A doctor’s career in the NHS follows a long and highly structured training path, from medical school through to senior roles like Consultant or GP. This journey typically takes at least ten years after university and involves progressing through several distinct stages of training and responsibility.
The structure of a doctor's career
Unlike nurses, allied health professionals, and other clinical staff, doctors are not employed on the Agenda for Change (AfC) pay and grading system. Instead, they have their own national contracts and a career progression framework overseen by several bodies, including Health Education England and the General Medical Council (GMC).
The GMC is the independent regulator for all doctors in the UK. It sets the standards doctors must meet, and it manages the official register of medical practitioners. To work as a doctor in the NHS, you must not only be on the GMC register but also hold a licence to practise, which you must maintain throughout your career.
Stage 1: Medical school – the foundation of knowledge
The first step to becoming a doctor is completing a medical degree at university. This is an intensive course that typically lasts for five or six years.
The structure of medical school usually includes:
- Pre-clinical years (Years 1-2): Focused on the scientific foundations of medicine, such as anatomy, physiology, and biochemistry, delivered through lectures, seminars, and lab work.
- Clinical years (Years 3-5/6): Students are based in hospitals and GP practices, rotating through different specialties. This is where they learn to apply their knowledge to real patients under the supervision of senior clinicians.
Upon successful graduation, a new doctor receives their medical degree (such as an MBBS or MBChB) and is eligible for provisional registration with the GMC. This allows them to start the next stage of their training: the Foundation Programme.
Stage 2: The Foundation Programme – from student to doctor
The Foundation Programme is a two-year, work-based training scheme that all UK medical graduates must complete. It's designed to bridge the gap between medical school and specialty training, giving new doctors a broad range of experience in a supervised environment. Doctors in this phase are often called 'junior doctors'.
Foundation Year 1 (FY1)
As an FY1 doctor (or 'house officer' in older terminology), you work with provisional GMC registration. This means you are legally practising as a doctor but under the close supervision of your clinical team. The year is typically made up of three four-month placements in different specialties, such as general medicine, general surgery, and perhaps a niche area like psychiatry or paediatrics. On successful completion of FY1, you are granted full registration with the GMC.
Foundation Year 2 (FY2)
In your second foundation year, you have more responsibility. You are now a fully registered doctor and will be expected to make more complex decisions, though still with senior support readily available. FY2 rotations continue to build a broad base of experience. Many doctors use this year to gain 'taster' weeks in specialties they are considering for their future career before they begin the competitive application process for specialty training.
Stage 3: Core and specialty training – becoming a specialist
After the Foundation Programme, doctors choose a specific area of medicine to specialise in. This is the longest part of a doctor's training, often lasting between three and eight years. Doctors in this phase are known by various titles, including Specialty Registrar (SpR), Registrar, or simply 'resident'.
There are two main routes through specialty training:
- Run-through training: This is a single, streamlined programme. You apply once and are then guided through all the stages of training for that specialty, from ST1 (Specialty Trainee Year 1) right through to completion. Examples include General Practice, Obstetrics and Gynaecology, and Paediatrics.
- Uncoupled training: This is a two-step process. First, you enter a 'Core Training' programme (CT1 to CT2 or CT3) which gives you broad experience in a general area like medicine or surgery. After completing core training, you must apply again in a second competitive process for a 'Higher Specialty Training' post (starting at ST3/ST4) in your chosen sub-specialty, such as Cardiology or Trauma & Orthopaedic Surgery.
Applying for these posts is a significant step, and crafting a compelling application is key. Tools like an application co-pilot can help you structure your supporting statement to effectively showcase your skills and commitment.
During these years, doctors take on increasing seniority, manage complex cases, and start supervising more junior colleagues. They also need to pass rigorous postgraduate exams to progress.
A day in the life: a registrar's responsibilities
Let's imagine Dr. Ben Carter, an ST5 registrar in Acute Internal Medicine. His day might involve leading the morning ward round for a ward of 30 patients, making key decisions about their treatment and discharge. He would then see new admissions from the Emergency Department, perform practical procedures like chest drains, and teach FY1 doctors. In the afternoon, he might run a specialist clinic before being on-call for the hospital overnight, where he would be the senior decision-maker for any medical emergencies until the consultant arrives.
The end goal: senior doctor roles
On successful completion of a training programme, a doctor receives their Certificate of Completion of Training (CCT). This makes them eligible to join either the GMC's Specialist Register or GP Register, allowing them to apply for senior, permanent posts.
Consultant
A consultant is a senior doctor who has completed all of their specialty training in a hospital-based field. They are the clinical leaders of their teams and have overall responsibility for the care of patients. Their role is a mix of direct clinical work with the most complex cases, supervising junior doctors, management, teaching, and research.
General Practitioner (GP)
A GP is a senior doctor who has completed specialty training in General Practice. They are expert generalists and are usually the first point of contact for patients in the community. GPs manage a huge variety of long-term conditions, acute illnesses, and public health issues. Many GPs become partners in their practice, which also involves running a small business.
Specialty and Associate Specialist (SAS) Doctors
This is a diverse and essential group of senior doctors who are not consultants, GPs, or in training posts. SAS doctors have at least four years of postgraduate experience and work in a specific specialty, providing stability and expertise to their department. It is a valued and permanent career path, offering opportunities for senior responsibility (as a 'Specialist' or 'Associate Specialist') without the same training or management obligations as a consultant. For those building a portfolio for SAS roles, a well-structured CV is vital, and using a dedicated CV builder can help highlight your experience effectively.
Regulation and professional standards
Throughout their career, all doctors must adhere to the professional standards set out in the GMC's 'Good Medical Practice'. To maintain their licence to practise, they must engage in a process called revalidation.
Revalidation happens every five years and is based on a portfolio of evidence from annual appraisals. It's how doctors demonstrate that they are keeping their skills and knowledge up to date and remain fit to practise. This process involves collecting feedback from patients and colleagues, recording learning activities, and reflecting on their practice with a senior appraiser.
Pay and contracts for doctors
As mentioned, doctors have their own pay scales, separate from Agenda for Change. The contracts are negotiated nationally by the doctors' union, the British Medical Association (BMA), and NHS Employers.
Pay progresses with seniority. An FY1 doctor starts on a basic salary, which increases in FY2 and then again at each stage of specialty training. Registrars earn significantly more, and consultants are at the top of the pay scale. In addition to basic pay, doctors earn supplements for working nights, weekends, or being on-call. Because the system is complex, it can be helpful to get a detailed estimate using an NHS take-home pay calculator designed for medical and dental staff to understand your potential earnings.
Key takeaways
- The path to becoming a senior doctor in the NHS is a long-term journey, typically taking over a decade after leaving school.
- It begins with a 5-6 year medical degree, followed by the two-year Foundation Programme.
- Doctors then enter specialty training, which can last from 3 to 8 years, to become a GP or a hospital specialist.
- The main senior roles are Consultant, GP, and SAS Doctor, each with distinct responsibilities.
- All doctors must be registered with the General Medical Council (GMC) and undergo regular revalidation to maintain their licence to practise.
- Doctors' pay and contracts are separate from the Agenda for Change system that covers most other NHS staff.