How to Step up to Consultant as a Full-Time Locum Doctor
If you're taking time out of training to work as a locum doctor, you may be concerned that you risk letting your career stagnate.
Don't worry, you're not alone. Most locums experience the fear of missing out on career progression. In fact, a comment we often hear is, “I don’t want to be an SHO locum doctor when I’m 50.”
You probably also think you only have two options for your career path:
💡 Either choose locuming for the flexibility, higher salary, and autonomy, but accept you’ll be stuck working at the same grade forever.
💡 Or, sacrifice all those benefits and go back into training so you can move up the grades.
Thankfully, this is a common misconception that’s actually incorrect. You don’t have to choose between the two, and you can still achieve good career progression while working as a locum doctor.
In fact, we’re seeing the decision to work indefinitely as a ‘career locum’ become far more popular these days. That’s because locum doctors can still progress into more senior roles, moving from SHO to Registrar, and eventually even Consultant.
In this article, we’ll explain how you can work as a Consultant while you're a full-time locum, explore the different routes you can take to do this, and consider the pros and cons of doing so.
What is a Consultant?
A Consultant is a doctor who has been approved to join the General Medical Council’s (GMC) Specialist Register for their particular specialty.
Most doctors achieve this by securing their certificate of completion of training (CCT) at the end of their training programme.
A common alternative is to gain your Certificate of Eligibility for Specialist Registration (CESR). Taking this route allows you to join the Specialist Register outside of your training programme. This is often used by internationally-trained doctors, leveraging their overseas qualifications to join the Specialist Register. This is also becoming common for non-training doctors, such as long-term locums.
We'll explain the CESR pathway for locum doctors in more detail below.
Becoming a Consultant While Working as a Locum Doctor
It is possible to work as a Consultant while working as a locum doctor without being on the Specialist Register.
While you do have to be on the Specialist Register to be eligible for substantive consultant posts, this doesn’t apply to working locum shifts at the Consultant grade.
However, your opportunities will be based on whether the other Consultants in the department, and you yourself, believe you’re ready to work at that level. Before taking on any shifts, they’ll consider your experience and competencies, and look into whether you have successfully taken any relevant membership exams.
In some cases, the urgency of the department’s need for a locum Consultant may also come into play, as could your relationship with your team.
The transition up to this level will be similar to stepping up to a specialist registrar post while working as an SHO. You can learn more about that in our related article, which includes a detailed roadmap for successfully navigating that progression.
Many of the points covered in that article will also apply when you’re stepping up to work as a locum Consultant as well.
In summary, though, the key parts of that roadmap are:
✅ Research the specialty-specific annual review of competency progression (ARCP) requirements for that of a CT2 or equivalent doctor.
✅ Be proactive in sharing your ambitions with your Consultants and ask for their feedback on your progress regularly.
✅ Check out our guide to writing the perfect CV for locuming and keep updating your CV as you gain more experience.
✅ Make time for exams and clinical courses.
✅ Consider a clinical fellowship if you’re struggling to get enough experience through your locum position.
It’s worth noting that going this route to begin working as a Consultant locum won’t offer much job security or long-term work. Trusts will almost always prefer to hire Consultants on the Specialist Register as a first option, so you run the risk of only ending up with the few shifts that are left over.
You may also need to start working in a department as a Senior Registrar or Associate Specialist first to build relationships and credibility before stepping up.
With that in mind, it could be beneficial for you to get on the Specialty Register, via the CESR route, to increase your chances of finding more Consultant locum work. This will also make you eligible for substantive Consultant posts.
How to Take the CESR Route to Consultant
What is the CESR route, exactly?
Achieving your CESR allows doctors to join the Specialist Register by demonstrating that their training, qualifications, and experience are equivalent to the requirements for CCT.
Upon successful application, you’ll be officially recognised as a Consultant, and you’ll be able to apply for substantive Consultant posts in the NHS.
What does it involve and who can apply?
CESR is a route usually taken by:
👉 International medical graduates who have substantive experience in a specialty and whose professional exams aren’t recognised in the UK.
