The work of Consultant Clinical Psychologists is important because it is one of the main contributors to the value of our profession as a whole. Their work demonstrates what the most able and experienced Clinical Psychologists can contribute to health and social care. There has been concern within our profession that the down-banding of posts for experienced Clinical Psychologists has led to a loss of Consultant roles, and consequently a loss of experience and expertise, loss of career pathways and loss of qualified staff to the private and commercial sectors, with detriment to the quantity and quality of NHS services. In our opinion that is wasteful and benefits no one; we therefore intend this to be the first publication in a series entitled “Making Best Use of Scarce Resources”.

We are grateful for the many and detailed responses to the consultation on a draft of this document in March 2021 from well over 100 ACP-UK members.

Please use this document in your local discussions with colleagues, managers and commissioners. Feel free to download it and circulate print-outs or PDFs. You are very welcome to use it as an appendix to your own documents but please do not amend the text which is the copyright of ACP-UK. If you have questions or comments please send them to [email protected]

A pdf of the document can be downloaded here or you can read it in full below.

Making Best Use of Scarce Resources

‘Consultant Clinical Psychologists’

What Their Title Means, And How They Add Value to Health and Care Services

Introduction

 This statement is concerned with three issues:

• What characterizes the work of a Consultant Clinical Psychologist and how does it add value to services?
• What qualifies a Clinical Psychologist for appointment to a Consultant post in a National Health Service or voluntary sector organisation, or to use the title Consultant in independent practice in a charity, private limited company or when self-employed?
• Who has the authority to determine whether a Clinical Psychologist has those qualifications or has the capacity to undertake the work of a Consultant Clinical Psychologist?

ACP-UK anticipates that the statement will be of value to:

• Employers determining whether a Consultant Clinical Psychologist post is needed or whether the work to be undertaken by a post-holder warrants the job title ‘Consultant Clinical Psychologist’;
• Those involved in assessing and appointing candidates to Consultant Clinical Psychologist posts;
• Those commissioning or outsourcing services to an HCPC registered applied psychologist who describes themselves as a Consultant Clinical Psychologist;
• Clinical Psychologists who are considering applying for Consultant Clinical Psychologist posts;
• Clinical Psychologists (including independent practitioners) who may wish to use the title Consultant to describe themselves to colleagues, public, commercial, charitable, social enterprise and higher education organisations, users of services, and the general

Executive Summary

In this statement we identify current practice concerning:

• The characteristics of the work which requires the knowledge, skills and authority of a Consultant Clinical Psychologist;
• The characteristics of a Clinical Psychologist who will be considered competent to undertake that

We do so because the work of Consultant Clinical Psychologists is one of the main contributors to the value of our profession as a whole, there has been concern about the down-banding of posts for experienced Clinical Psychologists leading to loss of understanding within the NHS of the value that Clinical Psychologists can bring to health and social care, and loss of career pathways leading to loss of qualified staff with detriment to the quantity and quality of NHS services.

The work of Consultant Clinical Psychologists is characterised by the breadth and level of work undertaken. It is a higher level of work than that undertaken by Clinical Psychologists. By way of illustration, we identify Consultant level work in relation to: clinical skill; clinical leadership; teaching and training; innovation; service design and development.

Profiles for the two Consultant level posts identified in Agenda for Change systems are reprinted from the NHS Job Evaluation Handbook as an appendix to this document. They show the expected level on each of 16 job evaluation factors. It is important to note that the responsibilities recognised by those grades should primarily be professional responsibilities of the kinds identified in the previous section including professional management, not general management responsibilities.

In NHS settings the decision about whether an applicant for a Consultant Clinical Psychologist post is qualified for that post is made by the employer’s appointment panel guided by one or more BPS or ACP-UK appointed National Assessors. That ensures that psychologists are not appointed as Consultants who have inappropriate or inadequate qualifications or whose capacity to undertake the role is insufficient.

ACP-UK supports moves to develop a system for validating the entitlement of Clinical Psychologists in the independent, higher education and third sectors to use the title ‘Consultant’.

Why has ACP-UK published this statement? 

The work of Consultant Clinical Psychologists is particularly important because it is one of the main contributors to the value of our profession as a whole. Their work demonstrates what the most able and experienced Clinical Psychologists can contribute to health and social care. Because the perceived need to employ or use the expertise of Clinical Psychologists depends on other people’s perceptions of what Clinical Psychologists can offer, others may judge the value of our profession by the quality and effectiveness of Consultant Clinical Psychologists’ work.

