all newly qualified medical practitioners in the UK starting from 2005 onwards. The grade of foundation doctor has replaced the traditional grades of pre-registration house officer and senior house officer.
Sir Christopher Charles Booth was an English clinician and medical historian, characterised as "one of the great characters of British medicine".
Pre-hospital emergency medicine, also referred to as pre-hospital care, immediate care, or emergency medical services medicine, is a medical subspecialty which focuses on caring for seriously ill or injured patients before they reach hospital, and during emergency transfer to hospital or between hospitals. It may be practised by physicians from various backgrounds such as anaesthesiology, emergency medicine, intensive care medicine and acute medicine, after they have completed initial training in their base specialty.
Hilary Dawn Cass is a British medical doctor and a consultant in paediatric disability at St Thomas' Hospital, London. She was the President of the Royal College of Paediatrics and Child Health from 2012 to 2015.
Joseph Gavin Collier is a British retired clinical pharmacologist and emeritus professor of medicines policy at St George's Hospital and Medical School in London, whose early research included establishing the effect of aspirin on human prostaglandins and looking at the role of nitric oxide and angiotensin converting enzyme in controlling blood vessel tone and blood pressure. Later, in his national policy work, he helped change the way drugs are priced and bought by the NHS, and ensured that members of governmental advisory committees published their conflicts of interest.
Susan Jane Bewley is a British consultant obstetrician, and Emeritus Professor of Obstetric and Women's Health at King's College London.
Liam Brennan is a consultant anaesthetist, deputy medical director of Cambridge University Hospitals NHS Foundation Trust, and chair of the Centre for Perioperative Care. He was formerly president of the Royal College of Anaesthetists from 2015 to 2018. He specialises in anaesthesia in children and those with difficult airways and in plastic surgery. As vice chair of the Academy of Medical Royal Colleges, he has a significant role in quality improvement and Brexit issues. Brennan has in addition been editor of the British Journal of Anaesthesia.
Alexander Paton was a British gastroenterologist, writer and postgraduate dean for North-West London hospitals, who was a specialist in alcohol misuse.
Wendy Katherine Burn is a Consultant in Old Age Psychiatry. She was President of the Royal College of Psychiatrists from 2017 to 2020.
Azeem Majeed is a Professor and Head of the Department of Primary Care & Public Health at Imperial College, London, as well as a general practitioner in South London and a consultant in public health. In the most recent UK University Research Excellence Framework results, Imperial College London was the highest ranked university in the UK for the quality of research in the “Public Health, Health Services and Primary Care” unit of assessment.
The Edinburgh City Hospital was a hospital in Colinton, Edinburgh, opened in 1903 for the treatment of infectious diseases. As the pattern of infectious disease changed, the need for in-patients facilities to treat them diminished. While still remaining the regional centre for infectious disease, in the latter half of the 20th century the hospital facilities diversified with specialist units established for respiratory disease, ear, nose and throat surgery, maxillo-facial surgery, care of the elderly and latterly HIV/AIDS. The hospital closed in 1999 and was redeveloped as residential housing, known as Greenbank Village.
Emma Harriet Baker is a British professor of clinical pharmacology and consultant physician in internal medicine at St George's Hospital, London. She has a specialist interest in people who have multiple medical conditions at the same time and take several medications, with a particular focus on lung disease. She is director of the UK's first BSc in clinical pharmacology, clinical vice president of the British Pharmacological Society and training programme director at Health Education England.
Margaret Johnson is a British physician who is a consultant in thoracic medicine and chair of the St John & St Elizabeth Hospital. In the late 1980s, she was the first dedicated HIV doctor at the Royal Free Hospital.
Adrian Boyle is a British consultant and emergency physician at Addenbrooke's Hospital, Cambridge, England. In October 2022 he succeeded Katherine Henderson as the President of the Royal College of Emergency Medicine.