What’s the Difference Between a Clinical Fellow and Trust Grade Doctor?
If you are planning your F3 Year, you may be considering many different work options. From locum work to contracted (substantive) roles, there are a lot of different opportunities for junior doctors out there.
You’ve probably heard about trust grade roles and clinical fellowships, but teasing apart exactly what the differences are between these two jobs can be a challenge.
It’s true, there are a lot of similarities between the two roles, but there can also be big differences in regard to:
👉 pay
👉 rota
👉 responsibilities
👉 educational opportunities
So it is worth understanding how the two are different before you commit to one over the other!
In this article, we will outline the key similarities and differences between Clinical Fellowships and Trust grade roles. But before we dive in, check out our article ‘What is a Clinical Fellow’ if you are unfamiliar with the term.
Who can do the job?
Both roles are typically done by SHO grade doctors. This often means an F3 doctor, but can also mean a CT1 or CT2 (or ST1 or ST2) doctor too.
📑 Contract
Both roles are fixed-term contracted (substantive) roles lasting up to 12 months (though trust grade roles can be shorter and may be only 6 months). The doctor is hired directly by the Trust instead of nationally (by HEE) in a training post. Both jobs require an application and an interview in order to secure the role, though the formality and intensity of this process can vary depending on how competitive the role is. Generally, trust grade jobs are easier to obtain than fellowship jobs.
While you are in a contracted role, you are entitled to standard employee rights including annual leave, sick pay, and maternity pay (though maternity benefits may change depending on any breaks in NHS employment prior to the start of the contract). You are also be eligible for the NHS pension and NHS reckonable service benefits. Your contract will also have terms for giving notice should you decide to resign and end the contract early.
💷 Pay
Generally, the pay will be matched to where you are on the pay scale in terms of your experience. If you are are accepting an F3 job, then you may be paid either at the F2 (£34,012) or CT1 (£40,257) rate, depending on what you can negotiate when you accept the role.
Like training roles, both positions are paid a lower hourly rate compared to locum work, though they offer the benefit of NHS pension contributions where locum work does not.
🩺 Duties
Trust grade roles are generally created by Trusts where they experience gaps in service provision. Often this is because they have an unfilled training post, or a trainee has had to drop out of the programme which has created a vacancy. For this reason, the contracts usually last only 6-12 months as this is the length of time they have the gap in service for (until they go through another training recruitment cycle).
Therefore, trust grade jobs are service provision roles and the duties and rota (in regard to ward work, on calls, theatre/clinic time etc) will match those of the other SHO trainees in the role.
Clinical fellowships often involve some degree of service provision, though they also have an additional rostered component of ‘special interest’ that is specific to the fellowship role. Usually the role is split into clinical and non-clinical time (typically 80/20 but can be as much as 100% non-clinical in some teaching fellowships like anatomy demonstrator roles). The clinical work is often based in a particular specialty i.e. palliative care, microbiology, public health, elderly care, psychiatry etc., and offers a robust experience of the specialty that goes beyond typical ward-based work of foundation doctors. The non-clinical time is used for the particular interest of the fellowship whether that is research, teaching, or working towards a higher-educational qualificatio like a master’s degree.
An academic fellowship may have a teaching component or time to study for a higher education degree or diploma, a research fellowship may have time for audit, quality improvement, or to do lab-based scientific research. There are lots of different types of fellowships which offer exciting and unusual combinations of clinical specialty work and non-clinical duties.
💼 Professional Development
Clinical fellows generally get:
✅ inclusion onto a teaching programme (and peer group),
✅ allocation of a clinical and educational supervisor,
✅ a study budget and allocated study leave,
✅ access to a digital portfolio service,
✅ additional responsibilities i.e. giving teaching to medical students and junior doctors.
Trust grade roles may include some or none of the above provisions. In both cases, it is important to check your contract prior to accepting a role and negotiate extra learning provisions and opportunities where possible.
Both roles are non-training roles and therefore do not require an ARCP. However, you will likely be expected to complete an annual appraisal. In both cases, the employing Trust should offer this to you free of charge so you should not be expected to pay for this service. Though they can be scary, appraisals are actually much easier than an ARCP once you figure out what is required of you. However, it is worth noting that it may be much easier to accrue the evidence you need for your appraisal in a clinical fellowship role, as you will likely have more access to teaching, study budgets and study leave, and consultant supervision.