However there has been concern within our profession that the down-banding of posts for experienced Clinical Psychologists has led to a loss of Consultant roles, and consequently a loss of understanding of the value that Clinical Psychologists can bring to health and social care.

Clinical Psychologists have been employed in the NHS for over 70 years. During that time the profession has been reviewed and researched a number of times. The title ‘Consultant’ refers both to the responsibilities associated with particular posts and to the Clinical Psychologist whose capacity to fulfil those responsibilities has been recognised. In this statement we identify current practice concerning:

• The characteristics of the work which requires the knowledge, skills and authority of a Consultant Clinical Psychologist;
• The characteristics of a Clinical Psychologist who will be considered competent to undertake that

Throughout this statement we use the title ‘Consultant Clinical Psychologist’, not ‘Consultant Psychologist’. At present there is no statutory control of the use of the title ‘Consultant’ outside the medical profession. The title ‘Clinical Psychologist’ is one of those protected by the Health and Care Professions Council (HCPC). ACP-UK is of the opinion that the title Consultant should only ever be used in conjunction with one of the seven HCPC protected titles and the use of the generic title ‘Consultant Psychologist’ should be discouraged.

What characterises the work of a Consultant Clinical Psychologist?

The work of Consultant Clinical Psychologists is characterised by the level and breadth of work undertaken. It is a higher level of work than that undertaken by Clinical Psychologists, and characterised by the depth and breadth of professional knowledge required, professional autonomy and authority, and / or clinical leadership of psychological services.

Within the medical profession the title Consultant refers to experienced doctors whose job responsibilities include: expert practice in their field of work; clinical and professional leadership; contributions to the education and professional development of other doctors; and in many cases contributions to policy and service development, research and service evaluation. The need for, and value of the work of advanced practitioners has also been recognised in nursing and the allied health professions by the creation of Consultant-type roles.

Clinical psychology is a branch of professional applied psychology whose practitioners qualify through a Doctoral level post-graduate degree. Whilst the work of Consultant Clinical Psychologists shares some characteristics with that of Consultants in other healthcare professions, it is distinct in other respects. The phrase ‘higher level and breadth of work’ needs to be interpreted by reference to the wide range of applied psychology activities undertaken by Clinical Psychologists in the various settings in which they work.

All those forms of ‘higher level work’ share three core characteristics:

• The Consultant is expected to be able to practise independently and autonomously, to be competent to undertake complex work and to work on the most complex issues in their area of practice. That implies recognition of the Consultant’s personal authority in their field of work, and their freedom to act in the best interests of the services and those served by
• The scope of a Consultant’s work is such that it influences, shapes, develops, or changes the work of other people. Their work is not only about their own immediate responsibilities but also about supporting or managing clinical care in partnership with other professionals, families and carers, and about recognising the need for, and promoting
• The Consultant’s decisions and actions have long term as well as immediate consequences. That implies, firstly, a higher level of responsibility and personal accountability, commensurate with their personal authority. Secondly, that their personal knowledge needs to go beyond local policies and practice and includes knowledge of national developments and plans within their field of work

By way of illustration, we identify Consultant level work in relation to: clinical skill; clinical leadership; teaching and training; innovation; service design and development.

In a parallel with medicine, a Consultant Clinical Psychologist working in clinical settings must demonstrate the knowledge, skills, competence and experience to undertake or advise on complex cases and problems. In another parallel with medicine, some Consultant Clinical Psychologists may have a team of Clinical and other registered Psychologists or a multidisciplinary team to whom they delegate work, or the quality of whose work they assure through the clinical expertise they contribute.

A distinctive contribution by Clinical Psychologists throughout the history of the profession has been a concern with the organisational aspects of care, the management of the interactions between staff and patients, and the importance of the relationships between individuals and the communities of which they are members (both within and outside healthcare). Consultant Clinical Psychologists have often been the channel through which these developments have been communicated to the wider health and social care systems.

Clinical leadership will be implicit in the Consultant’s responsibilities. They will normally be expected to contribute to development of the policies and procedures of the services provided, train and mentor less experienced colleagues, and identify needs for innovation to improve the quality and effectiveness of the services for which they are responsible. The value of the Consultant’s work will not be just in their own casework but in their success in handling of those other responsibilities, potentially over periods of years.

