I work in a community learning disability team where I assess and treat people with learning disabilities who have behaviour problems, mental illnesses, and autism as well as physical conditions like epilepsy. Complex cases are treated more intensively alongside families and carers, and the most severely affected individuals are admitted for inpatient treatment. Here more intensive care is planned to hasten discharge to community life.
I have many leadership roles to influence the development of services in all these settings. I have a teaching role for medical students and trainee psychiatrists, as well as national roles with the Royal College of Psychiatrists to improve professional standards and perform research.
Introduction
When you have completed your higher speciality training, you will receive your CCT (Certificate of Completion of Training), which makes you eligible to work as a consultant learning disability psychiatrist.
As a community consultant, you will typically be expected to provide a service to a defined population of people with learning disabilities showing psychiatric and/or behavioural problems. You will normally be working with a highly skilled, multi-professional team, developing therapeutic partnerships with patients and their families.
As an inpatient consultant, you will be in charge of inpatient wards, looking after the most severe problems emanating from mental illnesses and from offending behaviour. There is also a demand for this expertise in prisons.
Consultants have an inherent leadership role. This can be further developed by taking on more formal roles, such as service lead or clinical director.
Most consultants develop their careers by carrying out different roles during different periods of their working lives. This can include teaching or research. Most consultants pursue these interests while still working in their clinical role.
Most services are based around multi-professional community teams serving a geographical area, or are linked to primary care practices. Some posts may include cover for specialist acute assessment and inpatient treatment services, or include the use of mainstream beds. A few posts may be inpatient only, especially in specialist forensic posts.
The number of patients seen per day can vary according to the post. Appointments will be longer than those in mainstream psychiatry, to allow sufficient time to communicate effectively with the patients and their carers.
Consultants are expected to provide in-service training to their own trainees and to broader groups preparing for examinations. They are also frequently linked to medical schools for undergraduate teaching.
Salary, hours and benefits
| Average salary | The starting salary for consultants is £79,000, rising to £107,000 |
| Typical hours | A higher-than-average number of consultants in this speciality work part time and there is a lot of scope for flexible working hours. Out-of-hours work is common in this specialty and can either be linked to mainstream rotas or standalone learning disability cover, which can be quieter. The European Union Working Time Directive limits the working week to 48 hours. It is also possible to work part-time once you are a consultant. |
| You could work | Consultants in learning disability psychiatry can work in a variety of settings, including in a hospital environment, and in the community, which could include home visits and community clinic appointments. There should be an appropriate balance between daytime and out-of-hours work, depending on the consultant’s individual job plan. |
| Benefits |
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What you’ll do
The work is usually very varied, ranging from mental health act assessments to safeguarding meetings and general hospital liaison visits.
An average day depends on the type of post, caseload, and service resources available. A large part of the work involves direct clinical care. In a hospital environment this means attendance at outpatients’ clinics and ward rounds. In the community clinic, appointments and home visits are an important part of the work.
Multidisciplinary team meetings and multi-professional reviews are held regularly wherever you work. The remainder of your working week will be spent on continuing medical education, service development, and clinical audit. Teaching is an important part of the work, which includes teaching medical students and trainees as well as educating carers.
Your day-to-day tasks may include:
- assessing people by getting a history from the person and their carers,
- identifying the nature of the problem, which would commonly be related to a range of causes such as mental illnesses, autism, physical illness, and environmental and social or interpersonal problems,
- providing treatment or working with other professionals, such as nurses, therapists, and psychologists, to provide treatment and support as a team,
- providing leadership to the doctors working in the service and also to some extent to the multidisciplinary team,
- providing advice and support to improve and develop services.
There is also the opportunity to work with other NHS organisations or professional bodies (e.g. the Royal College of Psychiatrists) to improve the skills and competences of psychiatrists.
Working environment
Consultant psychiatrists are often a part of community services for adults or children with learning disabilities and additional mental health and behaviour problems, usually as a member of a specialist multi-professional team.
