Doctors Grades and training within the NHS

If you are not used to the grades of doctor in the UK they can at first seem confusing. However, the main differences lie between the grades that lead to a Certificate of Specialist Training and those that do not. Consultants lead the teams of doctors and all other grades are supervised by a Consultant.

If you are a junior doctor and want to find out more about the first years of training after your university training have a look at this website

For information about speciality training please visit

Training grades that lead to a Consultant post

Year Old training system New training system
1 PRHO (House Officer) Foundation Year 1(FY1)
2 Senior House Officer (SHO) year 1 Foundation Year 2(FY2)
3 Senior House Officer (SHO) year 2 Specialist Registrar (StR)1
4 Specialist Registrar year (SpR)1 Specialist Registrar (StR)2
5 Specialist Registrar year 2 Specialist Registrar (StR)3
6 Specialist Registrar year 3 Specialist Registrar (StR)4
7 Specialist Registrar year 4 Specialist Registrar (StR)5
8 Specialist Registrar year 5 Specialist Registrar (StR)6
9 Consultant (min.7-9 years) Consultant (8 years)
Optional Training can be extended by 2-3 years for research purposes.  

Grades for doctors who are NOT in training posts that lead to a Certificate of Completion of Specialist Training.
Associate Specialist and Speciality doctors with very long experience within a speciality and other qualifications may apply to have their names entered on the GMC's Specialist Register.

Year Old system New system
1 PRHO (House Officer) Foundation Year 1(FY1)
2 Senior House Officer (SHO) year 1 Foundation Year 2(FY2)
3 Senior House Officer (SHO) year 2 Trust Grade doctors
4 Staff Grade: At least 3 years at SHO or higher grade within their chosen speciality.  
5   Specialty doctor: At least 4 years post graduation, two of which must be within their chosen speciality. 
  Associate Specialist: Minimum of 10 years experience after graduation including 4 years at Registrar or Staff Grade levels of which 2 years must be within their chosen speciality. No further Associate Specialist posts will be placed but doctors who hold these positions will be allowed to continue in the same post.

Middle Grade

This is not an "Official Grade" but it is a term often used in hospitals for Staff Grades, Specialty doctors and SpR.

Resident Medical Officer (RMO)

RMO's look after the in-patients in private hospitals. They are often resident at the hospital and then take a period of time off work. This can also be done on a one week on one week off basis. Being an RMO requires full registration (often taken one year after medical studies are finished).