Clinical Psychologists have a rich record of research-based innovation in response to identified needs, producing new ways of understanding clinical problems and new methods of assessment and therapy. For some the focus of their work is not the individual case, but the unsolved problems found in a flow of patients with similar needs. The results of their work can have a profound influence on practice, not only in Clinical Psychology, but in the work of other professions and across healthcare as a whole. All Clinical Psychologists are taught the basic knowledge and skills for this work in their basic training. Those who specialise in it are undertaking Consultant-level work.

Similarly, innovations only achieve value when implemented in the form of accessible and clinically robust, well governed services. Posts may be created to implement or upgrade services, or projects set up to audit or evaluate services but even if they are not, the complexity and timescale of service design and development identifies it as Consultant-level work.

There is a particular area of service design and development that is not concerned with clinical, patient-oriented services but with the training of successive generations of Clinical Psychologists. Ensuring that trainee Clinical Psychologists are provided with a basic training which enables them to build their careers and enhance their knowledge and skills throughout the next thirty to forty years of their professional lives also relies on the training organisers’ vision and capacity to handle complexity.

Consultant Clinical Psychologist posts in the NHS

At present those NHS employers who are not operating their own salary schemes determine that a post is a Consultant Clinical Psychologist post by reference to the Profiles published in the NHS Job Evaluation Handbook since March 2005 following the Agenda for Change initiative. Two of the four levels of posts carry the title ‘Consultant’:

Job Title	AfC Min	AfC Max	Publication
Clinical Psychologist	7	7	Mar-05
Clinical Psychologist, Principal	8A	8B	Mar-05
Clinical Psychologist, Consultant	8C	8D	Mar-05
Clinical Psychologist, Consultant, Professional Lead / Head of Psychology Services	8D	9	Mar-05

In those NHS Trusts which implement Agenda for Change job evaluations and salary bandings, posts for recently qualified Clinical Psychologists carry salaries in Agenda for Change band 7. Posts for more experienced Principal Clinical Psychologists carry salaries in Agenda for Change bands 8A and 8B. Posts for Consultant Clinical Psychologists carry salaries in bands 8C and 8D. Posts for Consultant Clinical Psychologists with additional responsibilities carry salaries in bands 8D and 9.

Over the past few years some NHS Trusts have been down-banding or disestablishing Consultant-level posts at bands 8C, 8D and 9. The consequence has been the loss of experience and expertise, loss of career pathways and a loss of qualified staff to the private and commercial sectors, with detriment to the quantity and quality of NHS services.

Profiles for the two Consultant level posts are reprinted from the NHS Job Evaluation Handbook as an appendix to this document. They show the expected level on each of 16 job evaluation factors. It is important to note that the responsibilities recognised by those grades should be professional responsibilities of the kinds identified in the previous section including professional management, not general management responsibilities.

Clinical Psychologists who are appointed to Consultant posts are highly trained, highly qualified, and will have considerable experience in their area of work. It is therefore important that they and the investment in their posts is used to best effect. They should be supported by appropriate administrative and clerical support so that they can make the most efficient and effective use of their time.

Consultant Clinical Psychologist posts outside the NHS 

At present there is no system for validating claims to the title of Consultant Clinical Psychologist outside of employment by NHS organisations, although the title may constitute an important indicator of professional ability, for example in legal and academic settings.

It is widely accepted, both within and outside the profession, that the title should signify levels of competence, expertise and capacity for higher level work in independent, higher education and third sectors organisations equivalent to those that it signifies in NHS settings. Irresponsible use of the title by those who could not demonstrate those characteristics if required to do so creates a danger that the profession will be brought into disrepute, to everybody’s disadvantage.

What qualifies a Clinical Psychologist for appointment to a Consultant post or to use the title Consultant Clinical Psychologist?

The principle that Consultant Clinical Psychologists are expected to undertake a higher level of work than their Clinical Psychologist colleagues implies that in order to be qualified for an appointment:

• the psychologist seeking the appointment must have experienced professional growth and development since they qualified;
• they may have pre-training or pre-qualification experience which they wish to be taken into account but this will normally only be appropriate in relation to a specific post or application for appointment;
• they must be able to demonstrate their capacity to use their knowledge, skills and experience to undertake at the time of appointment the higher level of work expected of the post-holder;
• they should be able to provide evidence of capacity for further professional growth and development after they have been

In NHS settings, and in well developed organisations of other kinds, the higher level of work required of the post-holder will be defined in a Job Description, and the knowledge, skills and experience required will be defined in a Person Specification.

