The first placement, known as your base placement, is at a Primary Care Trust (PCT) and will be assigned to you upon appointment to the programme. Registrars remain in the PCT they have been assigned to for a minimum period of one year. Workload varies from discrete short-term projects (e.g. health equity audit) to involvement in long term pieces of work and developing strategies. All work should cover some of your alloted competencies. It helps at the start of each project to compile which competencies the project will cover and which ones it will partially cover. This can change as the project continues so it is good to review them during and at the end.
Primary Care Trusts are responsible for assessing the health needs of their population, commissioning health services to meet those needs, improving and promoting the health of the population, developing primary and community health services, commissioning the majority of secondary care services and working with other organisations to build healthy local communities.
It is difficult to list exactly what you would work on as it will vary according to the PCT and the population they cover. Generally, you will do something about assessing the needs of a population (e.g. children, an ethnic group or a group of patients with a particular condition), designing and commissioning services, quality assurance, monitoring and evaluation of different services, clinical governance, writing policy and care pathways and providing evidence-based service provision (e.g. smoking cessation, obesity and other community services). Public health registrars and consultants talk about portfolios. This means that you are given certain areas to be responsible for - e.g. diabetes or cardiovascular disease. You are then expected to ensure that the PCT is providing (or commissioning) the best possible service in these areas to its population. This very often involves presenting papers (I call it, arguing a case)at senior management or board level.
You usually move on after Part A or B and many registrars/trainees spend time in what's known as a specialist training placement (that is, in a university, Department of Health, acute trust or local authority).
Registrars pursuing a career as a generalist (i.e. Consultant in Public Health) return to a PCT before their CCST date. Many will do a placement in a PCT other than their base as this exposes them to another environment, a different model of working and other issues. It is a good thing to do, particularly if your training programme covers large urban PCTs and smaller or more rural ones. Dealing with different populations and geographical areas will expand your range of skills and experience.
All registrars have to do a minimum of three month placement with a health protection unit (under the care of a Consultant in Communicable Disease Control). Since the change of curriculum in 2007, this placement usually takes place during the first phase of training or in phase 2 (i.e. after the Part A exam). You are expected to acquire the public health skills necessary to deal with health protection issues, like meningitis, flu, outbreaks of food poisoning etc. Work here is more reactive than in a PCT, as you would be responding to daily queries (e.g. immunisations), following up notifications of cases and working with the team on outbreaks. There is usually some additional training with local environmental health officers. Upon completion of your training period in the HPU, you become eligible to do on-call for public health.
More senior registrars (i.e. post Part B) may also do a placement with one of the national centres, such as the Centre for Radiation, Chemical and Environmental Hazards, the Centre for Infections and the Centre for Emergency Preparedness and Response. There are now opportunities for non-medics to pursue a career in health protection.
A Strategic Health Authority (SHA) is responsible for overall health strategy performance monitoring and workforce planning for a region. It typically covers a large area with a number of primary care trusts on its patch. The type of work done here will be largely strategic, for example, working in emergency planning for the region, developing a strategy for floods. This would involve engaging emergency planners from local authorities, PCTs, mental health trusts and hospitals.
Public health placement in an acute trust takes place in a hospital and is essentially a public health provider role.
The placement is usually only available to speciality registrars who have completed Part A of the MFPH exams and so is considered to be a 'specialist' training placement.
A placement can be between 3 months and a year of training, depending on what competencies you need to fulfill and they type of experience you wish to have.
Duties can vary but will largely consist of the following three components:
1. There may be a strong clinical governance role (for example, developing clinical effectiveness function). This can comprise of audits (including joint ones with PCTs), systematically monitoring mortality and clinical outcome indicators, ensuring NICE guidelines are implemented and training hospital staff in audit, critical appraisal and research methods.
2. You may be involved in service development. For example, you could be helping to develop clinical services strategies, where you can use the public health tools of health needs assessments and capacity projections to improve services. You may also be involved in producing care pathways, utilizing the best available evidence.
3. It is likely to incorporate health promotion. Public health consultants working in acute trusts have often said that the hospital environment is a microcosm within which you tackle the wider determinants of health. There are opportunities to promote health amongst hospital staff, like encouraging smoking cessation, improving the catering standards within hospital grounds and encouraging physical exercise. Hospitals also provide links to the wider community and this can be grounds to instigate health promotion initiatives. Staff can be trained in health promotion and in giving brief interventions concerning the health of the patients they look after, for example advice on tackling obesity or preventing cardiovascular events, diabetes or hypertension.
The Department of Health leads on health and well-being for the British Government. It sets directions and supports the delivery of the NHS and related health and social services. It is however a separate body to the NHS and a placement within the Department of Health will expose you to life in the civil service which is different to that of the NHS.
Public health placements in the Department of Health are usually only available to speciality registrars once they have completed their Part A of their MFPH. Sometimes, having part B is preferable to commencing certain placements. This makes a department placement a 'specialist' training placement. Placements are usually between 6 months and a year and such placements are mostly full time, although it may be possible to work at the department part-time alongside your work in another training venue.
Placements can be national or regional. A national placement is usually obtained through an advertisement in PH.Com, by word of mouth or through proactive seeking of working with a credited trainer on a project. It will normally involve spending time in London in one of the Department of Health buildings or you may be in Quarry House in Leeds. Regular travel to and within London is to be expected and depending upon the project, it will either be covered by Department of Health or by through claiming your expenses on your training programme. (Always check first!) It can also include some international work. A regional placement will involve working within a regional Department of Health office or working with a regional Department of Health team that is seconded to take a national lead on a project.
