Being Public Health Consultants

Where do public health doctors work in the UK?

Since April 1st 2013, public health is dispersed across a number of organisations in England. The dismantling of Public Health England in 2021 has led to the emergence of the UK Health Security Agency, the Office for Health Promotion (in Department of Health and Social Care) and health care public health was transferred to NHS England.

Health Education England (now part of NHSE) has a workforce census (Public health specialist capacity review) outlining where you can find public health doctors and other specialists. I've outlined below the main areas where you can work as a consultant.

Local Public Health

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 (i.e. school health and health visiting services). Directors of Public Health have responsibilities for the health of their local population (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.

From April 2020, public health input is also provided in place based commissioning through the integrated care services (ICSs), formerly known as strategic transformation partnerships (STPs). ICSs are the merger of a number of CCGs, acute and community providers over a larger geographical footprint. As of July 2022, ICSs became legal entities and they are appointing public health consultants to work across the ICS. Some of these posts are based in hospital or community trusts, which are reinvigorating provider public health work.

Healthcare Public Health (NHS England)

Within NHS England, there is a national healthcare public health team who provide advice to the NHS. This is a new function within NHSE and follows the transfer of healthcare public health consultants from PHE when PHE was dissolved on 30th September 2021. There are also specialist advisors to national programmes (which include public health doctors) and public health consultants provide advice into clinical networks and health inequalities work by NHSE.

Within regions, there are dental public health consultants and Screening and Immunisation Leads (SILs) who provide public health advice, systems and clinical leadership into primary care and public health commissioning (the latter is also known as Section 7a programmes).

Non Communicable Diseases Policy

On a policy level, there are national and regional roles for public health consultants within the Office for Health Promotion, Department of Health and Social Care, 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. Public health consultants sit in national teams or in regional offices.

Health Protection (UKHSA)

Consultants of health protection and Consultants of Communicable Disease Control work with their health protection teams across the country to control the spread of communicable diseases and protect the population against environmental hazards and exposure to chemical incidents, working closely with colleagues in NHS and local authorities. These teams from part of the UKHSA, which was set up in October 2021 as an agency with a global-to-local reach to protect the health of the nation from infectious diseases and other external threats to health.

There are national teams in UKHSA which focus on disease epidemiology, immunisations, antibiotic resistant microbiological organisms, infectious diseases, microbiology, environmental hazards and change, vulnerable populations and global health, amongst others. An example of a public health consultant post here is a consultant epidemiologist. Consultant epidemiologists provide strategic leadership in the surveillance of infectious diseases and environmental hazards, and they support the development, maintenance and evaluation of surveillance systems. They lead the collection, collation and analysis of data and research and provide advice across the public health system on specific topics, e.g. immunisation coverage and uptake.

Academia and other sectors

Public health doctors 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.

Global Health

There are opportunities to work on global health within the public health community. There are defined global health posts within UKHSA and OHID but there are opportunities within the NHS as part of the Better Health Programme, led by the Foreign, Commonwealth, & Development Office.

See Going Global NHS International Volunteering and Wessex Global Health Network for more information.

Have you an example of a typical day?

I get asked this a lot! The truth is that there isn't a typical day, that's the joy of public health. The work is varied and no two days are the same. Suffice to say that it is an office or desk based job and is generally a 9-5 job (although flexible, condensed hours and part-time work are common). Days are made up of meetings, emails, report writing, presentations, data analysis and interpretation, line management, matrix working and staying on top of the latest data and research.

I have written a blog on the typical day for publichealthjobs.co.uk which you can access here.
There is also an old blog I wrote in 2010 From PHD to public health doctor.

There are a few other blogs out there that provide further insight:

Contemplating consulting in public health, with Leah Roman

What do you actually *do* then – Sheffield DPH

Public health consultants and specialists (Health Careers)

Appraisals and Revalidation

All consultants, whether they are registered on the GMC register or the UK Public Health Register need to undertake annual appraisals and revalidation every 5 years. Revalidation is the process to keep the registration current and up-to-date and ensure that registrants are fit to practise. See FPH website on revalidation and UKPHR for more information on how to revalidate.

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.