UK NHS Doctor Roles and Responsibilities: A Complete Guide for IMGs

Medical titles in the UK differ from those in many other countries. For IMGs, considering working in the NHS (National Health Service), it is helpful to understand the job titles and responsibilities, as this will give a clearer picture of potential career paths.

When relocating, it is wise to think about which role you may start from, as well as the position you ultimately want to aim for. Career progression always depends on the current job market, so being aware of these structures is essential.

This article explains the typical medical positions within the NHS and their associated duties.

※This article is written by OET Bank, where we specialize in helping healthcare professionals prepare for OET and support their overseas career opportunities.

NHS Medical Roles

Let’s begin by listing the main medical positions in the NHS:

Junior Doctor
ST3+ Doctor
Specialty Doctor
Specialist Doctor
Consultant
General Practitioner (GP)
Locum Doctor
Academic Doctor

The names may give you a rough idea, but the actual duties can be difficult to imagine. Let’s look at each in detail.

1. Junior Doctor

A Junior Doctor is still in clinical training. The closest equivalent would be a resident or intern. While “Junior Doctor” is not an official title, it commonly refers to all doctors below Consultant level.

Subdivisions include:

FY1: Foundation Year 1
FY2: Foundation Year 2
ST1+: Specialty Training
CT1+: Core Training

“FY” stands for Foundation Year, “ST” for Specialty Training, and “CT” for Core Training.

The purpose of these posts is to establish a specialty and gain broad clinical experience. Duties include ward rounds, on-call shifts, writing discharge summaries, and managing specific ward areas. Doctors rotate across hospitals and departments to experience the diversity of the NHS.

Foundation (FY1 and FY2): broad exposure to multiple departments.
Specialty Training (ST1 and ST2): focus on chosen fields.
Core Training (CT1 and CT2): broad rotations, e.g., four different medical or surgical disciplines.

Other posts exist outside formal training, such as Junior Clinical Fellow or Trust Grade positions. The term SHO (Senior House Officer) is also widely used, especially in NHS job listings, to describe CT1/2 or ST1/2-level doctors.

2. ST3+ Doctor

After completing ST1/2 or CT1/2, Junior Doctors progress to ST3+. This stage is often called the “middle grade,” but they are still technically within the Junior Doctor category.

At ST3+, doctors begin advanced specialty training with increased responsibility. Depending on the field, training may extend from ST3 up to ST8. For example, radiology training may continue seamlessly from ST1 through ST3, while surgery requires completion of Core Training before advancing.

Positions such as Senior Clinical Fellow or Trust Grade ST3+ focus more on service provision than structured training.

3. Specialty Doctor

A Specialty Doctor has completed at least four years of postgraduate training, with a minimum of two years in a chosen specialty. Their duties cover patient care, research, and specialty-specific responsibilities.

This role is common among UK doctors seeking predictable hours or fewer on-call shifts, as well as IMGs who want to gain UK experience or pursue Royal College examinations.

4. Specialist Doctor

Introduced in 2021, the Specialist Doctor role recognizes senior physicians with specialty qualifications and several years of experience. Comparable to senior faculty or associate professors, they provide advanced clinical care, make key decisions, and often supervise other doctors.

They share many responsibilities—and even starting salaries—with Consultants. The main difference: Specialist Doctors are not required to work independently or obtain specialist registration. Because of this, many IMGs see it as an attractive high-level role without the full Consultant requirements.

5. Consultant

The highest hospital-based position. Consultants are senior physicians who have completed all training and obtained a CCT (Certificate of Completion of Training). It typically takes around ten years from graduation to reach this level.

Consultants deliver expert care, lead clinical teams, and oversee junior doctors. They also coordinate referrals to other specialties and participate in hospital leadership.

For IMGs, direct entry as a Consultant is rare. More often, IMGs work first as Specialty or Specialist Doctors while pursuing CESR (Certificate of Eligibility for Specialist Registration). Some may secure Consultant posts, but usually on fixed-term Locum Consultant contracts.

6. Locum Doctor

Locums are temporary doctors who cover shifts when permanent staff are unavailable (e.g., during maternity leave or illness). The NHS employs many locums.

Employment options include:

Agency staff: hired per shift via agencies, often at high pay.
Bank shifts: paid slightly higher rates through NHS Trust staff banks.
NHS locum contracts: fixed-term contracts directly with the NHS.

Locum roles exist at all levels (FY1, Specialty, Specialist, Consultant, GP). The duties depend on the role being covered.

7. General Practitioner (GP)

GPs provide primary care at community clinics rather than hospitals. They are the first point of contact for non-emergency medical issues and play a central role in the NHS.

Their work includes diagnosis, wound care, vaccinations, prescribing medication, mental health advice, and referrals to specialists or hospitals. GPs manage ongoing care for both acute and chronic conditions, usually within small local practices.

8. Academic Doctor

Academic Doctors focus on research and education. Roles range from Academic Clinical Fellows to full Professors. Professors typically focus on teaching, while fellows engage in clinical research. These positions are essential for the advancement of medical science within the NHS.

Summary

This has been an overview of medical roles and responsibilities in the UK.

While there are eight broad categories, titles are further subdivided depending on training and responsibilities. At present, London faces a shortage of Junior Doctor posts for IMGs, so the route you hope for may depend on timing and the job market.

As an IMG, think carefully about which role to aim for when entering the NHS, and which senior positions you may eventually want to pursue. Understanding the structure will help you plan more effectively for your UK medical career.

If you’re preparing for OET, consider exploring our practice resources at OET Bank. We’re designed not just as mock tests, but as powerful review tools that make it easier to analyze weaknesses and focus on what’s needed to pass.