Career Advice

UK Doctors Grades

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Understanding the career pathway and grades for doctors in the UK


For international doctors who are unfamiliar with the healthcare system in the UK, understanding the different titles for doctors can be confusing. That’s why we’ve written a blog to help you better understand the different UK doctors grades, what they mean and what the career pathway in the UK is:

Foundation Training

  • FY1
  • FY2

Specialty Training

  • Junior Middle Grade (ST1-2/CT1-2)
  • Senior Middle Grade (ST3-ST8)

SAS/Specialty Doctors

Consultant or GP


Foundation Training 

After completing medical school, graduates will enter the Foundation Programme. This is a two year training programme.

FY1 (Foundation Year 1)

FY1 doctors will put into practice the skills and knowledge that they obtained during their medical education. At this early stage of their career, they are under clinical supervision and have provisional GMC registration.

By the end of their FY1 year, doctors will need to have shown that they have met the required outcomes to be eligible for full registration with the GMC and to then move onto the next stage of their foundation training.

FY2 (Foundation Year 2)

In their second year of foundation training, FY2 doctors will have an increasing amount of responsibility for patient care. They do however remain under clinical supervision throughout.

Doctors will need to have started demonstrating clinical effectiveness, leadership and the decision-making responsibilities necessary for hospital and general practice speciality training by the end of Foundation Year 2.

A trainee shows that they are ready to move onto a core, speciality or general practice training programme by completing FY2. They can also be recommended for full registration with the GMC.

Specialty Training

Once a doctor has successfully completed their foundation training, they will progress into the early stages of training in either a specialist area or general practice. Training programmes usually last between 3-8 years but the length and structure can differ according to each speciality.

We’ve provided a brief overview of some of the training pathways that are available, below:

Run-through training programmes

Run-through training programmes typically last between 3-7 years. Applicants apply once, at the beginning of the programme, and are recruited for the full duration of the specialty training.

Uncoupled training programmes

Uncoupled training programmes are split into Core Training and Higher Speciality Training.

Core Training lasts for 2-3 years however, this can differ depending on the specialty.

Once a doctor has completed their Core Training, they can apply for a Higher Specialty Training post. Higher Speciality Training takes between 4-6 years to complete and in most specialties, begins at ST3 level. For the specialties where this does not begin at ST3 level, it will start at ST4 level.

The application process for Higher Speciality Training is competitive and the completion of Core Training does not guarantee acceptance.

Doctors Grades through training

Doctors in Speciality Training Programmes are known as Middle Grade Doctors.

Junior Middle Grade doctors are trainee’s who have completed their foundation training and are now in the early years of their speciality training. They are:

  • ST1/ST2: ST stands for Specialty Training. This is for doctors who are in their first few years of a run-through training programme
  • CT1/CT2: CT stands for Core Trainee. This is for doctors in their first few years of an uncoupled training programme
  • SHO: The term previously used for doctors at this stage was SHO.

Senior Middle Grade doctors are known as ST3-ST8.

What is an SAS/Specialty Doctor?

SAS/Specialty doctors are experienced and senior doctors who have at least four years of full-time postgraduate training, two of which have been in their relevant specialty.

There are routes, through gaining CESR (certificate of eligibility for specialist registration), for SAS/Specialty doctors to become consultants if they want to. 

Consultants or GPs

Once a doctor has completed their specialist training, they are able to work without supervision as a Consultant or GP.

In the UK, to work in a permanent/substantive post, you must be on the GMC Specialist Register. At the end of their specialist training, trainee’s in the UK will receive their CCT (Certificate of Completion of Training) and will be entered onto the GMC Specialist Register or GP Register.

Locum Consultant

You do not have to be on the Specialist Register to take up a Locum Consultant post (although you must have the appropriate experience). For this reason, many overseas Consultants will opt to enter the UK system in a fixed term Locum Consultant post, or at Senior Middle Grade, with the view to gaining entry onto the GMC Specialist Register via the CESR route.

What is CESR?

For doctors who have completed their training outside of the UK, the CESR route offers an alternative means of access to the GMC Specialist Register. For further information about CESR, read our blog by clicking here.

To check whether you may be eligible for direct entry onto the GMC Specialist Register, click here.


If you are interested in working in the UK, want to discuss available job opportunities or may have already begun your journey and need further advice, please contact our team today.


Our UK Doctors Grades article has been written as a guide to help simplify the terminology used for doctors in the UK.