Locum appointments in the specialist registrar grade

What is a LAS or LAT?

It is unavoidable that breaks in training programmes will occur —for example, when doctors leave temporarily for research purposes. These vacant posts must be filled, and trusts have two options. Specialist registrar placements consist of service and training components. If only the service element of the post is to be covered then a locum appointment, service (LAS) may be made. If, in addition to this service component, the training value of a post is recognised a second type of appointment may be made: a locum appointment, training (LAT).

A LAS does not attract an NTN, there is no training element, and it does not count towards a CCST. Because of the short term, service based nature of such a post these placements are usually limited to a maximum of three months. A LAT, although not attracting a NTN, does have a training element. The key difference between the two locum appointments, therefore, is that, since this training is acknowledged, a LAT will count towards achieving a CCST. However, it is important to note that repeated LAT posts will not to lead to the award of a CCST. A person will qualify for a CCST only if he or she has been appointed to a substantive post. This is a placement that has a recognised training programme. It has therefore been recommended that a LAT should not last more than one year.In addition to LAS and LAT posts, fixed term training appointments (FTTA) are available. These are appointments adapted to meet the training needs of individual doctors and are usually for overseas doctors without the right of permanent residence. They can cover vacancies in SpR training but ideally should be independent. They do not lead to a CCST and usually last between six months and two years.

The eligibility requirements for a LAS are similar to those of a substantive specialist registrar post, but the appointment is the responsibility of the employer, the hospital trust. The short term attraction of the post, other than financial, is that it fills a career gap with experience in a relevant specialty at specialist registrar grade. The long term advantages, however, are minimal. The training is limited, it does not count towards a CCST, and the appropriateness of a post should be questioned.

A LAT does count towards a CCST, and so these appointments are competitive. A representative of the appropriate royal college or faculty (or in Scotland a member of the national panel of specialists) is usually included in the appointment panel. A LAT therefore is suitable for those who wish to pursue a CCST training programme and have the entry requirements but have not yet been able to obtain an NTN. Valuable experience can be achieved in your chosen specialty, and if it has been agreed prospectively then the training gained during the period of a LAT will count in the calculation of time to completion of higher specialist training.The disadvantages of such a post are that trainees can be considered second class since they need to compete again for an NTN. A LAT is not, however, a separate grade and holds a contract as a specialist registrar, subject to specialist registrar pay, terms, and conditions. But it is also important to note that holding such a post does not confer special or priority right of entry into a substantive specialist registrar placement.

So should I take it?

Should SHOs take a locum specialist registrar post? Of course individual circumstances differ, but, generally, the answer is yes with the caveat that the locum appointment includes training. There are short and long term advantages. Not only does it save repeating further SHO training, it also gives valuable experience in your chosen specialty and, importantly, it counts towards the CCST. It needs to be stressed, however, that no retrospective recognition of LAT training can be given and that LASs cannot be turned into LATs at a later date. Be sure that postgraduate approval has been granted and that you have enrolled with the joint committee on higher medical training. This is vital for recognition of your LAT training towards a CCST. It is also important to realise that LAT holders are required to undergo the same assessment and appraisal procedures as apply to specialist registrars. If these points are taken into consideration then hopefully you will gain the maximum benefit from your locum post, and I wish you luck in obtaining that ever elusive NTN.

Further reading

Elkeles R. Specialist training in the UK [letter; comment] Lancet 1997; 350: 1851.

Department of Health. A guide to specialist registrar training. 1998.

Smith R. Countering poor training within the NHS. BMJ 1999;18:552.