Hot Deskhot 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
Consultants in Public Health
Consultants in public health or public health medicine are essentially strategists, senior managers or senior scientists. They usually are skilled across the three 'domains' of public health (health protection, health improvement, healthcare) but in practice they may specialise in one area. Whilst public health doctors can work in different organisations and areas of work throughout their career, their workload irrespective of health topic will broadly cover the following seven areas:
- Health needs, health status and health impact assessments.
- Compiling and assessing evidence including health economics.
- Strategy development, action planning and business case design.
- Contracting and devising models of care and patient care pathways.
- Performance management and quality control
- Audit and outcomes measurement, including patient satisfaction surveys and quality of life measurements.
- System leadership
Where do public health doctors work?
Since April 1st 2013, public health is dispersed across a number of organisations in England. On a local level, local public health teams sit within local authorities. They offer public health specialist knowledge on reducing the 'upstream' factors on health such as working with housing, education, transport, environment and reducing social inequalities. They also have commissioning responsibilities for health checks, universal sexual health services, alcohol and drug commissioning, childhood measurement programme, Tobacco Control, 0-19 health services (e.g. school health and health visiting services). Directors of Public Health continue to have responsibilities for the health of their local population (now defined by local authority boundaries) and this includes delivery of Joint Strategic Needs Assessments and Health and Well-Being Boards. Local public health teams also provide public health input into Clinical Commissioning Groups (CCGs) under the core offer (an agreement between local authority and CCG). CCGs are responsible for commissioning maternity, community and hospital services on behalf of their local population.
Immunisation, screening and health and justice system were collected under Section 7a agreements and are commissioned by NHS England. Teams which deliver these programmes consist of NHS public health commissioners and Public Health England (PHE) embedded staff. Public health consultants are PHE employed and usually in the capacity of Regional Screening & Immunisation Leads. Other public health specialists and their teams are employed within NHSE's specialised commissioning.
There are national, regional and centre roles for public health specialists within Public Health England, covering the policy and strategic aspects of health improvement, health protection, children's health, adult health, drugs and alcohol, dental public health, emergency planning, health care and mental health. Working with Strategic Transformation Plans (STPs) and devolution on the preventative agenda is a key component of regional PHE's work over 2016 and 2017. Consultants of health protection and their teams continue to operate across the country working closely with colleagues in NHS and local authorities to control the spread of communicable diseases and chemical incidents.
Public health specialists can also be found in academia and in acute and community trusts. In recent years, there has also been a growth of public health doctors in the private sector, including the health insurance industry, pharmaceutical companies and independent consultancy.
Appraisals and Revalidation
As a consultant, you will need to participate in the Faculty of Public Health's continuing professional development (CPD) system. This is an annual programme which runs April to April and you will be expected to achieve at least 50 CPD points a year. The maximum is 100 points and you will need to demonstrate activities with reflection notes across a number of categories such as conferences, learning on the job, self-learning and formal courses. Your CPD should be linked to your professional development plan (PDP) which is usually set by your professional evaluation, although many consultants also set them in their management appraisal. Also note that you may be audited. The easiest way is to fill out your CPD diary online at the FPH website. Details of what you need to achieve are there as well.
Both medic and non-medic public health consultants should also have an annual consultant job plan that is reviewed and renewed each year with their line manager. This should set out the number of hours or sessions a week (or annually) that a consultant will spend on a particular topic or area. Typically it is divided into what's called PAs and there are 10 a week. An hour a week supervising registrars or trainees equates 0.25 PA. See BMA and NHS Employers for more details.
Appointing a Consultant
All consultant job descriptions must reflect the nine core and defined competency areas of public health practice (as set out by the Faculty of Public Health). These are:
- Surveillance and assessment of the population's health and well-being.
- Assessing the evidence of effectiveness of interventions, programmes and services intended to improve the health or wellbeing of individuals or populations.
- Policy and strategy development and collaborative working for health.
- Strategic leadership and collaborative working for health.
- Health improvement.
- Health protection.
- Health and social service quality.
- Public health intelligence.
- Academic public health.
