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  • by Peter Sheridan, Registrar, FPH

The Faculty of Public Health (FPH) provides advice to employers and others on appointments procedures for senior public health posts at consultant level in the UK. Public health consultants work to promote healthy lifestyles, prevent disease, protect and improve general health and improve healthcare services.

They work across the spectrum from a rural community to the global population. Some consultants become experts in a specific area of public health, while others find that their job incorporates a cross-section of public health activities and research. It is this broad spectrum of background that can make it difficult to assess which consultant is the best fit for any particular role.

Consultants are required to have a broad understanding of all the factors that contribute to health, including the structure of healthcare systems and services, current government policy and how to interpret available data effectively. They need to be skilled at evaluating evidence to devise and implement strategies for improving and protecting health, and health services. They must be able to work on multiple projects at the same time, and be able to respond to emergencies.

Tough negotiation skills and good powers of persuasion are critical attributes. The consultant in public health has to be qualified as a public health specialist and on the GMC, GDC or UKPHR specialist register. They are also required to undertake CPD and revalidation to ensure they remain on the relevant specialist register and licenced to practice (where appropriate). This means that the consultant is qualified to FPH standards and formally regulated, including procedures to identify fitness to practise and apply sanctions if necessary.

FPH provides external professional assessment and advice, through its network of regional Faculty Advisers and FPH assessors who sit on appointment panels. The panels deliver the assurance that public health consultants have the necessary technical and professional skills required to promote, improve and protect health and provide high level, credible, peer-to-peer advice to the NHS about public health in relation to health services. This is based on the Faculty’s knowledge of training, professional development and standards and its ability to provide independent assessment and advice to local authorities on these issues.

FPH has worked with the Local Government Association, Public Health England (PHE) and Association of Directors of Public Health to provide local authorities with guidance on appointments of Directors of Public Health (links to pdf) and Consultants in Public Health (links to pdf).  This builds on the NHS process and ensures that there is senior professional input into selection with a senior PHE consultant and an assessor appointed by FPH.  We now have around 160 assessors trained in the last three years in Birmingham, London and Manchester and we now give them feedback on their contribution to the selection process.  We also do individual matching of assessors to particular types of post.

Many local authorities are maintaining the links to NHS terms and conditions (T&C) with posts advertised on medical consultant T&C or Agenda for Change (AfC) band 8d. This provides some equity with PHE and NHS posts.  Some authorities are moving to their own salary scales for new staff and some even restructuring existing staff.  These salaries can be significantly lower than what NHS was paying for a consultant in public health.

Those councils who have tried to recruit at lower rates of pay have not been particularly successful and have re-advertised at higher rates offering “market supplements”. We know that PHE are able to appoint to nearly all advertised posts but significantly fewer local authority appointments are successful. There is a demand for interim consultants across the country and I am turning down offers of up to £700 per day.  So I can see consultants moving on if they see their salaries cut either to a more enlightened authority or to NHS posts at Band8d or higher.

This has been the local authority response to equal pay challenges which have proved very expensive.  So James Gore, Head of Professional Standards at FPH, and I have been working again with our partners in LGA, PHE and ADPH to describe multidisciplinary teams in local authorities.  This has offered national guidance on how to address issues around equal pay, some encouragement to accept continuity of service and explains that a public health team will contain a range of specialists including those from a medical background. 

Medicine is the background of most of our members and half of our registrars.  It is important that medical public health consultants are not pressed into posts in PHE or NHS.  Their experience in local authorities will equip them to join the next cadre of Directors of Public Health (DsPH) and provide leadership of the public health system.  I work for PHE in Wellington House, where nearly all the consultants are former DsPH.  I believe it is important that they continue to be drawn from the field.

We need to start the conversation about retaining equity for AfC remunerated consultants who reach the top of scale.  If they take a DPH route they are rewarded with Band 9 or Very Senior Manager (VSM) pay or local authority equivalent scale.  This new guidance restates the FPH position that the AfC equivalent of medical consultant is band 8d/9.  I think we will need some additional items in the job description such as educational supervisor, Faculty assessor, and formal deputy director role.

James and I are continuing to meet with this group to take forward some of this thinking and monitor its implementation over coming months.

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