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Navigating the NHS›Building your career
08
Building your career

Locally employed doctors and job titles

Understand what LED means, decode local titles and keep a temporary post from becoming an accidental career.

20 min readLocally employed doctorsClinical fellowsTrust doctors
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The short answer

Locally employed doctor describes an employment arrangement, not a level of ability. Titles vary widely, so judge each post through its contract, duties, rota, scope, supervision and development.

What to do next
  1. 1

    Write down what your current title actually means in duties, level, supervision and contract.

  2. 2

    Set a three-, six- and twelve-month review with an intended destination or useful outcome.

  3. 3

    Ask whether a substantive SAS, training, Portfolio Pathway or other career route fits your evidence and aims.

Learning objectives

By the end of this chapter

  • Decode common locally employed titles and determine the actual level, scope and contract.
  • Recognise career drift and use structured three-, six- and twelve-month reviews.
  • Understand how national developments in England may affect permanence, appraisal and transfer to SAS terms.

Locally employed describes the contract, not one level of doctor

A locally employed doctor is appointed directly by an organisation on local terms rather than occupying a recognised national training post or necessarily a national SAS contract. The group includes doctors at very different career stages. Local titles can include trust doctor, clinical fellow, teaching fellow, research fellow and locally chosen senior grades.

Do not infer capability from the label alone. Identify the job's real duties, rota, supervision, decision-making, length and employment terms. Some posts provide excellent structured development; others rely heavily on service delivery with limited progression. The same title can mean different things in neighbouring organisations.

Practical points
  • Local contractual status.
  • Actual clinical level and scope.
  • Supervision and governance.
  • Rota and workload.
  • Development purpose and expected outcome.

Use a role decoder at appointment and review

Write a one-page role map: patient group, sites, clinical decisions, procedures, rota tier, senior support, teaching, improvement work, development time and evidence expected. Compare it with the job description and person specification. If the job changes, update the map and discuss whether title, pay or contract should also be reviewed.

Terms such as 'equivalent to ST3' may describe a rota level without making the post part of an approved training programme. Ask whether workplace assessments, courses or portfolio evidence are available and who signs them. Avoid assuming that time served will automatically be recognised by a future training or regulatory process.

Practical points
  • What do you decide independently?
  • What needs review or supervision?
  • Which competencies can be evidenced?
  • What protected time is available?
  • What is the intended next destination?

Prevent service contribution from becoming career drift

Career drift occurs when a doctor becomes essential to a rota but gains little new evidence, responsibility or security. Reliability can paradoxically make release for clinics, courses or projects harder. Set objectives early and review them before the end of a fixed term is close. Ask for specific access rather than a general promise of support.

At three months, check induction, scope and immediate evidence. At six months, review competency, feedback, development and contract intentions. At twelve months, decide whether the role is producing a credible route to training, SAS, specialist registration, academia or another chosen destination. Remaining in an LED career can be positive when terms, progression and development are deliberate.

Practical points
  • Three months: safe scope and systems.
  • Six months: evidence and development delivered.
  • Twelve months: destination, contract and progression decision.
  • Do not wait for the final month of a fixed term to ask what comes next.

Understand current England reforms without confusing the routes

England's 2026 resident-doctor agreement introduced important commitments for in-scope LEDs, including movement towards more consistent terms, greater permanence and an enhanced appraisal route connected to competency and pay progression. Separately, the SAS Eligibility and Permanency Framework allows eligible doctors who have undertaken comparable SAS work with the same employer for at least 24 months to seek transfer to permanent national Specialty Doctor or Specialist terms.

These are distinct mechanisms. Moving to a repurposed resident-doctor-style contract does not itself make someone an SAS doctor. The EPF has eligibility, competency and role-comparability requirements; Specialist transfer also engages the generic capabilities framework. Doctors should compare pay, out-of-hours arrangements and protections before accepting a transfer and seek individual advice where consequences are complex.

Practical points
  • Confirm whether the arrangement applies to your nation and contract.
  • Do not confuse enhanced LED appraisal with SAS appointment.
  • For EPF, evidence actual duties, scope and experience.
  • Compare total terms, not only basic salary.
  • Keep employer notification and application deadlines.

Label the nation before applying contract guidance

Health services and medical employment arrangements differ across England, Wales, Scotland and Northern Ireland. A national development announced in England does not automatically change an LED contract elsewhere. Even within one nation, a local contract may incorporate only part of a national template.

Use the employer's written terms, the relevant national employer body and current union guidance. When moving between nations, re-check pay scales, leave, working-time mechanisms, terminology and appraisal arrangements. Your GMC professional duties continue across the UK, but employment mechanisms do not become uniform because the regulator is UK-wide.

Practical points
  • Identify jurisdiction on every source.
  • Check the actual contract rather than its informal label.
  • Record the publication and review date.
  • Seek local advice before relying on another nation's process.

Build a portfolio that keeps options open

Record clinical scope, workplace assessment, feedback, CPD, audit and improvement, teaching, leadership, complaints, significant events and reflection. Ask supervisors to describe observed capability rather than provide only a character reference. Maintain accurate job descriptions, rotas and work schedules because they may later help demonstrate level and duration of practice.

Choose evidence according to the intended route. A training application, EPF transfer, Specialty Doctor appointment and Portfolio Pathway application do not ask the same question. One organised evidence base can support several routes, but it must be mapped and interpreted for each rather than uploaded unchanged.

Practical points
  • Current CV and complete chronology.
  • Scope, supervision and decision-making evidence.
  • Workplace assessment and feedback.
  • Governance, teaching and improvement.
  • Career objective and next evidence gap.
Reflection

Apply this to your own position

If your current LED post ended in six months, what new verified evidence would you have that was not present when you started?

Keep any written reflection proportionate and confidential. Do not include identifiable patient or colleague information.
Key takeaways
  • LED is a contractual category covering many levels and purposes.
  • Review the role at three, six and twelve months to prevent accidental drift.
  • England's LED reforms and the EPF are related developments but not the same route.
Evidence to keep

Build the record as you go

  • Contracts and job descriptions
  • Complete role dates
  • Scope and supervision records
  • Appraisals and PDPs
  • Competency and feedback evidence
  • Twelve-month career review
Practical workbook

LED and SAS Career Pathway Workbook

Decode the current role, prevent career drift and plan evidence for SAS, Specialist or Portfolio Pathway progression.

Download workbook PDF ↓
Chapter knowledge check

Test practical understanding

Six questions on Locally employed doctors and job titles. This is a learning check, not professional, regulatory, legal or immigration advice.

Question 1 of 6
What does the title 'clinical fellow' reliably establish?
Choose one answer to continue.
Check the live source

Official guidance

Rules and processes change. Check these sources again before a significant decision.

Information reviewed 2026-09-07. This independent guide provides general professional information, not individual legal, immigration, employment, pension, tax, regulatory or clinical advice.