Hot Desk

hot 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

Public Health Estate Agent 

During your five years as a registrar, you get to experience the applications of public health approaches in a number of different settings.  How many you do and where you go depends upon you and on the training sites available. Training sites have to be accredited with the regional postgraduate medical deanery and will have an educational supervisor attached. There can be other opportunities available to you whilst in an educational site whereby you can work on projects with public health doctors in other fields as long as they are accredited clinical supervisors.

How do you pick your settings?


Have a chat with your training director or educational supervisor about what opportunities are available to you in your area. You have five years to play with so make the most of it and pick and mix your placements to make your training as exciting and interesting as possible. Remember, you do have to keep your end goal in sight. Do you want to be a consultant in public health, an academic or a consultant in health protection? Make sure that your experience in each placement will help you.

Read below for some information on the typical placements that public health registrars do.

Local Authorities

When: Phase 1 of your training 

Duration: Approximately 2 years (up to 30 months)

Since April 2013, local public health teams sit within local authorities. Directors of Public Health have responsibility for the health of the local population. The day-to-day role and responsibilities of the local public health team may involve:

  1. Providing information and advice to relevant bodies within its areas to protect the population's health
  2. Providing local intelligence information on population health requirements e.g. JSNA
  3. Independent scrutiny and challenge of the arrangements of NHSE, PHE and providers. This function may be carried out through agreed local mechanisms  - e.g. Health and Wellbeing Boards, Health and Social Overview Committees (HSOC or scrutiny)
  4. Commission public health services such as sexual health, school nursing, drugs and alcohol
  5. Contribute to the reduction of health inequalities within the population and to the health improvement of the population (e.g. reduction of childhood obesity)
  6. Under a memorandum of understanding (MOU) or an integrated governance framework (IGF) provide public health input into the Integrated Care System (ICS) [formerly into CCGs]

Registrar placements are likely to cover health needs assessments, production of annual Director of Public Health report, JSNA, working with Health & Well-being Boards, engagement with ICSs, working in partnership with other parts of the council, including councillors and community leaders. Environment, culture, housing and leisure services fall under the remit of local authorities and are major determinants of health. There are opportunities to work with them in reducing health inequalities. Since commissioning of drugs and alcohol services, sexual health services and 0-19 services are now local authority functions, trainees now will be exposed to public health commissioning more so than in the past.

To find out more about public health teams in local authority and the public health role of local authorities, read The New Public Health Role of Local Authorities and Public Health in Local Government.

Health Protection Teams (UKHSA)

When: Phase 1 of your training

Duration: 3-4 months

All registrars have to do a minimum of three month placement with a health protection team (under the supervision of a Consultant in Communicable Disease Control or a Consultant in Health Protection). 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 local authority or NHS England/Improvement, as you would be responding to daily queries (e.g. clinical advice on 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 HPT, you become eligible to do on-call for public health.

More senior registrars (i.e. post FPH membership exam) may also do a placement with one of the national or regional PHE centres, working on responses to chemical incidents or emergency preparedness and response (EPPR). There are also opportunities for non-medics to pursue a career in health protection.

NHS England

When: Phase 2 of your training (post Part B)

Duration: Usually 6 months to a year

Most NHS care is commissioned by Integrated Care Systems (ICSs).  However NHSE directly commissions five areas: primary care (although this is mostly delegated to ICSs), public health (screening and immunisations), specialised services, health and the justice and some services for the armed forces.   Since 1st October 2021, the national healthcare public health team from Public Health England have been in NHSE and there may be opportunities to do a placement with this team.  

NHS England National and Area Teams (i.e. regional offices) have public health specialists and practitioners within their specialist commissioning teams and their public health commissioning teams of Section 7a programmes. Section 7a programmes cover screening, immunisations, military health, Child Health Information Systems and health & the justice system (this includes commissioning health services for youth offending institutions, probation services, youth offending services and point of arrest). There are consultant leads on these teams (known as Screening and Immunisation Leads or SILs). These public health consultants are accountable and responsible for improving uptake and coverage of the Section 7a immunisation and screening programme and they provide the public health/clinical input into commissioning these programmes. They also provide internal quality assurance of providers. 

Placements here will expose you to public health commissioning, operational and strategic thinking on a regional scale, devising and embedding fail safes for immunisation and screening programmes, quality assurance of immunisation and screening training and knowing and implementing the details of a systems overview. 

Similarly, opportunities in Specialist Commissioning will expose you to how NHSE commissions specialised services to support people with a range of unusual and complex conditions like HIV and Chronic Kidney Disease.   Public health consultants play an important role in minimising public spend (ensuring that the finite resources are used for interventions that bring the most benefits for the most sensible funding), improving quality of services, developing care pathways and providing advice on individual funding requests.

Office for Health Improvement and Disparities - Regional/National Centres

When: Phase 2 of your training

Duration: Usually 6 months to a year, though you can have shorter projects

Formerly the regional and national centres of Public Health England, from the 1st October 2021, these centres are part of the Department of Health and Social Care (DHSC), under the Office for Health Improvement and Disparities.  This is the civil service and will expose you to a different way of thinking to that of the NHS or local government.  OHID, as it's known, has the functions of health improvement, the wider determinants of health and health inequalities.  It has joint responsibility with NHSE for health services.  (The nine regional directors of public health are jointly aligned to OHID and NHSE).  

Placements can be national or regional. A national placement will normally involve spending time in London.  It can also include some international work on global health. A regional placement will involve working within a regional PHE office.

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 public health teams in this setting do not deliver health or social care services directly 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. NHS England, ICSs, local government, voluntary sector, private sector, ministers and working with other governmental bodies and international bodies). They will also provide you with experience in working in policy. 

Typical topics to work on will be policy making on health improvement (such as sexual health, preventing obesity, mental health), child public health, TB and working on PHE priorities such as the digital strategy.  

Health Intelligence Placements

When: Phase 2 of your training

Duration: Usually 6 months to a year, but 3-4 months is possible

Knowledge and Information Services (known as KIS) and field epidemiology are the intelligence hobs of public health. They collect and share data and information about health and the wider determinants of health. This covers common diseases like cancer and lifestyle factors such as smoking, diet and exercise. Staff also interpret data to provide a meaningful health 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 local authorities and ICSs. Local public health teams have their own public health intelligence staff but OHID have regional KIS and UKHSA have field epidemiologists.  

A placement with field epidemiology or KIS 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 local authorities and other policy makers, that is providing information that can be practically harnessed to help improve services or assess needs of populations.

Acute Trusts

When: Phase 2 of your training

Duration: Usually 3-6 months up to a year

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 MFPH Diplomate and/or membership 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 fulfil 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, 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.

Academic Placements

When: Phase 2 of your training

Duration: 3 months to a year; possible to take 'time out' to do a PHD or a research fellowship

All training programmes have one if not more universities on their doorstep. There are lots of opportunities to undertake a piece of academic research.   The main option is to do a short placement.  This can be 6 to 12 months, where you focus on learning a specific research skill, complete a project, get some teaching experience and ideally write an academic publication.  Many registrars do this short term 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 (Academic Clinical Fellowship placement) . 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.

Overseas Placements

When: Phase 2 of your training

Duration: Up to a year, though can be 2 years; usually considered 'out of programme' experience.

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 through registrars' networks. 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.

Other Placements

When: Phase 2 of your training

Duration: Usually short term of 3 months, though can be 6 months

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.

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.  I have also heard of registrars working with public transport bodies.