According to the ILO (International Labour Organisation) medical doctors diagnose and treat human physical and mental illnesses, disorders and injuries, and recommend preventive action, based on the scientific principles of modern medicine. They may specialise in certain disease categories or methods of treatment, or assume responsibility for the provision of continuing and comprehensive medical care to individuals, families and communities. See text here
An inquiry by the Royal College of Physicians in 2005 further examined the nature of a doctor’s professionalism. Their report defined professionalism as “a set of values, behaviours, and relationships that underpins the trust the public has in doctors.” It talked of a covenant between the medical profession and society, which went far beyond compliance with contracts or job plans and even technical ability. It required doctors to work in partnership with patients and to exercise honesty, empathy, confidentiality, humanity, and above all judgment in the face of uncertainty. It concluded that the most important aim of professionalism was securing trust. See text here
However, 5 years further on, the role of a doctor in 2010 now focuses on the attributes and abilities that doctor’s need and the range of tasks they undertake. As well as supporting patients in making decisions about their care, doctors must be active in teaching the next generation of doctors, managing resources, and improving the quality of care. They must also be able to work in teams and must take account of finite resources in their decision making, “notwithstanding the primacy of the individual doctor-patient relationship.”
And in its simplest breakdown, there are three major types of doctor based on locality.
- Hospital doctors
- Community doctors
- Industry doctors including the Armed Forces
HOSPITAL DOCTORS
The hospital is where the majority of UK doctors work and it is where the highest seniority within the medical profession can normallybe achieved. For although medical professors are normally attached to a university for their professorial chair, that chair is usually attached to a specific hospital too. Newly graduated doctors will usually join the hospital system full time by requesting selection onto the 2 Foundation Years (FY1 and FY2). Progressing in any direction is not possible without FY1 and FY2. Within any hospital there will be four main grades / types of doctor
Junior hospital doctor
All doctors are regarded as junior until they achieve the position of consultant or specialty doctor. As junior hospital doctors progress through training and gain experience, their responsibilities increase, but they are always under the supervision of a senior doctor, though not necessarily directly. Junior doctors are generally given ward based roles, reviewing and monitoring patients daily on behalf of a consultant or senior doctor. The ward may be as diverse as orthopaedic or acute respiratory problems.
Specialist Registrar
Specialist registrars (SpRs) are still junior doctors but have passed through the basic foundation years FY1 & FY2 and have now applied for specialist training ST1 to ST8+ say depending on the specialty being studied. As previously, as SpRs progress through training and gain experience, their responsibilities increase, but they are always under the supervision of a senior doctor, though not necessarily directly. Once an SpR has completed their entire training programme and passed all the relevant Royal Medical College exams, they gain a certificate of completion of specialist training (CCST) and appear on the General Medical Council’s specialist register (GMC). They are now free to apply for a vacant consultant position nationwide.
Senior Doctors: The Specialty Doctor
The specialty doctor is a new grade established by the NHS in 2008 to replace the previous staff and associate specialist grades (SAS) with a single grade. It also subsumes other grades such as trust grade, clinical medical officer, hospital practitioner and clinical assistant.
Specialty doctors will have a minimum of four years postgraduate training (FY1, FY2, ST1 and ST2 or CT1 and CT2) and will deliver routine and emergency clinical care under the supervision of a consultant, but with time they will take on more responsibility, with doctors at the top end of the grade resembling the old associate specialist grade, working independently with only indirect supervision. Contrary to previous NHS protocols, doctors in this grade will now be able, if they wish, to gain specialist registration and become consultants through keeping a portfolio of experience and competence. At all levels the specialty doctor will be part of a team led by a consultant and will take part in all of the activities of their specialty including teaching students and junior doctors.
Senior Doctors: Consultants
These doctors have achieved the highest status of clinical duties and will have passed the final examinations of their respective Royal Medical College. A consultant has the ultimate responsibility for the clinical care of patients and will normally manage a multidisciplinary teamwhich will include nurses and other healthcare professionals as well as other doctors. Consultants are responsible for the education and supervision of junior doctors in their team and also for the supervision of specialty grade doctors. All consultants will be trained in one of over 50 specialties recognised by the GMC and NHS (see Appendix A).
COMMUNITY DOCTORS
Community doctors work with the public at large and are generally known as General Practitioner or GP. They can work in a number of localities including local health centres, GP clinics, out of hours clinics, NHS24, the prison medical service and family planning clinics. The size of their patient list could be in the thousands depending on whether they are operating in an urban or metropolitan area or rural practice.
GPs in a local healthcare practice will have overall responsibility for the management of their patients’ healthcare, including the diagnosis and treatment of health problems and the referral of patients for specialist treatment where necessary. They are responsible for monitoring their patients’ health on a regular basis. They are also increasingly likely to be responsible for monitoring some complex chronic illnesses.
To become a GP requires completion of FY1 and FY2 as usual plus ST1 to ST3 specialist GP programme. This leads to entry onto the GMC’s GP register. Once registered the GP would be expected to undertake CPD or continuing professional development.
INDUSTRY DOCTORS
Doctors that practice in industrial situations can include GPs and senior doctors who specialise in occupational health. Having an in-house doctor has become standard practice for the rising number of large cruise ships now common in the travel trade, and similarly at large industrial plants such as a steel works. And finally let us not forget the significant presence of doctors within the UK Armed Forces, both home and abroad.
In the Armed Forces, there are generally two opportunities. Firstly the forces employ GPs to maintain the health of the professional soldiers, airmen and sailors and secondly they bring in consultants, especially surgeons, on six month secondments. It is widely considered in medical circles that a 6 month stint in the battle zone of Afghanistan is worth years of training in a DGH (district general hospital).
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