The Faculty of Public Health have templates which can be used to devise a consultant post. All proposed consultant posts should be run by a Faculty Advisor to see if the post adheres to the standards. Since April 2013, many posts may also have to be run by Public Health England (e.g. Directors of Public Health and NHS England consultant posts). There is guidance available on this at the FPH website on senior public health appointments. Appointments should be made via an Advisory Appointments Committee (AAC) process - i.e. a panel (see here for the composition) - and all appointments are regulated by statute. Consultants must demonstrate in their annual workplans and workloads that they are meeting all nine competencies and are registered with either UK Public Health Register or General Medical Council.
How do you apply?
There are two routes to becoming a consultant - a prospective route and a retrospective route.
The main prospective route into being a public health consultant is to complete the four to five year postgraduate training programme in public health as outlined in Hot Desk. This is where you start as a junior doctor and work your way through your competencies. Unlike other medical specialties, public health training programme intakes non-medical graduates as well as medical. The difference is that non-medical consultants are registered with the UK Public Health Register whilst medical consultants are registered with General Medical Council. Medics need to demonstrate that they have met the Foundation requirements in order to be considered for GMC registration. If not, they'll be registered on the UK Public Health Register. Some medical public health registrars therefore apply for the CESR route (see below) whilst doing the training programme if they want to have GMC registration rather than UK Public Health Register registration.
There is also the CESR-CP route for medics. Applicants usually start at ST3 so they will need to have achieved parts A and B of the Faculty of Public Health membership exams. It is usually registrars of other medical specialty programmes who take this route as they already have some competencies done.
Both non-medical and medical consultants perform the same jobs and have to keep their competencies up-to-date including annual professional appraisals as well as their managerial appraisals and continuing professional development (returns of which are submitted annually to the Faculty of Public Health). Consultants also need to be revalidated every 5 years and Public Health England runs a revalidation appraisal scheme for its employees.
For the retrospective route, you need to demonstrate that you meet all the competency requirements before applying for registration. Referred to as 'the portfolio route', this is restricted to people who have held senior public health posts for several years. They need to demonstrate through a portfolio of past work that they meet the required competencies to become public health specialists. Medics and non-medics can apply to do the Specialist Registration by Portfolio Assessment (SRbPA). This was opened in September 2018 and is a two stage application process. For more details, please see UK Public Health Register. There used to be a defined specialist route and a generalist route but these are now closed.
Medics also have the option of doing CESR (Certificate of Eligibility for Specialist Registration). This is an assessment against standards of UK CCT curriculum and the application is online via the GMC. Once you activate your account, you have to submit your application within 12 months. Typically it takes 6 months from submission to the GMC making a decision. To be eligible, you need to have had 6 months continuous training in public health or in a specialist medical qualification and have a specialist qualification in public health (e.g. Masters in Public Health, membership of the Faculty of Public Heath exams). See GMC website for more details.
It is worth noting that the retrospective routes may have an element of prospective work as you may have gaps in your training which you will need to address with new pieces of work or placements.
Getting the Consultant Job
It has been some time since I have had an interview for a consultant post but I’m sure the experience I had and those of my peers are still relevant today.Below is a combination of tips I collected when I was applying for jobs and some have been collated afterwards from friends.We’ve all been successful in getting jobs so hopefully these tips will help prepare you too.
- Many PH jobs will be advertised on NHS jobs so set up a search alert for consultant in PH jobs so you can see what kind of jobs are being advertised. Many can be in BMJ and HSJ and others will be advertised through local authority routes. You may hear of upcoming jobs whilst doing your last leg of your registrar post – such as when you may be in an acting up post.Be aware that sometimes it can take three months for a post to be finally advertised but do keep your ears and eyes open to where the post may be advertised.
- Start the application at least a week beforehand.The first few sections are easy enough to fill in (personal details, qualifications, last few jobs) – save as you go along and do it in sections.I would print off and read through to make sure it reads properly and the spelling is correct. You may have apply using NHS jobs website – it took a friend of mine 5 hours to complete the first time she applied!However, your core information then gets saved and so it is quicker next time though you may need to spend time updating it and personalising it to the job you are applying for.
- The additional information section is the bit to show off.Use the job specification to make headlines – if this isn’t obvious, you could use the standard public health competencies as headlines. What helped me with filling in this was my part b of the old training portfolio (this is the section where you filled in a description for each project you did in each training venue including aims and outcomes).Having that information at hand was really useful for filling out the form.
