Working as a doctor in the third sector

Authors: Elvina Chu, Rajendra Shah, Zerak Al-Salihy 

Publication date:  14 Aug 2013

As more organisations seek to provide health services, many UK doctors are considering opportunities in the third sector. Elvina Chu, Rajendra Shah, and Zerak Al-Salihy describe their experiences of moving between NHS and third sector roles

Changes to the way health services are commissioned and provided are creating more opportunities for doctors to work outside the NHS, often in the “third sector.” Third sector institutions occupy the space between the state and the private sector; this includes charitable hospitals that use their surpluses to further their own objectives and pursue independence from government.

There is currently little guidance for doctors working in organisations outside the NHS and a general lack of information about clinical work in the third sector. People looking to pursue alternative opportunities should consider several differences between roles in the NHS and those in the third sector, including salary, benefits, and career progression (boxes).

Moving to the third sector

Rajendra Shah, previously specialist trainee year 3, South London and Maudsley NHS Foundation Trust

As an NHS trainee, I experienced a structured system of professional development working in various psychiatric subspecialties in highly supervised environments, with plenty of opportunities for formal learning and teaching. When I considered moving to the third sector, I was concerned about giving up on traditional career prospects and ending up in a dead end job, but I have had many new opportunities for progress and development.

Perhaps the biggest difference has been the emphasis on service provision, which takes precedence over all other activities. Also, although teaching and learning opportunities exist, they are not as obvious and may require some effort to set up as there is no protected time outside clinical work when this can be done. However, with more control over daily activities as a specialty doctor rather than a trainee, it is possible to organise timetables to ensure dedicated time for non-clinical activities.

Being in the same place for longer than 12 months has made it possible to begin audit projects that have a real impact on practice, to develop management projects for new services, and to organise better out of hours medical cover. The sense of job satisfaction gained by remaining in the same post long enough to see patients progress is immense. Active participation in non-clinical activities compares well with opportunities as a trainee, with weekly supervision and a formal appraisal process with support to ensure revalidation from the General Medical Council.

Taking experience back to the NHS

Zerak Al-Salihy, specialist trainee year 6, Norfolk and Suffolk NHS Foundation Trust

I decided to complete my specialty training in old age psychiatry after two years of working in the third sector. I have realised there are advantages to having worked outside the NHS that may be overlooked by those considering doing this. Because of my direct experience in healthcare economics, I am more aware than many colleagues of how to operate in a competitive market with limited resources. I have also gained experience in building a long term strategic vision for the organisation to flourish and have observed how the workforce can be shaped to respond to local and national demands. There are of course pitfalls that can discourage doctors from leaving the NHS, but these are not necessarily a hindrance. Achieving target bed occupancy and working with limited medical cover in the absence of more junior team members, such as foundation year or core trainee doctors, inevitably results in senior doctors getting involved in activities that can be seen as a more junior responsibility, such as phlebotomy. I would argue that the NHS no longer gives a sense of job security, and my experience of working outside the NHS was a positive one. Moving back into training was not an easy decision to make, but I was able to draw from my experience outside the NHS to demonstrate that I was a better candidate in my interview for a competitive training post.

Consultant posts in the third sector

Elvina Chu, consultant neuropsychiatrist, St Andrew’s Healthcare, Northampton

At first I was reluctant to consider moving out of the NHS as there seemed to be too many unknown factors, but I have enjoyed moving into a dynamic and efficient organisation. It has been possible for me to hold posts simultaneously in the NHS and the third sector, which has allowed me to develop a good insight into differences in management structures.

Mentoring from senior colleagues is available, and a systematic appraisal method has been adopted to assess all doctors thoroughly, while the annual “individual personal development review” focuses on what doctors can do for the organisation and can attract financial incentives. Job security is dependent on occupancy status and referral rates, but procedures are in place to move staff rather than making them redundant—doctors are in demand and well respected, unlike at some NHS trusts.

Although there are no official sessions set aside for supporting professional activities, there is sufficient flexibility in the system for all doctors to progress by careful reflection on personal development needs and the freedom to be innovative without being weighed down by endless bureaucracy.

Some non-NHS organisations may offer better remuneration, but the NHS payscale is clearly defined and regulated, and remains, at junior levels, unaffected by performance targets. Also, while NHS organisations have formally agreed study budgets, third sector organisations often do not, so doctors working outside the NHS may find that course fees and conferences soon eat into their salaries.

Despite recent reforms, the NHS pension scheme still offers better value for money than many schemes offered by other employers. NHS employees also benefit from more favourable sickness policies than those in other organisations, with doctors in the NHS being far better protected when they are off sick for more than a few days in a year.

Maternity leave and redundancy packages may also be smaller in non-NHS organisations and there may be higher fees to pay for professional indemnity, as well as fewer annual leave days. As job contracts are not standardised, these should be reviewed by an employment adviser in case any areas need to be negotiated.

There is also less support in third sector organisations for doctors looking to complete membership examinations, and there may be no formal teaching programme, with continuing professional development events focusing on organisational development and local policies.

“Some non-NHS organisations may offer better remuneration, but the NHS payscale is clearly defined and regulated”

Competing interests: Drs Chu and Shah work for St Andrew’s Healthcare, a charitable hospital in the third sector. Dr Al-Salihy was previously employed by St Andrew’s Healthcare.

Elvina Chu consultant neuropsychiatrist  St Andrew’s Healthcare, Northampton, UK
Rajendra Shah previously specialty trainee year 3  South London and Maudsley NHS Foundation Trust, London, UK
Zerak Al-Salihy specialty trainee year 6  Norfolk and Suffolk NHS Foundation Trust, UK

Cite this as BMJ Careers ; doi: