The largest employer is the National Health Service (NHS), with over 300 types of careers on offer. The healthcare workforce directly care for people who are ill, investigate and develop new or improved treatments, and educate communities on achieving healthier lifestyles through health promotion.
Medical provision in the NHS is largely divided into primary and secondary care. Primary care is provided in the local community, by GP practices, NHS walk-in centres, dentists, pharmacists and opticians. Secondary care largely consists of hospitals, which are managed by NHS trusts. There are also mental health trusts and ambulance trusts.
Types of Employment
The medical sector employs people at all levels of skills and experience, including doctors, nurses and health visitors, specialist health professionals such as dentists and pharmacists, hospital managers and other office staff.
The majority of doctors, nursing and medical support staff are located in NHS hospitals, where they complete their initial training. They might then continue in hospitals or move on to private hospitals, public and private clinics, general practice surgeries, laboratories, pharmacies, care centres, hospices or residential homes.
Teaching hospitals at Universities are also significant employers. Specialist practices employ practitioners such as dentists, opticians and physiotherapists. Many nurses are also employed via agencies, working in different locations to replace staff who are on holiday or who are themselves sick. The prison service, the Armed Forces and various charitable and voluntary organisations also employ trained medical staff.
Allied health professionals provide treatment and rehabilitative help for people, but aren’t usually employed directly by the NHS, although they work within both the primary and secondary healthcare systems.
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Doctors and Surgeons
In addition to general practice, the range of specialisms open to doctors is considerable. Surgery, obstetrics, gynaecology, radiology and psychiatry are just some of the areas, with posts available in the NHS, the private sector and independent practice. Training is challenging. It takes around 10 years to qualify as a general practitioner and 14 years to qualify as a surgeon.
Science subjects at 16-18 years are followed by completion of a five-year degree at a medical school. Doctors then receive their primary medical qualification – MBBS, MBChB, BM, or MB – and continue on to a two-year Foundation Programme, which provides trainee doctors (“house officers”) with a grounding in practical medicine and core clinical skills. This is followed by either two years of specialist training or on-the-job training as a GP Registrar in a practice.
Dentists usually work in teams of dental healthcare professionals, including dental nurses, dental technicians, hygienists and therapists. They work in general dental practice, community dental care, hospital dental care or dental public health, although usually self-employed in their own practices. Consequently they either work under the NHS, in the armed forces, in teaching at universities, or in private practice.
Dental education is akin to medical education, being lengthy and highly regulated. A five-year Bachelors’ degree (BDS or BChD) from an approved dental school covers subjects including health, biological and behavioural sciences, as well as clinical dental skills. Graduates with other science degrees, with a high level of biology and chemistry, can pursue shorter dental courses of four years. This is followed by further years of vocational practice.
Dental hygienists and therapists train on approved university degree courses in the subject. Dental nurses train on an approved full-time course, currently offered by a small number of universities, or undertake NVQs while in a part-time position. Dental technicians study on courses such as an HND in Dental Technology or complete a BSc degree in Dental Technology.
Nurses work throughout the healthcare system and are involved in providing direct patient care, usually in a team. They work in settings including hospital wards, operating theatres, clinics, doctors’ surgeries and patients’ homes, nursing and residential homes, occupational health services, hospices, the pharmaceutical industry, university education, cruise ships and resorts, or in the military.
Nurses train for an approved, full-time 3-year degree or Diploma of Higher Education. From 2013, entry will be via University degree only, reflecting the level of technical competence and clinical decision making skills needed. Trainee nurses study in one of the four areas of nursing: adult, children’s, mental health or learning disability nursing. Half of this time is working in placements in hospital or community settings.
Allied Health Professionals
Most specialist therapists involved with the treatment and rehabilitation of children and adults with physical ailments come under the classification of allied health professionals. This includes physiotherapists, radiographers, dieticians, occupational therapists, speech and language therapists, podiatrists, prosthetics and psychologists. There are many subdivisions within these professions.
The training for most of these professions involves undertaking a full-time degree in the specialist subject. While many of the clinical support functions are provided within hospitals, many of the therapists are private practitioners. Many have their own practices away from the hospitals.
The ambulance service recruits either paramedics who have trained on an approved full-time university course or trainees who will learn while working as a student paramedic with an ambulance trust. Besides paramedic, roles include emergency care assistant, ambulance care assistant and patient transport service driver. Driving licence requirements vary from one ambulance trust to another.
Those wishing to become midwives usually need to have a degree in midwifery. Students learn about the theory and practical skills involved in caring for pregnant women, in delivering babies, and in educating and supporting parents. Wider issues on a social and cultural level are also considered. If already a qualified nurse, they need to complete a midwifery short programme before practising. Compulsory registration is with the Nursing and Midwifery Council (NMC).
Many midwives have their own caseloads and work in the community, while others work in hospitals. Areas of specialism include public health, women’s health and teenage pregnancy clinics.
Science and Research
Health is an enormous area of scientific research. While some of it is laboratory based, with universities, private companies or foundations, other healthcare scientists have a lot of patient contact and so work in hospital clinics and wards. The three main areas are life sciences, physiological sciences, and physical sciences and engineering.
Research scientists are usually qualified to postgraduate or doctoral level in their specialist areas. A vast number of supporting roles also exist, with different levels of non-degree training, such as phlebotomist, hearing screener, clinical support worker, pharmacy technician, etc. The NHS is supporting training for such roles under its Modernising Scientific Careers programme, as well as the Scientist Training Programme and Higher Specialist Scientific Training Programme.
Information Technology (Health Informatics)
The management of information and data is critical to the functioning of modern hospitals, along with the programming and maintenance of communication systems. Staff involved with these functions are said to be working in ‘Health Informatics’. There are four main areas: ICT, clinical informatics, information management and knowledge management. Transferable skills such as IT and programming will help you gain a job in some of these areas, but others require specialist training.
The administration of the NHS is huge and complex, so managers and administrators are involved in every area and discipline. There are many informal routes to management, starting in administration positions and working up, or transferring from a managerial position outside the health service.
If you’ve completed a degree, it’s also possible to apply for a place on the NHS Graduate Management Training Scheme, which is designed to fast track managers to senior roles in four areas: general management, human resources, finance and health informatics.
Information on careers within the NHS can be found here: www.nhscareers.nhs.uk
The General Medical Council is a good starting point for information on becoming a doctor: www.gmc-uk.org
The Royal College of Nursing regulates all nurse training: www.rcn.org.uk
The Royal College of Midwives regulates midwife training: www.rcm.org.uk
Information on health informatics: www.hicf.org.uk
Institute of Healthcare Management: www.ihm.org.uk