Non consultant career grade doctors: past, present and future

Abstract

Staff grades were created in order to resolve the issue of the thousands of locum registrars and SHOs working within the NHS without security or tenure. The grades were intended to achieve balance with secure jobs, but largely failed in this intent due to trust freedoms and abuse ‐ which saw NCCGs used to plug staffing gaps without appropriate support or protection ‐ and an undermining of the status of doctors in these positions. Some NCCGs had unrealistic expectations of the post, overestimating their chances of becoming a consultant, or conversely seeing the post as lacking any prospects. Before the European Specialist Medical Qualifications Order (ESMQO) in 1995, the chances of becoming a consultant were real, if distant; they depended on the doctor’ s medical degree, training, experience and ability to fill the post. After 1995, this avenue of advancement was closed. However, this is not necessarily a cause for despair: the career grades should not be seen as inferior to consultant posts, merely different. There is nothing wrong with concentrating on teaching and clinical care without the distractions of other duties such as management and organisation. The future should see the development of the staff grades, concentrating on seeing them as performing valuable functions and finding ways to realise their full potential. The question of allowing NCCGs to reenter and complete training should also be explored; this, however, presents problems since the posts are not, in their purpose or structure, training posts, and making them so might lessen their usefulness. Staff grades should also be given new contracts that ensure a good standing and salary.