They could be part of a similar multidisciplinary team within inpatients services for children, young people, or adults, either in acute assessment and treatment services, or in services with offenders in low-, medium-, or high-security hospitals.
Psychiatrists are often a part of the NHS but can also work for private companies providing inpatients services.
Characteristics and skills required
As well as the academic skills required to undertake a medical degree, specialty training, and continuous professional development, a consultant learning disability psychiatrist also needs:
- empathy and compassion, and the ability to treat others with understanding and respect,
- emotional resilience and initiative to work in challenging situations,
- the capacity to monitor developing situations and anticipate issues,
- the ability to work flexibly as part of a large multidisciplinary team,
- good problem-solving skills, using logical/lateral thinking,
- an analytical and scientific approach,
- good leadership skills, with the ability to organise and motivate other team members.
Career path and progression
The role of the consultant is the highest level that a doctor can aspire to reach in the United Kingdom and offers long-term stability, satisfactory remuneration, high levels of autonomy, and considerable job satisfaction.
There are also a number of roles which can be taken on in addition to working clinically as a consultant, including taking on additional leadership roles within their services, such as clinical leads within their specialties, clinical directors in larger departments, or medical directors across whole organisations.
Consultants who take up teaching as a special interest can progress up the hierarchy to roles such as training programme director, associate dean, and postgraduate dean.
They can also become a responsible clinician and have overall responsibility for care and treatment of inpatients being assessed and treated under the Mental Health Act.
| Career Framework level | Role | Degree? |
|---|---|---|
| 3 | Staff, Associate Speciality and Speciality (SAS) Doctor Support workers work with people with a learning disability and autistic people to promote independence and wellbeing, and they sometimes provide direct physical help when called for. They mainly work in the community and are most commonly employed by organisations outside of the NHS. | Yes |
| 3 and 4 | Consultant When you have completed your higher speciality training, you will receive your CCT (Certificate of Completion of Training), which makes you eligible to work as a consultant learning disability psychiatrist. | Yes |
How to become a consultant psychiatrist
After completing three years of core psychiatry training, trainees move into higher psychiatry training or specialty training, which normally takes three years.
During those three years, training will reflect the subspecialty of intellectual disability psychiatry, and can include child psychiatry and forensic psychiatry, as applied to people with learning disabilities.
When higher speciality training is complete, a Certificate of Completion of Training (CCT) is awarded, which gives the eligibility to work as a consultant learning disability psychiatrist.
Restrictions and requirements
As well as providing evidence of the required academic qualifications, certificate of completion of training, and clinical experience, applicants to learning disability psychiatry consultant posts will also need current UK professional registration by the General Medical Council and to pass enhanced background checks. Applications from job seekers who require current Tier 2 sponsorship to work in the UK are considered alongside all other applications.
Tier 2 skilled worker applicants applying for entry clearance into the UK must present a criminal record certificate from each country they have resided in continuously or cumulatively for 12 months or more in the past 10 years.
Financial support
The two foundation years are remunerated and so are the jobs for obtaining postgraduate core and specialty training.
Once working as a consultant, if you work in an NHS organisation in London, you are given an uplift in salary, known as London weighting.
This is a percentage increase in your salary depending on the location of your employer within the London region.
Current opportunities
Jobs in the UK
You can apply for roles via individual NHS trusts. The NHS jobs service can help you with your search for jobs and send you alerts when new jobs become available.
Courses in England
Doctors are required to undertake an average of 50 hours per year of Continuing Professional Development (CPD) education, over each five-year period. A minimum of 25 of these must be external, where the learning takes place with others outside the place of employment.
Continuing Professional Development must cover the clinical and non-clinical aspects of practice, along with any management, research, and teaching or training responsibilities the doctor may have. It can be a mix of formal and informal learning, and the formal learning can be delivered by NHS or private organisations.