- See yourself as the person appointing, what would you look for?(In other words, does your application match the job description?) And most importantly, show why you want the job.This is different to saying why you’re the best person for the job, this is about showing enthusiasm for working in that organisation and in that job.
- The adverts tend to say who is the recruiting officer.It is worth contacting them with questions or talk to other people from that organisation.This isn’t about sending them your CV, this is about finding out a little more about the organisation, its culture and the nature of the work there.
Once shortlisted, you are likely to have to take part in an assessment centre.This will vary from place to place but be prepared to have your skills and knowledge tested!The assessment centre can happen on the day or may be part of a process that lasts over a couple of days.There is likely to be a form of exam, logical reasoning and a form of focus group such as with patients, commissioners or the public health team.A few friends of mine were given an hour to write a briefing for councillors on the impact of certain interventions, e.g. impact of the recession in Sheffield. It is worth knowing your RRR, ARR, RRI, ARI, NNT and NNH.
For my first substantive post, I had to do an online personality test (took about 20-30 minutes) prior to interview.There was also a whole day assessment centre.This comprised of a written exam, a logical reasoning online test, a focus group, being observed over lunch and a one-to-one interview which went through the results of the personality test to see what kind of a leader you would be.The only preparation was to read the commissioning intentions which was circulated prior to the assessment and was ‘examined’ so to speak at the focus group discussions.The written exam was tough – drew on somewhat rusty mathematical skills. I don’t remember all the questions but one was about smoking.There was a stop smoking service running at full capacity that did so many quits in a period of time, which was higher than the success rate from the GPs.You were then asked questions about a commissioning intention to increase numbers but do it through the GPs.Another question had to do with looking atA&E and admission rates and answer questions about whether any of these could be seen in urgent care centres (polyclinics) or what could be moved to the community.
The evening before the interview (so the following week), I had to do an informal interview with councillors and council staff.(This was because the post was jointly funded by NHS and the local authority).Each candidate had to sit at a table and the others circulated around (a bit like speed dating).They asked you questions about yourself.This was a tough situation as it was difficult to ascertain how formal it was or how much you could be yourself. Certainly, you needed to make yourself likable.
Panels tend to consist of 9- 10 people and the interviews last about an hour. Depending on what post you are going for, expect a chief executive, a commissioning director, CCG clinical lead or chair, director of public health, councillor, a local authority director of services, non-exec director, an academic, a director of public health from elsewhere and a FFPH representative or two. Each person will ask you a question and there is usually room at the end for additional questions.Be prepared that when you go there will be no ice-breakers and that each question will be assessed and scored.There may be a presentation.
Types of questions:
- Questions about the presentation.
- Why do you want this job? What skills do you offer? Tip: this is the bit that you’ve done your research and you know about the population needs.
- What experience do you have of xxxx depending on the job description.
- Needs assessments leading to service improvements which you have led.
- Scenario question – a sort of how would you go about this type question (really checking the public health approach).
- Experience of working with GPs/ councillors/ mental health trust/ VCFS/ depending on JD. This is where you’ll need to know about what is happening in social care, NHSE, PHE and other partner organisations.Know about the national drivers for the relevant public health areas of the portfolio that you are applying for – example, child health if applying for a consultant post with a child public health portfolio.
- Time management. What would you do first 100 days. Challenges of the job. Role of the organisation – are we doing enough. Involving users and carers.
- Managing staff/ budgets. Good team/ bad team. Experience of dealing with difficult people that went well/ where you could have done better
- Developing policies. Self care. Advocacy. How to ‘take people with you’.Managing difficult situations. Commissioning for quality/ equity. What leadership style, examples.
- FPH- confirm on specialist/ vol register and if so from when. CPD status. Appraisal status. Your CPD needs in this post. Being a trainer. Experience of supervising others – staff/ trainees/ research projects.
- Always have a couple of examples to give in your answers not just one.
- Take up any offers of interview experience and ask for it if no one offers –the more you prepare, the more confident you’ll be.
- Read and reread the job description as this will form the basis of most of the questions
- Feel good in your own shoes (not just your outfit though I think that is important too)
- Reading HSJ and BMJ every week is good practice generally but really helps in an interview setting for being up to date