Because of the variations in age and prior experience of those who enter clinical psychology training there can be no hard and fast rule concerning the number of years that a Clinical Psychologist should have been qualified, and the specialist post-qualification experience and training they should have gained, before applying for Consultant Clinical Psychologist posts. Further, employment law does not permit age and years served to be taken into account.

However, in general, in order to be considered to be eligible for a Consultant appointment a Clinical Psychologist is likely to have been qualified for some years, and be able to demonstrate development in their professional work during that time. In order to demonstrate their capacity for professional growth and development, those who intend to apply for Consultant Clinical Psychologist posts will normally be expected to be able to describe their career aspirations and provide evidence of their progress.

Use of the title ‘Consultant’ by independent, and third sector Clinical Psychologists

Whereas the roles and responsibilities of posts for Consultant Clinical Psychologists in NHS Trusts are usually defined by reference to the organisational arrangements of the Trust, that principle cannot easily be applied to third sector and independent clinical psychology services. They are much smaller organisations with simpler internal arrangements, and may focus on specialist areas of service. The concept of ‘Consultant’ in those settings inevitably relies to a greater extent on the achievements and potential of the Clinical Psychologists using the title and the same is true of Clinical Psychologists working in higher education.

ACP-UK supports moves to develop a system for validating the entitlement of independent and third sector Clinical Psychologists to use the title ‘Consultant’. We envisage a system that provides them with the opportunity to demonstrate, to peers or National Assessors, the quality of their professional development to date and their personal capacity to fulfil at ‘Consultant’ level the demands of the services they are providing. It is important that the system provides both the Clinical Psychologist and those who use their services with the assurance that the Clinical Psychologist is entitled to use the term “Consultant Clinical Psychologist” and it is likely that such a system will provide formal certification of entitlement to use the term.

We anticipate undertaking further work to identify indicators of Consultant-level responsibilities, and the capacity to undertake those responsibilities, in third sector and independent clinical psychology services and non-NHS organisational settings such as higher education.

Who has the authority to determine whether a Clinical Psychologist has the qualifications to use the title Consultant Clinical Psychologist?

In Medicine the position of Consultant is of such significance that the procedures for appointing Consultants are regulated by law. In England they are governed by a Statutory Instrument. Appointments in Wales, Northern Ireland and Scotland are governed by different Statutory Instruments, but the principles are the same. In all cases the composition of an Advisory Appointment Committee (AAC) is specified and must include a professional member in the appropriate specialty, nominated by the relevant Royal College, who is not employed by the employing body hosting the AAC. The British Medical Association’s Central Consultants and Specialists Committee (CCSC) also issues guidance on appointment procedures.

In NHS settings the decision about whether an applicant for a Consultant Clinical Psychologist post is qualified for that post is made by the employer’s appointment panel guided by one or more BPS or ACP-UK appointed National Assessors who must be included in the appointment process. That ensures that psychologists are not appointed as Consultants who have inappropriate or inadequate qualifications or whose capacity to undertake the role is insufficient. ACP-UK will support NHS heads of clinical psychology services to ensure that National Assessors are included in appointments panels as appropriate and necessary.

In due course ACP-UK would like to see the work undertaken by applicants from the independent and third sectors assessed to determine whether the applicant and their work responsibilities are consistent with a Consultant-level post. Such assessments might include National Assessors and peers from other independent and third sector organisations. However we do not envisage that such a system will be implemented until further investigations have been undertaken.

Acknowledgments

We are grateful for the many and detailed responses to the consultation on a draft of this document in March 2021, from well over 100 ACP-UK members. Some comments and suggestions have been incorporated in this version. Others are the subject of further investigation or discussion.

References and bibliography

Scottish Government (2010) Consultant Nurses, Midwives & Allied Health Professionals (NMAHPs). Guidance for NHS Boards

NHS Job Evaluation Handbook. 4^th edition, July 2013.

Health Education England (2017). Multi-professional framework for advanced clinical practice in England