👉 Doctors who have so much experience that it prevents them from applying for training programmes (usually 18 to 24 months of experience post-F2).
👉 Doctors preferring the flexibility of trust-grade or locum work, who want to become formally recognised as Consultants.
Much like a training programme, you’ll need to collect evidence through your portfolio showing all the equivalent skills and experience from the curriculum of a full GMC-approved training programme in a specific specialty. This evidence can be collected from non-training posts, such as your locum work.
There is an addition rule that, to be eligible to apply for a CESR, you must have undertaken specialist training for a minimum of six months. If you’re not on a training programme, you can get these six months of required specialist training roles from certain fellowship and trust-grade roles which can prove you’ve received sufficient training. An overseas specialist qualification by a non-UK country can also count towards this requirment. See here for more information about eligibility on the GMC website.
What are the benefits of taking this route?
By taking the CESR route, you’ll be able to enjoy all the benefits of being a locum doctor, such as higher rates of pay, flexible hours, the choice of where you work, and a better work-life balance.
As a result, you can complete your training in one area without the issue trainees have of moving around regularly.
You can also do everything in your own time, so if you’re not in a rush to reach the Consultant grade, or if you have other commitments to juggle, this is a steady way to progress while you focus on other things.
Are there any challenges to becoming a Consultant this way?
It’s no secret that this is a less popular approach than the more traditional route. To be successful with your CESR application, you’ll need to be very proactive as you won’t have the support or structure of a training programme.
One important thing to be aware of is that the evidence you provide for your CESR is usually heavily scrutinised. You’ll also need to collect evidence and show written documentation and reflections for any evidence you submit, as proof of your competencies, which requires you to be very dedicated and organised!
Anecdotally, doctors who follow this route often find it can take longer than the standard CCT approach. This is due to the challenges finding work which can provide the experience you need to gather all the competencies.
Finally, you might also see some variance in how proactive and helpful the Consultants are from department to department. If you find one department is unhelpful or unsupportive, you might need to consider moving to work as a locum in a different hospital.
Will these challenges vary across different specialties?
In some specialties, it can be more difficult to gain experience in the competencies you need to submit your CESR application.
Competitive specialties
Surgical specialties and other competitive areas, like anaesthetics and dermatology, can be the most difficult to gain experience in as a locum.
There's a lot of competition amongst trainees and other doctors to get exposure to the relevant cases, making it difficult to build up your portfolio. For example, the opportunity to attend theatre and gain experience in specific surgical procedures as a locum doctor can be nearly impossible when there are four core surgical trainees all competing to attend as well.
Niche specialties
Specialties that require you to gain experience of areas where locum work is harder to come by, such as critical care units and neonatal intensive care units. For instance, anaesthetics and paediatrics.
For these specialties, it’s common to have to apply for clinical fellowships with attachments within the departments in which you’re looking to build up your experience and competencies.
More common specialties
For specialties like emergency medicine, general psychiatry, and general medicine, it’s easier to demonstrate the required competencies, because they’re usually very accessible to you as a locum doctor.
For instance, to work as locum registrar in the emergency department, most Consultants will want to know you have the clinical acumen, as well as experience working in majors, minors, resuscitation, paediatric emergency, and urgent care. Fortunately, these areas are all accessible from a standard SHO locum role.
There’s also usually a shortage of doctors in these areas, so these departments are more incentivised to help you progress to the point where you’re able to fill their rota gaps. That means you’re more likely to be approached by one of the Consultants or rota co-ordinators to step up to a higher grade.
If you do find yourself struggling to gain enough experience, another option is to take up long-term staff-grade or fellowship roles to help you get over the line with your CESR.
What evidence will you need to collect?
The GMC requires you to submit evidence in their four domains, which reflect good medical practice.
These are:
1️⃣ Knowledge, skills, and performance
2️⃣ Safety and quality
3️⃣ Communication, partnership, and teamwork
4️⃣ Maintaining trust.
You’ll need to give evidence of each of the above, to demonstrate that you have all the competencies associated with a doctor who has completed a training programme.
