Guidance for the employment of medical and dental consultants

Guidance for recruiting and employing medical and dental consultants in the NHS.

10 April 2024

Guidance documents which provide employers with useful information on the employment of consultant doctors and dentists in the NHS.

This article outlines useful guidance documents related to the employment of medical and dental consultants. There have been a number of guidance documents produced which provide employers with useful information on the employment of consultant doctors and dentists in the NHS. These include information on the following:

Job planning

We have worked with the British Medical Association (BMA) to produce a guide to consultant job planning (PDF). The challenges facing the NHS highlight the continued importance of consultant job planning as a means of organising resources effectively and efficiently.

Access job planning resources on the consultant contract web page.


A practical guide to calculating on-call work (PDF) and a guide to determining on-call availability supplements (PDF) both published by the former consultant contract implementation team in 2004.

Private practice

The code of conduct for private practice (PDF) sets out recommended standards of best practice for NHS consultants in England about their conduct in relation to private practice. The standards are designed to apply equally to honorary contract holders in respect of their work for the NHS. The code covers all private work, whether undertaken in non-NHS or NHS facilities.

Part-time consultants

The Department of Health and Social Care, the central consultants and specialists committee of the BMA and the NHS Confederation intended that the 2003 consultant contract should provide the necessary flexibility for those consultants who wish to work part-time. This part-time guidance (PDF) focuses on those aspects of the contract that relate specifically to part time working as well as highlighting other aspects of the agreement that will be of particular interest to part-time consultants.

Locum consultants

This locum guidance (PDF) supplements the provisions on locum appointments set out in Schedule 22 of the Terms and Conditions of Service for NHS Consultants (2003).

Study leave

Circular HC(79)10 - study leave, issued by the Department of Health and Social Security in April 1979, records an agreement for consideration of applications for study leave.

Supporting professional activities

NHS Employers' guidance on supporting professional activities (PDF) suggests some parameters for assessing the time required to undertake supporting professional activities.

Annual appraisal for consultants

The Department of Health have produced two circulars relating to annual appraisals for consultants:

There is guidance in the consultant job planning toolkit about how job planning links with appraisal.

Arrangements for 'acting down' by consultants and SAS doctors

From time to time, consultants and SAS doctors will be asked to act down to cover the absence or shortage of junior staff. Arrangements for doing so will be a matter for local discussion and agreement.

Employers might find these examples (Word) useful in drawing up their own policy, although NHS Employers does not endorse any one approach.

Senior doctors can be asked to act down, however employers should take account of the doctor's other commitments and how these can be covered; and the requirement for, and arrangements for provision of compensatory rest. Employers should also take account of whether the doctor has the appropriate and up-to-date skills to cover this work.

  • There is information on the Department of Health's website to be used by NHS trusts, primary care trusts and strategic health authorities (SHAs) when making appointments to consultant posts. 

    It provides good practice guidance (PDF) on the NHS (appointment of consultants) Amendment Regulations 2004 (Statutory Instrument 2004 No. 3365). 

    Please note that primary care trusts and strategic health authorities (SHAs) were abolished by the Health and Social Care Act 2012. The Department of Health has confirmed that the appointment of consultants regulations do not apply to clinical commissioning groups (CCGs). 

    NHS foundation trusts are not covered by the consultant appointment regulations.

    The Academy of Medical Royal Colleges (AoMRC) and the Foundation Trust Network (FTN) have agreed a concordat regarding the role of the medical royal colleges in the recruitment process for consultants to posts in NHS foundation trusts.

    Appointment to public health posts

    Employers should ensure that advertisements for consultant grade posts in public health are clear about any component which requires the post holder to be a registered medical or dental practitioner.

    It is generally accepted that most of the duties of a public health consultant post can be done by a person who either is, or is not, a registered medical or dental practitioner. If through custom and practice a post holder has given, for example, medical advice then this should be recognised in the individual's job description. 

    If a post is advertised which requires a post holder to be a registered medical or dental practitioner then the job description should clearly justify this. If a post is advertised which could be filled either by a registered medical or dental practitioner or otherwise because only a minority component of the post requires this and the employer would utilise other arrangements to cover this function e.g. giving medical advice - then this component should nevertheless be clearly identified in a job description when filled by a registered medical or dental practitioners.

    Registered medical or dental practitioners in a post including these functions will appropriately be placed under the terms and conditions of service for NHS medical and dental staff rather than Agenda for Change.

  • The GMC has changed its guidance on foundation trusts (FT) hiring consultants who are not on the specialist register.

    We have discussed this issue with the GMC and understand that for foundation trusts, specialist registration is no longer a legal requirement for appointment to consultant posts.  However, FTs must still satisfy themselves that the doctor is competent to undertake the requirements of the post. This of course should be rigorously ensured for all consultant appointments in all trusts, even where the doctor is on the specialist register, as their entry to the register is to some extent a snapshot of a particular point in time and not proof of specific current clinical competences. 

    It is our view that FT employers should continue to appoint doctors who are on the specialist register if possible, but that there may be specific circumstances where a doctor clearly meets the requirements of a consultant post but due to issues such as e.g. their pattern of subspecialty training and practice overseas, they would not have met the requirements for the old CESR registration process. In these situations, if the doctor is appointed we would also recommend that the trust and the doctor consider whether the new portfolio pathway could provide a mechanism for them to enter the specialist register. Changes to how doctors demonstrate the standard required for specialist and GP registration.