Neither post is part of an approved training programme and therefore neither will lead to CCT. However, depending on the portfolio evidence that you compile during the role, you may be able to count the experience towards a training programme in the future and get time off that training programme. For example, a 12 month role in acute medicine may count towards 1 rotation as a CT1 in ACCS, IMT, or GPST depending on the quality of evidence you can provide (therefore making your training programe 1 rotation shorter).
🤝 Flexibility
Depending on the Trust’s ability to recruit doctors, there may be some scope for negotiation of the clinical duties if you find a trust grade role that the Trust is struggling to fill. For example, you may be able to negotiate out of night shifts or weekends, or negotiate a less-than-full-time role (though this will impact your take-home pay). You may also be able to negotiate additional perks reserved for trainees or clinical fellows such as a study budget, study leave, time to attend teaching with the F2’s or CT1’s, allocation of an educational and/or clinical supervisor, and free access to the Trust’s portfolio service (i.e. Horus).
Once you have been offered a clinical fellowship role, you may be able to negotiate the responsibilities of the role, including opting out of an on-call rota, negotiating a less-than-full-time role, or agreeing to a hybrid working model where you can do your special interest work remotely.
🎓 International Medical Graduates
Both roles are suitable for IMG’s and can be a great way for international doctors to gain NHS experience. A trust grade role may offer a more realistic experience of what it is like to be a trainee in the NHS, whereas a fellowship may provide more opportunities to gain additional points for future applications if you are able to get teaching and research experience, and a publication during your fellowship.
📋 Main Pros and Cons of a Trust Grade Role
👉 They are a great way of gaining specialty experience without committing to a training programme.
👉 These roles are abundant in certain specialties and are generally quite easy to acquire (i.e. elderly care, ED, acute medicine, general medicine, general surgery).
👉 You may be able to negotiate your contract so that it suits your needs (i.e. LTFT or provision of study budget and study leave).
👉 A contract means guaranteed work and stable income for a fixed period of time, with paid annual leave, sick pay, pension, and maternity benefits (unless your contract stipulates otherwise).
👉 These roles typically give you the bare minimum in terms of professional development benefits (ie. teaching and learning opportunities).
👉 Pay and responsibilities are the same as an F2 or CT1 doctor, but without the benefit of moving you towards CCT.
📋 Main Pros and Cons of a Clinical Fellowship
👉 These roles often provide significant career development perks, such as a study budget, study leave, and funded diplomas or degrees in higher education.
👉 They offer a better balance of professional duties if you find 100% clinical work unappealing, and may be able to accommodate hybrid working schedules.
👉 Often the roles are Monday to Friday, 9-to-5, and may not be part of the on-call rota (or you may be able to opt-out of on-calls when negotiating your contract) which means a better quality of life for you.
👉 They offer a unique experiences in a niche specialty that you often can’t get as a foundation doctor.
👉 You are more likely to get teaching and research experience, and portfolio-boosting opportunities.
👉 You may be able to negotiate the role so that it suits your needs (i.e. LTFT or remote working).
👉 A contract means guaranteed work and stable income for a fixed period of time, with paid annual leave, sick pay, pension, and maternity benefits (unless your contract stipulates otherwise).
👉 Fellowships can be competitive to obtain and there are normally limited opportunities within a particular specialty or Trust.
👉 Pay is the same as an F2 or CT1 doctor, but without the benefit of moving you towards CCT.
👉 Next Steps
If you still aren’t sure whether a trust grade or clinical fellowship is right for you, check out our other articles on the topic, like this one or this one. If you prefer a video format, check out this video that breaks down the most common F3 job options. You can also visit our F3 Hub for more information about what you can do in you F3 Year.
If you want to see what roles are out there, check out NHS Jobs and LinkedIn for fellowship posts and advertisements for trust grade roles. Job advertisements typically come out in June for an August start, but will occasionally be released earlier. You can also speak to your Medical HR to enquire about jobs that may not yet be advertised.
If there is a specific job you want to do, but you cannot find a fellowship that matches your wants, then try speaking directly to the head of that department as hospitals are often open to creating or adapting a fellowship if a doctor is keen to work. If there is something you want in a role that isn’t included in the contract, negotiate for it and ensure it's added to your contract before signing.
If you are looking for a Trust Grade role, Trusts will tend to be flexible with your requests as it costs them much less to employ a trust grade doctor than a locum.
This article is part of a wider series of comprehensive guides and information to help doctors ensure their F3 year is a success. We cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience.
Click here to visit our F3 Resource Hub to explore the full list of guides and articles.
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