These are specialty-specific requirements. However, using emergency Medicine as an example, you can expect the following:
1️⃣ Knowledge, skills, and performance
⏺️ A work-based assessment (WBA) providing evidence of competencies in the required specialty areas, such as acute medicine, intensive care, anaesthetics, and paediatric emergencies, for emergency medicine applicants.
⏺️ WBAs to cover common competencies, such as managing anaphylaxis, sepsis, and so on.
⏺️ Evidence of being signed off for required procedures, like level1 ultrasound.
⏺️ Evidence of continued professional development.
⏺️ Evidence of appraisals, which will usually be twice annually with your educational supervisor.
⏺️ Evidence of completion of mandatory and suggested courses.
⏺️ Evidence of teaching and training. You’ll normally need to have attended multiple courses on teaching, participate in regular teaching, train to be a clinical or educational supervisor, and even be an instructor for one of the mandatory courses.
⏺️ References to support your skills and performance.
It’s also worth noting that for some specialties, you may also be required to submit evidence of successful completion of research, publications, and presentation at conferences.
2️⃣ Safety and quality
⏺️ Audits.
⏺️ Evidence of improvising patient care and safety, service development, clinical governance, and health and safety.
3️⃣ Communication, partnership, and teamwork
⏺️ Management and teamwork, such as chairing meetings or leading group projects.
⏺️ Evidence of compliments and appreciation that you’ve received from patients or colleagues.
⏺️ Written feedback from colleagues to support you.
4️⃣ Maintaining trust
⏺️ Structured references to show you work and act with honesty and integrity.
⏺️ Proof that you’ve completed conflict resolution courses and anything else relevant.
Durations
There are also requirements for duration. This is usually equivalent to the time a trainee would take to achieve CCT in their specialty. So, in the case of emergency medicine, a minimum of six years would be required through two years of acute care common stem (ACCS) and four years of emergency medicine.
Who will assess your application?
The GMC will conduct an initial review of your application, then pass it on to the Royal College of the specialty you’re applying for. The Royal College will then review your application in detail to determine whether the evidence you've submitted demonstrates sufficient experience, training, and qualifications for CCT.
After submission, the college has exactly seven weeks to submit their evaluation. If you're deemed to be capable, you'll be recommended for entry to the Specialist Register. The GMC will then need to reach a final decision, which can take around two or three months.
Returning to Training
You may wonder what this would mean regarding your ability to pivot and return to training later in your career.
If you want to work as a locum doctor for a while, then enter training later, it’s important to note that you’ll need to be careful with how much work you do in certain areas. There’s actually is a maximum limit to the amount of experience you’re allowed to have when applying to ST1, CT1, or equivalent training posts.
For the majority of specialties, this is 18 months, with the exception of neurosurgery and obstetrics and gynaecology, which are limited at 24 months.
While there doesn’t appear to be the same limit for ST3 posts, there is a stated “maximum desired” amount of experience. Depending on the individual specialty, this ranges from 48 to 60 months. Going over this limit can count negatively towards your application in certain specialties, particularly surgical.
In Summary
You don’t necessarily need to be on the Specialist Register to work as a locum Consultant. However, if you decide to do so without that status, it’s unlikely to be a secure long-term career path.
If you want more stability as a locum Consultant, you should consider going down the CESR route to get on the Specialist Register. Of course, this is mandatory if you want to apply for substantive Consultant roles.
As mentioned earlier, it can be challenging to reach the consultancy grade this way, but if you can make it work then the range of benefits available will be very worthwhile.
You can find more useful information about CESR from the GMC here:
📖 Understanding the CESR route
📖 The different types of CESR routes
📖 Specialty-specific guidance and requirements.
Your Ultimate Guide to Succeeding as a Locum Doctor
This article is part of a wider series of resources and guides that are designed to support you as a locum doctor, covering areas such as getting your first job, managing your finances, understanding your rights, and many more. Visit our Locum Doctor Hub for everything you need to know about locuming today.
Additionally, if you're considering an F3 year, you might also find it useful to look through the selection of resources we've put together in our F3 Resource Hub.
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