Preparing for Your First Consultant Role in ICM

Authors

Ms Natalie Bell, FICM Training Manger; Dr Taqua Dahab, MRCP, FFICM, FICM Deputy Lead Intensivist in Training; Dr Matt Williams, FICM Vice Dean and Chair FICM Careers, Recruitment & Workforce Committee & Dr Rosie Worrall FRCA, FFICM, FICM Lead Intensivist in Training.

1. Final Two Years as an Intensivist in Training

Mentorship

• Consider identifying a mentor to support your transition through Stage 3 into a consultant post, ideally a consultant who will offer honest, constructive advice and guidance.

CV Preparation

• Begin shaping your CV at least 18 months before CCT. This allows time to complete relevant projects, leadership roles, conference presentations, and publications to show readiness for becoming a consultant.
• Your CV should be polished and ready for applications during your final year. Consultant posts may be advertised before you're eligible to interview, you can apply early but can only be interviewed within six months of your expected CCT date, provided your progress is satisfactory and your final ARCP is expected to confirm completion.
• Reflect on your unique selling point (USP) - what distinguishes you from other candidates?
• Remember, the CV is just one part of the interview, be prepared to discuss it, but don’t rely on it to carry the whole process.

Where to Apply

• Keep your options open.
• Consider both sides: is the department right for you, and are you right for them?
• Have you worked there before? Do you really know the department? Understand the team dynamics, strengths and challenges?
• Speak to newly appointed consultants, what influenced their decisions?
• Factor in personal logistics: commute, housing, schools, family & dependents, partner’s career.
• Express interest early, ideally 12–18 months in advance, by speaking to the Clinical Service Lead (CSL). Departments need time to plan.
• Don’t be discouraged by rumours like “this job is made for X”, departments may create multiple posts if strong candidates apply.

Job Type

• Locum vs. substantive: understand the implications.
• Are there opportunities to develop a special interest?
• If the post is dual specialty, clarify how the job is split.
• Explore the potential job plan, including DCCs, SPAs, and on call commitments.

Creating a Job

• Is there capacity in the department? Consider upcoming retirements or staffing changes.
• Posts require funding, if not replacing someone, a business case may be needed, which takes time.

2. Consultant Interview Process

The Advisory Appointments Committee Panel

• The Advisory Appointments Committee (AAC) typically includes:
  • A Trust/Health Board executive
  • Departmental representatives
  • Specialty-specific members (e.g. research, dual roles)
  • A FICM representative (if applicable)
  • A lay chair (typically a non-executive director)
• Try to meet panel members beforehand, they may offer insight into the interview focus.

Interview Preparation

• Treat it like an exam, preparation is essential.
• Speak to recent interviewees and former Clinical Directors to understand common questions.
• Be mindful: your final 18–24 months are an informal interview, professionalism matters, showing readiness for a consultant post.

Acting Up

• You can formally act up in the final 3 months of training through an Out of Programme Acting Up Consultant (OOPAUC) arrangement. This must be approved by the Head of School and the Postgraduate Dean, and you must have completed all required elements of your training (e.g. LLP). The process is outlined in Section 3.160 of the COPMeD Gold Guide (10th Edition) and Section 5.7 of FICM’s ICM Curriculum.
• Many departments also offer informal opportunities, if you've planned with your ES and TPD to act up, give your department advance notice so they can adjust rotas accordingly.

Post-CCT Options

• You don’t need to start a consultant post immediately after CCT, there are several options to consider depending on your goals and circumstances.
• Period of Grace: This is a formal option that allows you to remain in your training post for a short period after CCT (typically up to 6 months), often used when a consultant post isn’t immediately available. It can provide financial continuity and clinical experience while you secure the right role. Given current employment pressures, this may become more common.
• Post-CCT Fellowships: These are increasingly popular for gaining additional, focused experience before stepping into a consultant role. Examples include:
  • Neuro-ICU fellowships
  • Cardiac ICU with TOE (transoesophageal echocardiography) skills
  • ECMO training posts
• These fellowships can help you build confidence, develop niche expertise, and prepare for consultant posts with specific skill requirements.
• Deferred Start Dates: If you’ve accepted a consultant post, you may be able to defer your start date by up to 12 months (subject to employer agreement). This time can be used for fellowships, travel, research, or personal development.

3. Negotiating a Job Plan

The Offer

• Negotiate your job plan thoughtfully. Identify a few non-negotiables, but remain flexible, roles evolve over time.
• Ask:
  • What does the on-call rota look like? Is there any on call responsibility for a second specialty – separately or combined (not recommended in GPICS)
  • Is there a workforce sustainability plan?
  • Will you be expected to work cross-site?

