‘Consultant life’ series authors – Seb Gray, Nick Schindler, Rachael Mitchell, Nancy Bostock, Nikhil Ganjoo, Ollie Bevington, James Dearden, Louise Budd, Tom Whitby & David James

You get the phone call or the handshake at the end of the interview – you’ve got the job!

There aren’t many better feelings in the world than receiving this news. The affirmation that not only have you made it through training but a hospital wants you. Whether it is for a locum post, fixed term contract or substantive, they’ve chosen you. This needs to be celebrated and your loved ones will have suffered someof your preceding mood swings, stress and uncertainty so it is definitely a shared celebration! 

Don’t jump in straight away. When you accept a consultant post YOU get to choose when to start. This is a novel experience if you’ve been used to a long run through training programme. Take the time to think through your options and discuss it with the significant others in your life. There is a temptation to express your gratitude immediately by volunteering to start at the soonest opportunity. Don’t! Take at least a few weeks off before starting – it will be the last chance you get to have a long stretch off until you’ve earnt an opportunity for a sabbatical or until you retire. Obviously this won’t be paid and so your financial situation may determine how long is reasonable for you. Do whatever you want – you don’t have to travel the world or learn a new skill. You’ve earned it so if you want to binge watch the latest Netflix series all day, do it.

Sort out all the HR paperwork and occupational health shenanigans as soon as possible. This might be the last time you ever have to do it, so remind yourself about that when you’re filling in the same forms you’ve completed on every single attachment since Fy1. Remember that this might be your workplace for the next 30-35 years so be extra friendly to everyone. Introduce yourself and try to learn people’s names (a skill much easier for some than others). Have a good look at your contract and try to understand it as much as possible as this will help with some of the next pointers.

Starting work

For some, there is a baptism of fire when you start as a consultant. Poor planning or bad luck can mean you start during an intense on call period or with some really challenging patients. For most, there is a honeymoon period where you can’t really figure out why everyone else is so busy and you haven’t got anything to do. 

There is certainly an element of feeling the luxury of having SPA and admin time. Although this is now becoming more established as part of training, for many all the additional work they did was outside of work time. This is the opportunity to tie up all those loose ends. Finish the projects you were half-way through. Submit the publication/abstract/Milestones piece. Write that FOAMed piece that’s been on your to-do list for ages. It’s also a great opportunity to compile an electronic resource library. The ADC Education & Practice 15 minute consultations are brilliant for this and having a one-stop library of guidance, protocols and information will save you hours during clinics, duty weeks or complex patients. They’re also a great knowledge refresher.

Office space

If you are fortunate enough to get your own office space, take advantage of this. Having two screens allows significant more multi-tasking functionality. Make sure you have a telephone, camera and headset. Little personal touches make a big difference. Coffee machines, soda streams, sweets/chocolates/snacks, photos of families, personalised/favourite mugs, etc can all enhance the feel. Declutter your home and bring in your medical books, folders and paraphernalia. You should be aiming to work when at work and not when at home so physically separating the two does wonders to reinforce this.

Some units may encourage you to do SPA from home, particularly in the COVID era. If this works for you, embrace it. It can definitely save on commuting time and potentially allow you to be more productive. Having a good camera and headset with reliable Wi-fi is key. Remember that setting boundaries is important as it is very easy to ‘just pick up that laptop’ at 9pm if you are set up for home working. 

Don’t be a stranger

Go and meet the team you’re working with. You will not be shift-based working clinically non-stop and so there is time to go and sit in handovers or in the various new environments you’ll be working in. Your colleagues will all work in slightly different ways. The larger variety you witness, the more choice you’ll have to emulate when refining what you do. Go beyond just your department. Some trusts will have a list of people they think you should meet but ask around to see who else people would recommend. Befriend your secretary (if you have one) – they can make your life infinitely better. Find out what they like and make a note of it – it will come in very handy when Christmas comes, and you can do something a bit more thoughtful than a bottle of wine (unless their main hobby is wine). 

Be nice

It’s not rocket science but be polite and friendly to everyone. Transitioning from big teaching hospitals to smaller units can be challenging for some. Assertive behaviour doesn’t need to resemble a bull in a china shop and incivility is thankfully becoming less and less tolerated.

Set up your systems

You might not know exactly how you want to do things yet but you’ll need systems in place to run things efficiently. To-do lists are great for many – the satisfaction of crossing off jobs as you complete them will never be lost. There are all sorts of electronic systems that resemble this and there’s an app for absolutely everything but you’ll need something that is going to work practically for you.