A department placement is abundant in opportunities to meet your competencies. Indeed, most of them can be met from departmental placements, in particular, data, communication, policy-making and strategy competencies. It is also a wonderful opportunity to develop the political side of public health, e.g. dealing with self-interest of different groups, persevering in the face of adversity, demonstrating foresight, negotiation and leadership skills etc. Because the Department of Health does not deliver health or social care services to the public, they deliver through working with a variety of partners. This will provide you with a good experience in partnership working from a local level to international (e.g. SHAs, other NHS bodies, local government, voluntary sector, private sector, ministers and working with other governmental bodies and international bodies).
A placement at the Department of Health could involve working as part of one the National Support Teams. As of December 2009, there are National Support Teams for sexual health, tobacco control, health inequalities, alcohol harm reduction, response to sexual violence, teenage pregnancy, childhood obesity, infant mortality and childhood immunisation. Public health registrars can partake in NST visits, national workshops, observe at national committees (e.g. Marmot Review) and in developing toolkits. It can be challenging to work in a virtual team but no doubt interesting. Trainee opportunities with all NSTs need developing so you will have to be proactive in looking for them.
Ask your training director what Department of Health opportunities are available to you within your training programme.
All training programmes have one if not more universities on their doorstep. There are lots of opportunities to undertake a piece of academic research. Many registrars do a 6 to 12 month placement whereby they work with a team on a trial or undertake other types of research, such as a survey, qualitative research or an epidemiological prevalence study. Some registrars enjoy the academic work so much that they opt to do a doctorate or apply for funding to undertake a larger piece of work. They usually take time out of the programme to complete their studies and resume the programme thereafter. This option is different to that of the Academic Public Health post. Such a post is appointed separately to the 'generalist' public health registrar posts and the time is spilt between the university and the NHS, with the majority of time spent at the university. People who do this role want to be an academic in public health.
Related to this are teaching opportunities. Public health specialty registrars are required to contribute to the teaching of public health. Opportunities vary between programmes but they typically involve teaching undergraduate medical students or supervising their projects. You can also be proactive and seek out teaching in another field but which is related to public health.
Apart from teaching, an academic placement is a specialist placement that can be done after Part A.
Public health observatories are the intelligence hob of public health. A public health observatory is a place (virtual or otherwise) which collects, stores and shares data and information about health and the wider determinants of health. This covers common diseases like cancer and lifestyle factos such as smoking, diet and exercise. Staff at the public health observatories interpret data to provide a meaningful healht intelligence which can be used to inform public health action. They produce information and data on people's health and health care for practitioners, policy makers and the wider community. They compile the profiles and statistics necessary for enabling decision making in PCTs. PCTs have their own intelligence units (with a public health component) but the public health observatories are regional and are also commissioned to undertake specific data collection and not just routine statistics.
A placement with an observatory is not unlike working in an academic environment in so far as you are working on a computer with figures, statistics and facts rather than with people. However, it is different in that you are not undertaking a piece of research in accordance to a specific protocol. Here you are helping to compile profiles and intelligence that can be utilized by PCTs and other policy makers, that is providing information that can be practically harnessed to help improve services or assess needs of populations.
This is a specialist placement that can be done after Part A and registrars typically spend 6 months to a year here, although short placements may be possible.
It is possible to do international public health whilst doing your training. There can be some red tape involved so it is advisable to discuss it with your trainer and training director. Some placements are classified as out of programme experience, which you can do up to a year. Other placements have an accredited trainer and can count towards your RITA. For example, there are accredited trainers at WHO Geneva. Posts can be found through word of mouth, linked to research being done in universities on your patch or are advertised in PH.Com. I also know trainees/registrars who got travel scholarships from the Faculty of Public Health to undertake work in other countries which is related to their work here in the UK. For more information check out the international health section on the Faculty of Public Health's website.
Recently, there have been opportunities to do a placement in local authorities or with the police. These placements are done post Part A and can be done on a part-time basis (i.e. you can work in two locations at the same time). With the move towards joint appointments between local authorities and health services of public health consultant and director posts, chances to work in local authorities will increase. Work placements can be in adult social care or children and young people's services. You can also spend time in housing, urban planning or transport. A placement may also encompass a joint strategic health needs assessment or a health impact assessment. It is a good idea to spend some time with a local authority. Environment, culture and leisure services fall under the remit of local authorities and are major determinants of health. Working with them will help to reduce health inequalities. You can also gain insight into the different working culture of a local authority which will stand to you in future partnership working. If you are interested in doing a placement at local authority, then talk to your training director about what is available.
Regarding police, I have heard of registrars who have spent time working on prevention of violence at police headquarters. With the national move towards more upstream interventions, there may be opportunities to link in with police on preventing child abuse, domestic violence and youth violence. Again, talk with your training director if you are interested.
Some registrars have done a placement of 6 months (full time or part-time)in specialist commissioning. This form of commissioning is usually done at a host PCT on behalf of a group of PCTs and involves commissioning specialist services, for example for chronic kidney disease or infertility treatments.
It is also possible to do a full-time or part-time placement at the National Institute for Health and Clinical Excellence (NICE). The placement is usually for 6 months to a year. In past, public health registrars have been based in the Implementation Team or in the Interventional Procedures section of the Centre for Health Technology Evaluation where they focused on the development of guidance on the use of new and existing procedures within the NHS. A placement with NICE is considered useful for those who are interested in health technology appraisal, research interpretation and synthesis, health service quality, health policy and planning. Opportunities for evaluation of the impact of guidance and the actual implementation process are also available.
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.