Agile Workagile work v,
to bring together people, processes, connectivity and technology in order to find the most appropriate and effective way of carrying out a particular task; used here to denote the adaptability of public health professionals in working in partnership and applying their expertise in different areas or fields
Consultants in Public Health
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 & Improvement.
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) or strategic transformation partnerships (STPs). ICSs or STPs are the merger of a number of CCGs, acute and community providers over a larger geographical footprint.
Healthcare Public Health
Immunisation, screening and health and justice system were collected under Section 7a agreements and are commissioned by NHS England & Improvement. Screening and immunisation teams oversee these programmes alongside NHS public health commissioners. These include public health consultants (Regional Screening & Immunisation Leads) who provide the systems and clinical leadership for the programmes. Other public health consultants and their teams are employed within NHSE/I's specialised commissioning. There are also specialist advisors to national programmes (which include public health doctors) and nationally there is a healthcare public health team who provide advice to the NHS (currently PHE employed, but moving to NHSE/I in September 2021).
Non Communicable Diseases
There are national and regional roles for public health consultants within Public Health England (from September 2021, the Office for Health Promotion), 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.
Consultants of health protection and their teams operate across the country working closely with colleagues in NHS and local authorities to control the spread of communicable diseases and chemical incidents. From September 2021, they will be part of the UK Health Security Agency.
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.
Have you an example of a typical day?
I did a couple of interviews on my typical day some years ago which may still be useful to you.
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/Improvement 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 become a Consultant?
There are two routes to becoming a consultant - a prospective route and a retrospective route.
Prospective (Training) Route
The main prospective route into being a public health consultant is to complete the 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.
Retrospective (portfolio) Route
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, the Faculty of Public Heath exams). Submissions should demonstrate recent and periodical 360 degree or multiple source feedback, workplace based assessments, full information on activities undertaken and full audit cycle. Having the diplomate and membership parts of the FPH exams is not mandatory but is advisory as they demonstrate a number of competencies. If a medic on the public health training programme has not met the foundation requirements for GMC and wish to have GMC registration, s/he can apply for the CESR within the training programme. 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.