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When you think of where you'll start in the NHS, your exact role and position can be confusing to understand. As a junior doctor in the NHS, what will you be expected to know or do? Who can you rely on for help? What is the best way to learn while in your post? Let's discuss the role of a junior doctor in the NHS.
The hierarchy of junior doctor in the NHS
First and foremost you should understand where you stand in the thick of a junior doctor's rota and schedule. The basic breakdown is as follows:
- FY1 (Foundation Year 1)
- FY2 (Foundation Year 2)
- CT1 (Core Trainee 1) / ST1 (Specialty Trainee 1)
- CT2 (Core Trainee 2) / ST2 (Specialty Trainee 2)
CT1/2 have now been replaced by IMT1/2/3 (Internal Medicine Trainee), but for the sake of what terms are currently used, this is what we will mention here. Essentially, the lowest on the totem pole is FY1, someone who, under the UKFPO, is on provisional GMC registration, and is just starting out in a medical role in the NHS. This is the level at which in most countries we consider to be internship. It is up to you if you wish to start in a non training FY1 position, but I would recommend aiming more for FY2 posts in the NHS as the responsibilities differ very slightly but there is a pay raise associated with being a FY2 level junior doctor.
There is no harm in applying for CT1/ST1 level posts as your first job if you feel you are up to it. Ensure you go through all person specifications and job descriptions, no matter the position you apply for, so that you know exactly what to expect when you starting working.
Worried about how your first day will go? Check out our article talking about your first day on the job so that you know what to expect!
There are other job titles like Junior Clinical Fellow, Trust grade junior doctor which are no-brainers that those are junior doctor posts in the NHS.
The general roles of each position may have slight variations from hospital to hospital, but essentially you can expect two general duties:
- Ward duties
- On-call duties
These roles are different in A&E, but we will go into that a little further down. Let's for now discuss the basic two duties mentioned above.
Again, this is ward dependent, but you can at the very least expect to attend ward rounds, and complete tasks such as requesting reports, tests, or bloods. You may even be expected to take bloods, put in catheters, do blood cultures, ABGs, VBGs, or write up discharges. You will also be expected to prescribe medications as and when it is appropriate. If you are unsure about dosing regulations, or antibiotics to be used, don't hesitate to ask.
There is often a trust policy regarding which type of medication is used in whatever situation has presented, so don't be shy to check the hospital's intranet and find the correct pathway for the patient you are seeing. Pathways can be anything from asthma management to correcting hyperkalemia.
On-call duties again have two parts you need to keep in consideration:
- Ward cover
- Admission (take) cover
Ward cover essentially consists of your being responsible for certain wards or parts of a ward. As the on-call doctor, you are not expected to round on each and every patient; rather you job is to continue or complete any outstanding tasks from the day team, or follow up on any acutely ill patients. You may be asked to review patient's who've had a drop in blood pressure, a spike in temperature, are in urinary retention, or are otherwise scoring a high NEWS. There is a slight variation of NEWS for obstetrics (OEWS) and pediatrics (PEWS).
Admission or take cover is where you are asked to see and clerk patients that have been admitted from A&E, the GP, or are specialty referred. Your hospital will have a proforma to follow which you must fill out in its entirety, writing pertinent information such as the patient's current complaints, past medical history, medications, examination findings, etc and what you think the differentials may be along with your plan of treatment. At some point, you or one of your colleagues will then see this patient again with a consultant, who will do the post take round of the patient, basically condensing whatever was done before again, and putting down a concrete plan for the patient's care.
Be it ward or on-call duty, you will be given a bleep or pager on which will be an extension number you can be reached on. If you're on ward cover, you may be bleeped to review an acutely ill patient, write up fluids, prescribe more medications, cannulate, or catheterize a patient. On-call bleeps may come from registrars needing you to clerk a patient, or from the consultant wanting to post take.
Handover is something that is done at the beginning and end of each shift. It consists of handing over the patients you've seen either during the night or during the day on-call. Occasionally as a part of your ward duties there may be a handover between you and the nurses, or a general morning handover everyday where the on-call ward cover doctor discusses any patients that required reviewing across the hospital.
