Specialty Registrars train on a similar system to specialist registrars in other medical specialties. 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. The training programme 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 competencies which all public health trainees should achieve during their training and is assessed annually by a RITA panel. These competencies relate to the ten key areas for public health practice. Each SpT and SpR must demonstrate all of these competencies to a satisfactory standard in order to be judge to have satisfactorily completed their training programme and be awarded a Certificate of Completion of Training. At this point, the registrar can look for a Consultant post either in Public Health or Health Protection.
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 Primary Care Trusts (PCTs), Public Health Observatories, Department of Health, Health Protection Agency, hospitals, local authorities 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.
I'm in my fourth year of my training and and I am currently on a year long placement in the Department of Health. Between July 2007 and January 2008, I led on the development of national guidance on pandemic flu planning for mental health services and for vulnerable groups. This was an interesting piece of project work and required me to spilt my time between Leeds and London, where the pandemic flu team are based. Both guidances involved organisation of consultation groups (stakeholders), workshops, development of audit tools, presentations at the National Pandemic Flu Workshop and of course, writing the guidance! Since January 2008, I have continued to work within the Department of Health but this time I am working on two distinctive topics. Part of my time involves working on the proposed 'Prevention of Violence and Abuse' strategy, whilst the other half of my work revolves around screening and specialist services. At the moment, I'm grappling with chronic kidney disease and abdominal aoertic aneurysm screening.
Before that, I spent about two and a half years in a Primary Care Trust (PCT) and a 3 month placement at Health Protection Agency. In case you're unfamiliar with Primary Care Trusts, they are the NHS bodies (health authorities) responsible for commissioning health services (e.g. hospitals, GPs) and providing community health services for the public. Each PCT covers a defined geographical area of ~600,000 people and works towards ensuring that the local health services meet the needs of the people.
My work is essentially a 9 to 5 desk job and involves leading and initiating a number of projects, which have a dual purpose: getting my 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. For example at Calderdale PCT, I had large projects such as leading on the local implementation of the Hepatitis C Action plan, acting as 'Flu Lead' in the PCT and investigating the rise in levels of Vitamin D deficiency in the local population. Smaller projects are so called because they are shorter in time. In August 2006, I led on the local implementation of the changes to the childhood immunisation programme and in December 2006, I produced area profiles of the health needs of the people in Calderdale, to help with the move to Practice Based Commissioning. This was to help the consortia of primary care practices to plan services for their unique populations. For instance, there's no point in setting up excellant family planning services when the majority of your population are elderly! 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.
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.
Information about the specialist training in public health programme can be found at the Faculty of Public Health.
The Public Health Practice Resource Pack is an excellent starting point for those interested in what public health entails.
Another useful source is a www.publichealthy.com, which talks about public health training from the perspective of a specialist registrar.
The selection process is by co-ordinated recruitment process. If you were thinking of joining the public health speciality training programme in 2008, the selection process for England and Wales closed at midnight (GMT) on Sunday 27 January 2008. All information including the application process, person specification and the national recruitment timetable is available on the FPH website: Specialise in Public Health - Eligibility and Applications. 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.
Views expressed in this website are those of the author only. It is not associated with the National Health Service (NHS) or any other public bodies.