NCCG doctors have relationships too

We were interested to read the article by Drs Garelick and Fagin (Garelick & Fagin, 2004) on doctor-to-doctor relationships, which we agree is an important area to consider. However, we were disappointed to find that there was no mention of the relationship of consultants or training grade doctors with non-consultant career grade doctors.

Non-consultant career grade (NCCG) doctors, who include staff grades and associate specialists, play an important role in psychiatry and the number of posts is rising. The Department of Health considers NCCG doctors to be senior doctors, yet we have a position very different from that of consultants with regard to professional relationships. NCCG doctors are no longer in training grades but do not have consultant status with its associated position and authority.

Furthermore, the position of NCCG doctors changes with time. Initially, they may be recruited from the senior house officer (SHO) ranks and be regarded as such; however, as they gain experience, skills and expertise their roles change. This is brought into sharp focus when a newly qualified consultant is appointed to work with an NCCG doctor of many years’ clinical experience. Issues of autonomy, supervision and mutual support arise in order that each can feel valued in their role.

NCCG doctors also relate to their peers, but in such a diverse group there may be conflicting interests, for example between those wishing to progress to the specialist register and consultant status and those who have chosen this career path, or between those wishing to study for examinations and those who seek to concentrate on service provision.

The role of NCCG doctors is likely to increase with the proposed changes to the consultant contract and training grade doctors’ hours, and we would therefore be interested to hear the views of Garelick and Fagin on the relationships between NCCG doctors and others.