Guidance for the employment of medical and dental consultants

There is information on the Department of Health's website to be used by NHS Trusts and other employers when making appointments to consultant posts. 

It provides good practice guidance on the NHS (appointment of consultants) Amendment Regulations 2004 (Statutory Instrument 2004 No. 3365). 

Please note that primary care trusts and strategic health authorities (SHAs) were abolished by the Health and Social Care Act 2012. The Department of Health has confirmed that the appointment of consultants regulations do not apply to clinical commissioning groups (CCGs). 

NHS foundation trusts are not covered by the consultant appointment regulations however may wish to follow the standards to ensure a robust recruitment process.

The Academy of Medical Royal Colleges (AoMRC) and the Foundation Trust Network (FTN) have agreed a concordat regarding the role of the medical royal colleges in the recruitment process for consultants to posts in NHS foundation trusts.

Appointment to public health posts

Employers should ensure that advertisements for consultant grade posts in public health are clear about any component which requires the post holder to be a registered medical or dental practitioner.

It is generally accepted that most of the duties of a public health consultant post can be done by a person who either is, or is not, a registered medical or dental practitioner. If through custom and practice a post holder has given, for example, medical advice then this should be recognised in the individual's job description. 

If a post is advertised which requires a post holder to be a registered medical or dental practitioner then the job description should clearly justify this. If a post is advertised which could be filled either by a registered medical or dental practitioner or otherwise because only a minority component of the post requires this and the employer would utilise other arrangements to cover this function e.g. giving medical advice - then this component should nevertheless be clearly identified in a job description when filled by a registered medical or dental practitioners.

Registered medical or dental practitioners in a post including these functions will appropriately be placed under the terms and conditions of service for NHS medical and dental staff rather than Agenda for Change.

Employment of consultants not on the specialist register

Non-foundation trusts are legally bound by the consultant appointment regulations, including strict limits on the employment of doctors not on the specialist register. For these trusts, the legislation permits employing a doctor not on the specialist register for no more than two consecutive six‑month fixed‑term consultant appointments (a maximum of 12 months). Beyond this limit, the law provides no mechanism to extend or circumvent the requirement, and employers must ensure compliance with the statutory regulations.

Entry to the specialist register is, by its nature, a reflection of training and assessment at a particular moment in time, and does not in itself guarantee ongoing, role‑specific clinical competence. Employers, therefore, have a responsibility to rigorously check whether candidates can safely and effectively perform the specific requirements of the role.

Specialist registration is not a legal requirement for appointment to consultant posts in NHS foundation trusts. However, foundation trusts must still ensure that any doctor they appoint, whether or not they are on the specialist register, has the current competence to undertake all the duties of the post.

While it remains best practice for foundation trusts to appoint consultants who are on the specialist register wherever possible, there may be exceptional circumstances where a doctor clearly demonstrates the skills, experience and capabilities required for a consultant post but does not yet meet the registration requirements, often due to factors such as patterns of training or experience gained overseas. In these situations, where a foundation trust appoints a suitably competent doctor who is not on the specialist register, both the employer and the doctor should consider whether the portfolio pathway offers a route to obtaining specialist registration in due course.

In addition, employers should be aware of the requirements in GMC Good medical practice (2024) regarding the transparency of a doctor’s professional role. Doctors must present themselves honestly and use the correct title for their current role when communicating with patients, colleagues, and the public. This supports clarity, maintains trust, and ensures patients and colleagues understand the doctor’s actual level of responsibility and authority.

Changes to how doctors demonstrate the standard required for specialist and GP registration.