Job Plan Structure

• Recommended starting point is 10 Programmed Activities (PAs), including 1.5 Supporting Professional Activities (SPA). While the BMA Consultant Contract applies to England, similar principles are reflected in consultant contracts in Scotland, Wales, and Northern Ireland, with some regional variations. Refer to your local health board or trust HR guidance for nation-specific terms and conditions. See the BMA website for information on Consultant Contracts by nation.
• Consultant job planning is governed by national frameworks in each UK nation. While the 2003 Consultant Contract underpins job planning in England, Scotland, Wales, and Northern Ireland, each nation has its own implementation guidance. For example:
• Scotland: NHS Scotland guidance and Scottish Academy input
• Wales: Amendment to the National Consultant Contract (2003) and local Health Board procedures
• Northern Ireland: Department of Health NI consultant contract documents
• England: NHS Employers and BMA guidance

Dual/Triple Specialty Roles

• Clarify your base specialty, most intensivists retain ICM as their base, with sessional work in their second (or third) specialty of Anaesthesia, Emergency Medicine, or Acute/Renal/Respiratory/General Internal Medicine.
• Bespoke job plans are increasingly common, discuss options with your department.

Resources

• FICM’s Stage 3 Resources for IiTs webpage includes examples of consultant job plans across specialties. Review relevant sections for inspiration.

4. Mentorship and Early Consultant Life

Mentorship

• Secure an informal ICM mentor for your first year, primarily for clinical, practical and logistical support and advice. Lots of things will be new and unexpected to you in the first few years.
• It is well worth considering accessing the formal mentoring schemes offered by Trusts and Health Boards for new consultants. These are senior doctors trained in mentorship. The support from someone external to the department can be very useful.

First Week

• Even if you're staying at the same Trust/Health Board, the transition from IiT to consultant is significant. Consider taking some time off before starting, this allows space for adjustment not just for you, but also for your colleagues, residents, and other specialties who will now interact with you in a different role.
• Make sure practicalities are sorted: induction, IT access, ID badge, parking etc.

First Year

• Departmental responsibilities:
  • Be selective, only take on roles that genuinely interest you.
  • Be aware that others may try to offload their unwanted tasks.
• CPD and appraisal requirements can accumulate quickly, so it’s important to stay ahead. Consider:
• Setting up a system early - use a digital portfolio (e.g. FourteenFish, Clarity) to log activities regularly.
• Blocking time regularly to update your CPD log and reflect on learning.
• Joining local or regional consultant CPD groups - these often provide structured sessions and peer support.
• Keeping records of teaching, audit, QI, and leadership activities, these are often overlooked but form a crucial component of appraisal and revalidation.
• Using your SPA time effectively, plan ahead to ensure CPD, governance and non-clinical role activities are built into your job plan.
• Reviewing the GMC and FICM guidance on CPD and revalidation to understand what’s expected.

Tax and Pensions

• It’s important to understand the basics of your financial responsibilities as a consultant. Depending on your income and circumstances, you may need to complete a self-assessment tax return and consider how your pension contributions are managed.
• Many doctors find it helpful to seek advice from a medical accountant or financial advisor early in their consultant career.
• There are useful resources available online, for example, Medics’ Money and professional bodies like the BMA offer guidance tailored to doctors.

Career Planning

• Think Long-Term: Your first consultant role might not tick every box, and that’s okay. Sometimes you’ll need to compromise initially, whether it’s on location, job plan, or specialty mix, while waiting for the ideal opportunity to arise. This is a normal part of career progression.
• Taking a role that offers good experience, supportive colleagues, or flexibility can be a strategic step toward your longer-term goals.
• Keep sight of what matters most to you and revisit your career plan regularly, opportunities often emerge when you’re open, proactive, and well-prepared.
• Evolving Job Plans: Your job plan may evolve over time, what suits you in your first few years as a consultant may not align with your priorities 10 or 20 years down the line. This is important because:
• Personal and professional circumstances change; family responsibilities, health, interests, and career goals all shift over time.
• You may develop new clinical or non-clinical interests, such as education, research, leadership, or QI, which can be reflected in your job plan.
• Departments themselves evolve, new services, staffing models, and strategic priorities may open up opportunities or require flexibility.
• Being open to change helps maintain job satisfaction and work-life balance and allows you to shape a career that remains fulfilling.

It’s helpful to revisit your job plan periodically and discuss adjustments with your Clinical Director or department lead.

Career mobility

Moving between hospitals or regions is increasingly seen as a natural part of career development. It can offer fresh opportunities, broaden your experience, and help you shape a consultant role that aligns with your evolving interests and goals. Flexibility and mobility are valued more than ever in today’s NHS.