Hot Desk

hot desk v,

to share a desk, office, or other work space between employees on different shifts or schedules; used here to denote the rotations of public health registrars and other medical trainees working in public health


Registrars in Public Health

What are Specialty Registrars in Public Health?

Specialty registrars are public health doctors. They are just like registrars in other medical specialties. They are training to be specialists or consultants in their field. Sometimes they are referred to as public health trainees and were previously known as Specialist Registrars (SpRs) if they had a clinical medical background and Specialist Trainees (SpTs) in Public Health if they did not. Like other registrars, public health registrars train within regional postgraduate medicine and dental deaneries: East of England, East Midlands, Wessex, London, KSS Deanery, Yorkshire and Humber Deanery, Oxford Deanery, South West Deanery, Northern Deanery, North West, Wales and West Midlands. In the UK, specialist accreditation in public health is provided by the Faculty of Public Health (FPH). This accreditation is done through a training programme that is usually five years and consists of sitting examinations to gain membership of the Faculty of Public Health (i.e. Part A and Part B MFPH exams) and working on the training portfolio. This is a list of 10 key area of competencies which all public health trainees should achieve during their training for public health practice. Since April 2009 an e-portfolio is utilised to compile the evidence that demonstrates that they have completed each competency and that it has been signed off by their trainers. All competencies must be completed to a satisfactory standard before registrars are allowed to finish their training programme and be awarded a Certificate of Completion of Specialist Training (CCST). At this point, the registrar can look for a Consultant post either in Public Health or Health Protection.

A new curriculum was developed and implemented in 2015, which was approved by the General Medical Council (GMC) and the UK Public Health Register. This contains a new Key Area 10 (Integration and Application of Competences for Consultant Practice). Registrars on the old curriculum (i.e. 2010) can now transition onto the new curriculum and all new recruits will do this new curriculum, which has been streamlined and consists of only two stages (opposed to the previous 3). An annual panel review called ARCPs are conducted and these look at the workplace assessments collected in the portfolio and progress made. Registrars still undertake the Part A and B Exams and will spend the first 18 months of the training programme in local authorities and 4 months in health protection. After Part B, registrars can then do the 'specialist' placements, such as placements at Public Health England or with a screening and immunisation team at NHS England. All training placements must be accredited with GMC and will require an accredited educational supervisor and/or named clinical/project supervisors.

What does the job entail?

Like other medical registrars, public health registrars do rotations but instead of rotating around different wards or hospitals, public health trainees work in a variety of settings, such as local authorities (with local public health teams), Public Health England health protection teams, Department of Health, Public Health England public health intelligence or health improvement directorates, NHS England, hospitals and in academia. Public health registrars are mentored by Directors of Public health and other consultants, who act as advocates on behalf of the general or local population. Registrars (both medic and non medic) are also expected to do on call, where they are on call one in nine days. This largely comprises of taking notifications of infectious or communicable diseases from other medical professionals and ensuring that steps are taken to prevent close contacts with the infected individual from becoming ill. Sometimes an outbreak or a chemical incident may occur and trainees would work with their 2nd on-call (the consultant) in taking public health action. Depending on previous public health experience, registrars may undertake a Master in Public Health (MPH) in their first year of training and prior to sitting the Part A exam.

The work is essentially a 9 to 5 desk job and involves leading and initiating a number of projects, which have a dual purpose: getting your competencies signed off and helping to improve the health of the local population. The workload varies, depending on the project. Some are discrete pieces of work whilst others involve long term planning and the setting up of systems. The work itself can consist of policy or strategic planning, written reports, presentations to lay audiences, senior management or health professionals, doing evidence based research, teaching at universities or talking to the media.

Check out Public Health Estate Agent for more details on public health placements.

What about pay?