Email organisation

Create email folders and keep your inbox as clear and tidy as possible. Mark the important emails that you’ll want to refer back to regularly. Make the decision about how accessible you want your emails to be. Some would say leaving them at work would be best. Others prefer to avoid the accumulation that can happen if not monitored more frequently. 

Email etiquette

Don’t ‘reply all’ to mass emails. Don’t send an email when hungry, angry, late or tired (or drunk!). Think about picking up the phone or popping down the corridor to speak face to face – it’s much better for the environment and usually more efficient. Set your out of office when off and be honest with when you’ll be able to reply otherwise everyone will expect a response on the day of your return. 


Figure out how much annual leave you have and how this works in your trust. Some will work in PA’s, others in days/ weeks. Some will ask you to swap on call commitments, others will have prospective cover. Whichever is used, make sure you book your leave.  If not entirely sure what your plans are, book one week off every 10 weeks to give yourself a break. You know you’ve had sufficient time off when you struggle to remember your password on your return.

Treat yourself

Having something to look forward to does wonders for morale. Booking in a spa day, fancy meal, weekend away, concert or whatever it is that excites you periodically gives you that boost. We all go through periods where we just want to go home and collapse on the sofa watching rubbish. Unwinding and relaxing is just important but you’ve earnt and are now earning the right to reward yourself every now and then.

No………….t right now

Just say no remains the motto when it comes to drugs but saying no to everything may not serve you the best. There was some debate amongst this group as to how extensively you should resist signing up to new roles when you become a consultant. Most of us would recommend pro-actively volunteering for roles you’re passionate about. Rota coordination is marmite – some felt that the recent understanding of being on both sides of the fence equip you with the best possible mind-frame to coordinate a rota (especially if you have a fancy for a colour-coded Excel sheet). The majority advised this is the biggest thing to avoid in the first couple of years (and the most likely to be offered). Whatever you decide, don’t be that person that does stuff externally for their own benefit but avoids mucking in to do the jobs needed to help run the department. 


Find yourself some people you trust that you can go to for advice and support. Ideally at least one of these should be outside your organisation to allow for some home truths and honest advice. You may need someone to be frank with no political allegiances or you may want someone you trust to confide in that won’t directly impact on your work relationships. Checking in for debriefs after a difficult on call, interaction with another colleague or struggling trainees can be priceless. Make yourself available to be that person for others also. It’s extremely rewarding as long as you know your limits and don’t end up carrying others’ burdens on top of your own.

CEA Awards

Whether you agree with them or not, Clinical Excellence Awards (CEA’s) are the current system in place for additional payments as part of the NHS consultant contract in England (devolved nations have various other systems). It’s worth finding out how your local system works in your trust and looking at the form. During the COVID era, local award pots are mostly being equally distributed between eligible consultants. Things are likely to resort back to the traditional system and you’ve got to be in it to win it. You will hear of lots of bad experiences but over the first year (when you’re not eligible to apply), think about what you might put in each category.  Most trusts have a transparent system where you can see the previous successful local applications as a starter for ten. It’s very similar to the appraisal form so will probably only take an additional hour when done at the same time (which is worth it for £3k per award!!). With the pension crisis, some senior consultants may hold off applying. Females, minority groups and paediatricians are under-represented and for no good reason and it would be great to see that trend reversed. 

So what now?

Enjoy it! Being a new consultant is, for the most part, brilliant. However, you won’t be alone in finding it challenging. There will be down days and ones where the imposter syndrome dial gets set to maximum volume. Those in the group who have made it to consultant unanimously agree that the new consultant years are much better than being a trainee – the light at the end of the tunnel really is worth it. Don’t be afraid to ask for help and make sure you pass it on. Share your acquired wisdom of new consultantdom with your future colleagues – the title of new consultant doesn’t stick for very long and you have the opportunity to support your new colleagues for years to come.

Other resources

If, like us, you were/are desperate to hear more about others experiences and get as much advice as possible, we would strongly recommend the following other resources:

–        Don’t Forget the Bubbles – The End of the Beginning. Tips for New Consultants by Tessa Davis

–        Don’t Forget the Bubbles – The Consultant Interview. Top 10 Tips for Consultant Interview by Tessa Davis

–        RCPCH – Stepping Up – Transitioning for a trainee to a new consultant

–        BMJ Blog – Onwards and upwards? The first few months as a consultant by Ian Wacogne, Vin Diwakar, Helen Jenkinso

If you’ve got a bit longer to go and want to work more on your leadership/ management skills, there are plenty of resources available (please comment below if you’ve got any feedback on these or any other suggested courses resources):

  • Multiple courses available for free – RCPCH via Compass

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.