The best method to use when presenting a patient in the handover is SBAR:
Basic Principles of Handover:
- All patients under the care of the on-call team must be handed over
- Any patient that is unstable must be mentioned
- Any patient who may become unstable should be identified
- All outliers should be mentioned along with their location
- Cardiac arrest bleeps must be handed over to the corresponding oncoming doctor
How A&E (Emergency Medicine dept) works
In A&E, generally there is no separate on-call rota, as your schedule overall is unsocial for the most part. The handover is still SBAR based, but it need not be as extensive as it is in other wards. A&E can have you working day time 'normal' hours, afternoon to evening, late evening to early morning, or overnight hours, but as you have no need to leave the department, you have no use for a bleep.
For more information on A&E, check out working in A&E.
Must-haves for the Ward
There are certain apps which will make your life infinitely more easy, so keep them on your phone. The BNF has a directory of drugs that you can look up, along with treatment summaries, basic guidance, and wound care, among other features. It is something you will use regularly when you need to prescribe treatments or check for interactions. SIGN Guidelines is for any of you in Scotland, and most importantly, the Induction app for all your first-day needs.
You’ll find that sometimes when you need to refer a patient or present one in a board round, and someone may ask you to ‘score’ the signs and symptoms accordingly. This is where MDCalc comes in handy. You can even save scores that you use frequently to allow for quick calculating.
Now let’s talk about the books you’ll need to stay at the top of your game. Depending on the department or level you’re starting at, you may need one or more of the following:
- Oxford Handbook of Clinical Medicine
- Oxford Handbook of Emergency Medicine
- Oxford Handbook of Clinical Specialties
- Oxford Handbook of General Practice
- Oxford Handbook of Clinical Diagnosis
- Oxford Handbook for the Foundation Programme
And if you’re not already a member, look into a free one month trial of Amazon Prime. You can cancel even before the time runs out, and you’ll still receive all the benefits associated with Prime, such as 1 day free shipping, access to movies, music, etc.
Tips and Advice
- If you're in a new setting or this is your first job, take everything in stride.
- Know your limits and don't try to overwork yourself, thinking that you will gain brownie points by working longer hours or seeing patients faster.
- The most important thing is to be a safe doctor. This means taking breaks every 4 hours, handing over when appropriate, and knowing when to step back when things are too much for you to handle. No one will judge you for taking the correct precautions to make sure you don't make a mistake, but don't let your being new hamper you from learning.
- Take notes on how to do certain tasks, and have someone show you how to do something so that next time you are able to do it yourself. Alternatively, you can see if your hospital offers any course booking within the medical education department on doing certain tasks you feel you need practice.
- Don't be afraid to ask questions, but at the same time, don't keep asking the same questions over and over again. I like to keep a small notebook with me (I wear scrubs, so it's small and fits in my scrub pocket) where I list how to do certain things that I could forget after just learning it once, so that the next time I have a source of reference.
You can always ask your colleagues, the nurses on the ward, your registrar, and even occasionally your consultant (if it's appropriate) if you have any questions or concerns about a particular job that needs doing.
Make Use of Your Time
You won't always be flooded with work while on the ward, and rather than just sit and let the time pass by, try and be as productive as possible. Look into any course on your trust's hub/intranet, or anything on the ResusUK website that would be appropriate. These are also great ways to boost your portfolio. I would suggest trying to complete courses such as ALERT, BLS, ILS, and/or ALS.
Also participate in any teachings that your hospital may be hosting, such as any ward-related multi-disciplinary team (MDT) discussions, journal clubs, grand rounds, etc. These are great ways to learn new topics and brush up on things you may not have been involved in for some time.
Junior doctor's salary in the NHS
Please read this article A doctor's pay in the UK to know about pay of a junior doctor in the NHS in detail.
Still have concerns? We've got you covered!
We've done a webinar outlining the role of a junior doctor that should hopefully answer any other questions or concerns that you may have. The most important thing is to not unnecessarily stress yourself- everyone started from day one. Good luck!