Overview of health organisations and job structure

A guide about the national healthcare system and information about coming to work in the UK.

Key health organisations in the UK

The National Health Service (NHS)

The NHS in the UK delivers healthcare to the general population. Some aspects of healthcare are devolved to each of the four nations, England, Scotland, Northern Ireland and Wales.  Healthcare is free of charge at the point of delivery, funded through general taxation. Provision of health care takes place in two main ways: primary and secondary care.

  1. Primary care is delivered by general practitioners (GPs) in the community. It is not possible to get secondary care without initial referral from a GP, except for emergency treatment.  In the eye care sector, primary care is provided by optometrists in the community.  They are able to diagnose potential eye disease or concerns and refer on to the hospital eye service.
  2. Secondary care is provided in a hospital setting. All referrals are made by a GP, or an optometrist for eye care, and each patient is allocated to a particular consultant (specialist), who will retain overall responsibility for a patient’s care, whether as an inpatient or an outpatient, until the patient is discharged. In the eye care sector, patients can be discharged to follow up and continued care by an optometrist, either as a hospital optometrist or in the community setting, in opticians on the high street.  Within hospitals, doctors work in multidisciplinary teams which include consultants, doctors in training, doctors in non-training posts (eg staff grades and associate specialists), nurses, optometrists, orthoptists, allied healthcare professionals and a range of scientific and technical staff.
  3. Independent sector provides secondary care in either a private capacity or as a NHS provider.

The General Medical Council (GMC)

The General Medical Council (GMC) is responsible for registering doctors to practise medicine in the UK, regulating doctors and ensuring good medical practice. GMC registration is mandatory for those who wish to provide direct patient care.

Health Education England

Health Education England works with partners to plan, recruit, educate and train the health workforce.

About NHS Scotland

NHSScotland currently employs approximately 140,000 staff who work across 14 territorial NHS Boards, seven Special NHS Boards and one public health body. All NHS Boards work together for the benefit of the people of Scotland.

Health and Social Care Northern Ireland Online

The official healthcare gateway for Northern Ireland, containing information about Hospitals, GPs, Social Care, Family Practitioners and other HSC Organisations.

Health in Wales

Health in Wales aides the Welsh Assembly Government to enable people in Wales to become far more involved in their health.

Local Education and Training Boards (LETBs) / Deaneries

The UK is divided into Local Education and Training Boards / Deaneries, each of which has a school for each medical discipline. The LETBs / Deaneries are responsible for assessing standards during training and for recognising training hospital posts. Each LETB / Deanery has a Specialty Training Committee for ophthalmology which conducts an Annual Review of Competence Progression (ARCP) for each trainee every year, to check on their progress.

Appointment to hospital posts in the UK

Training posts

Medical students in the UK typically study for five years to receive their medical degrees. This is followed by a two-year Foundation Training programme for doctors who have just graduated from medical school.  After finishing the Foundation Programme, doctors choose an area of medicine to focus their training on and apply for specialty training.

Medical training in the UK is a highly competitive field and there will always be more doctors seeking to undertake training than places available. Registration with the GMC is an essential requirement before coming to work in the UK.

Doctors wishing to enter postgraduate specialty training in ophthalmology must have no more than 18 months’ experience in this specialty since gaining their primary medical qualification –  whether in the UK or in another country – and must provide evidence of completion of foundation programme competencies.

Run-through specialty training in ophthalmology commences at level one (ST1) and will continue, subject to satisfactory annual review, until completion of training and award of CCT at level seven (ST7).  Trainees may take longer if they wish to train part-time or take time out of programme, e.g. for research or to undertake subspecialty training.

Entry into training posts is through online application and subsequent competitive interview.

Health Education South West (Severn) coordinates national recruitment into Ophthalmic Specialist Training (OST) on behalf of The Royal College of Ophthalmologists.

A unique identifier called National Training Number (NTN) is issued by Postgraduate Deans to successful applicants who formally accept to enter a training programme as Specialty Registrar at the end of the recruitment process.

For more information, visit the UK’s specialty training and recruitment website.

On completion of training, trainees receive a Certificate of Completion of Training (CCT) or equivalent and are entered on to the GMC’s Specialist Register, which allows them to work as a consultant in the NHS.

Fixed-term specialist training appointments (FTSTAs) and Locum appointments for training (LATs)

Stand-alone, fixed-term but educationally approved training posts that are not part of run-through training programmes may be accredited towards the total time for training and contribute to a CCT; however, they do not confer a right of entry to run-through specialty training posts.

Clinical Fellows/Trust grades

Many hospitals have middle-grade registrar jobs, but these are not officially training jobs and are not officially recognised or reviewed by the LETBs/Deaneries. These jobs can be used for clinical experience and are advertised in the BMJ .

Consultant positions

Consultants are appointed through open competition. The RCOphth usually approves posts before they are advertised and has a representative at the interview. Applicants applying for a consultant post need to:

  • Have obtained a CCT or equivalent
  • Be fully registered with the GMC
  • Be on the Specialist Register

Non-EEA nationals will need a work permit from the Home Office.

Staff grades and associate specialists

Staff grades are career grade jobs where specialist registration is not required. These are not training posts and usually have a degree of autonomy and responsibility. Most involve some on-call ward commitment. Staff grades may be promoted to associate specialists.

Clinical attachments

It is still possible to come to the UK as a visitor without GMC registration to undertake a clinical attachment or observer placement. These usually last a few weeks and are usually unpaid. Visitors will have to pay for their own accommodation and for any checks of health status, etc.

The RCOphth does not arrange clinical attachments or observer placements.  Visitors need to make arrangements directly with the host hospital; if accepted, visitors would be observers only and would not be allowed to treat any patients.

For a list of hospitals, please see the NHS hospital directory. We suggest writing to the Clinical Director of Ophthalmology asking if a clinical attachment is possible.

Many hospitals do not provide clinical attachments or observer placements, so visitors should be prepared to try many hospitals before getting a positive response. A personal connection can only help.