Medical speciality registrars in public health are paid the same as registrars in hospital settings. Since Agenda for Change, non-medical speciality registrars are paid a similar rate, which is calculated as a percentage of the final point on the NHS 8d salary scale. First year is 45%, second year 47%, third year 49%, fourth year 52% and fifth year 56% of the final point on the 8d NHS salary scale. If your current pay exceeds that of a public health trainee, pay protection is offered. Salary also continues throughout any integrated Master of Public Health course. Both medics and non-medics receive a supplement (~20% of salary) for participating in the local health protection on-call rota.

Where can I get further information?

Information about the specialist training in public health programme can be found at the Faculty of Public Health.

Health Education Authority website has some useful links to people currently involved in public health training such as https://www.hee.nhs.uk/hee-your-area/north-west/our-work/attracting-developing-our-workforce/public-health

London Deanery/UCL has a general introduction document on public health training as well as their own site London Deanery

How do I apply?

The selection process is by co-ordinated recruitment process. If you were thinking of joining the public health speciality training programme in 2018, the selection process for England and Wales is likely to start in November 2017 and deadline for applications likely to be December 2017 . All information including the application process, person specification and the national recruitment timetable is available on the FPH website under Recruitment. For information on training posts in Scotland, please visit the MMC Scotland website and for information on training in Northern Ireland see The Northern Ireland Medical and Dental Training Agency website.

What does the selection process entail?

If you're successful at the application round, you'll be called to undertake numerical and verbal reasoning tests and a situational analysis test. While there aren't any specific preparation books or tests you can do, many applicants practise using online resources that help people prepare for the GP training programme. If you pass this round, you'll be called for interview.

What happens at the interview?

Things have changed since I interviewed for the programme - I hear you now do scenarios similar to the OSPHEs - but I can give you a rough idea of what to expect. I faced a panel of people, each one had a question and each question was scored. It's important to get one's head around this as it's not like other interviews where there are nice questions asked to get you talking! The main thing to get across is: show that you've had some experience in public health and you're really enthusiastic about working in public health. [So look over your CV and see where your projects or work experience could be repackaged as public health. E.g. say you did a project on improving communication about cancer for a PCT, you could use that to say that your results were fed into the PCT's work on health promotion and your recommendations (e.g. smoking in public places) were taken on board and changes made.] Questions that crop up include "Talk me through your CV" (i.e. what public health experience have you got?); "Have you ever done an audit?" (i.e do you understand the importance of evaluation and outcomes? - i.e. improving patients' health and not just process); "Give me an example of where you were faced with conflict?"; "Give me an example of when you led on a project?" (such questions are to gage whether you have leadership skills and negotiation skills), "why is mental health a public health issue?" and "what do you think I should do to lower the incidence of obesity in my area?".

Be careful of questions that include medical conditions, e.g. HIV. Just have one general sentence like 'HIV is a big problem...' and move onto the crux of the question - are they asking you about prevention? promotion? health protection? services evaulation? Throughout maintain the public health stance of population based, prevention, up stream efforts and evidence based approaches (i.e. objectivity). There are usually some scenario questions like - "You are working on an important report. The deadline is 2 hours and it must be presented to the Board. A phone call comes in and there has been a chemical incident in the town. Three people are dead. What do you do?" This is health protection type question - you can pounce this question off on different people to see what they would say but essentially you need to get the details of the chemical incident (when, where, how, who's there, what chemical involved)) and get it to your Consultant of Communicable Disease Control. The chemical incident is a priority. Another scenario question would be "You're on a local partnership committee for drug misuse. The local policeman, who's the secretary, wants to use some of your funds for binge drinking prevention. How do you stop him from using the resource earmarked for drug misuse?" (this question is a test of leadership skills and facing conflict - public health people lead from behind and keeping people on side is a big part of it!)

There is some reading you can do - the 'Oxford Public Health Handbook' is quite good at helping you understand the managerial and leadership skills you need. Donaldson & Donaldson 'Essential Public Health' is really good for an overall view. Be aware of the Wanless report  (really old now but still relevant) -particularly the catchphrase of 'reduce salt, reduce saturated fat, cut out smoking, reduce alcohol intake and exercise'. It can be used to answer a lot of health promotion questions!