NHS Role Comparison

jakubdebski7
Apr 22
2 min read

If you’re entering the UK healthcare system for the first time, or even just looking to progress within it, understanding the hierarchy of medical roles in the NHS can feel overwhelming. Each title comes with distinct responsibilities, required qualifications, and a place in the patient care pathway.

In this blog, we’ll break down the key medical roles in the NHS—Consultant, Specialty Doctor, Clinical Fellow, and Registrar (including Senior/SpR)—and explore how they each contribute to the function of a typical NHS department.

👨‍⚕️ 1. Consultant

Overview:

A Consultant is a senior doctor who has completed all specialty training (up to ST7/8), often gaining a Certificate of Completion of Training (CCT), and being listed on the GMC Specialist Register.

Responsibilities:

Leading patient care within a department or specialty
Supervising junior doctors and multidisciplinary teams
Making final decisions on diagnosis and treatment plans
Leading audits, teaching, and quality improvement
Engaging in management, governance, and service development

Required Skills:

High-level clinical expertise in a specialty
Leadership and decision-making
Teaching and mentoring
Strategic planning and service improvement

Progression:

Often considered the peak of clinical progression, consultants may move into:

Clinical Directorship
Medical education
Research and academic posts
Executive NHS leadership roles

🩺 2. Specialty Doctor (SAS Doctor)

Overview:

Specialty doctors are experienced medical professionals who are not in a formal training programme and haven’t completed CCT but have significant experience (typically 4+ years post-graduation, including 2+ in a specialty).

Responsibilities:

Delivering high-quality patient care in their specialty
Managing clinics, procedures, and inpatient responsibilities
Supporting junior doctors and registrars
Working semi-independently under the supervision of a consultant

Required Skills:

Strong clinical knowledge and autonomy in practice
Reliability and independent decision-making
Teamwork and cross-specialty communication

Progression:

Specialty doctors can apply to become a Specialist Grade (new senior SAS role), or work toward CESR (Certificate of Eligibility for Specialist Registration) to become a consultant.

👩‍⚕️ 3. Registrar (ST3+ / SpR / Senior Registrar)

Overview:

Registrars are doctors in specialty training. These doctors have completed core training and are now working in higher specialty training, typically ST3 and above. They are on the formal path toward becoming consultants.

Responsibilities:

Running ward rounds and supervising junior doctors
Performing specialty-specific procedures
Taking on on-call responsibilities (often the first point of contact for acute patients)
Engaging in teaching and departmental audits

Required Skills:

In-depth specialty knowledge
Confidence in clinical decision-making
Teaching and leadership development
Time management and rota balancing

Progression:

Upon completing training and achieving CCT, registrars progress to consultant roles.

👨‍🔬 4. Clinical Fellow

Overview:

A Clinical Fellow is a flexible role often taken by international or UK doctors who are:

Between training posts
Gaining experience in a specialty before applying to training
Working towards postgraduate exams or GMC registration

Fellowships can be non-training or training-equivalent posts.

Responsibilities:

Providing clinical support at SHO or registrar level
Assisting in ward rounds, clerking, procedures, and on-call duties
Often involved in audits, research, teaching, or simulation training

Required Skills:

Foundational clinical knowledge
Willingness to learn and adapt
Good communication and team integration

Progression:

Clinical Fellows may:

Apply for training programmes (ST3+)
Progress toward CESR
Continue as trust doctors or move into research/education roles