How to Navigate the Substantive vs Locum Consultant Interview: What Really Changes?

In this episode of the Ace Your Consultant Interview podcast, Tessa Davis and Becky Platt break down the real-world differences between substantive and locum NHS consultant interviews.

They discuss:

• How substantive panels set a standardised, formal environment - while locum interviews may feel ad hoc and unpredictable
  
  
• Why relying on single patient stories can hold your interview answers back, and how using team or project examples showcases your readiness for a consultant role
  
  
• Practical advice for handling questions about equity and MDT working, including examples that go beyond clinical competence to show system-scale impact
  
  
• The number one time-management tip for busy clinicians: why prepping early - even with small actions - makes a massive difference
  
  

Listen for sparing, actionable advice grounded in daily NHS realities, designed for intelligent, ambitious doctors at the pivotal consultant interview stage.

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What is Ace Your NHS Consultant Interview?

Welcome to Ace Your NHS Consultant Interview - the podcast for doctors who want to take the stress and guesswork out of their NHS consultant interview prep.

We know how overwhelming it can feel to prep for your consultant interviews when you’re already stretched thin.

Each episode, we’ll break down what actually works - no fluff, no endless reading, just practical steps you can fit into a hectic week. You’ll hear honest advice, real stories, and the frameworks we use with our own students inside the Academy to help you show up confident, prepped, and ready to secure the job you want.

If you’re a final year trainee or locum consultant and you want to prepare, not panic, you’re in the right place.

Hello and welcome to the Ace Your Consultant interview podcast. I'm Tessa Davis. And I'm Becky Platt.

And if you're a final year trainee or a low-income consultant and you want to prep, not panic, then you're in the right place. Welcome back to our Ace Your Consultant interview podcast. We are going to get stuck right in.

So let's get started, Becky, with our question of the week, this week. So this is a question that's been asked to us by one of our academy students. So what have we got for this week? So the question of the week this week is, what is the difference between a substantive and a locum interview? OK, so this gets asked quite often, doesn't it? Because we have, most people will go through a locum interview and then a substantive interview.

Some people do just go straight into substantive interview. And so the approaches to how you prep for them both, I would say, are the same, which is that you just prep as though it is a substantive interview and you do all the same due diligence beforehand, all the same pre-interview work and all the same prep. But actually, in reality, the interviews themselves can be quite different.

I think the main reason is that in the substantive panel, we've got lots of rules about what has to happen. It has to be advertised for a certain length of time. There has to be certain reps, you know, college rep on the panel.

There has to be a rep of the chief exec. There's usually seven-ish people on the panel. Everyone will need to get asked the same questions.

And so it's much more regimented, I guess, as to what will happen. So you kind of know what to expect. But with a locum interview, the rules are not the same.

So there is this thing that can happen where they can advertise a locum job and suddenly it disappears. It gets taken off because, you know, they have had enough people apply or they want to close it. There doesn't have to be a certain number of people on the panel.

They can basically ask you whatever they like. And I don't know what you've seen from academy students, but it's very variable, isn't it, what locum interviews are like? Some are like substantive interviews, but others are just very sort of ad hoc and informal. Yeah, I think it's a real mixed bag when it comes to locums.

I think the key point is that they can seem to ask you whatever they want. Often where we've had two students going for the same post, they haven't been asked the same things. And so I think that's a risk in locum interview as well, that they may be more inclined to ask you personal questions, not personal questions, but individualised questions based on your CV or your own personal experience.

And it's not structured in quite the same way. There's often a clinical question in a locum interview. That we don't tend to see in a substantive interview.

So they do just have a bit of a different feel. Equally, there are some locum posts that are so competitive where we've got multiple people going for them that they actually seem to treat them more like a substantive interview. And it feels just as formal, even though the panel may not be quite what we would expect for a substantive interview.

Yeah, so it's interesting what you were saying about clinical questions in substantive interviews, because I do think they come up occasionally, but the bulk of the time when it feels like it's a clinical question because it's about a case, it's actually about a non-clinical element of that case. Like there was a drug error or there's some conflict in the team. And so it's sort of your senior level, non-clinical take on a clinical question.

But yeah, I totally agree. In a locum interview, they do just ask straightforward clinical questions because in a way, they do want to check your competence in a way that's assumed in a substantive interview. So by your substantive interview, you're signed off formally, you're CCT'd or Caesared, they know you're clinically competent.

So they don't usually spend so much time probing to find out whether you're clinically competent. Yeah, exactly. And I think that's a bit of a kind of trick of thinking about substantive interviews as well.

If you're asked a question in a substantive interview that feels like a clinical question, you really do need to sit there and think, why are they actually asking me this in a consultant interview? What do they want to hear? And probably what they want to hear is, you know, you thinking about the more senior elements of that clinical scenario, maybe some system and process issues around that, rather than just being able to answer it on a purely clinical basis, the way that a good registrar would have been able to do. Yeah, exactly. And you were kind of saying before about asking you more personalised questions or more tailored questions.

And that might be like, oh, I see you've just come from a DGH and now you're moving to a tertiary hospital. What do you think the challenges would be? But you know that that can't be the same question they're asking to everyone because not everyone's come from a DGH or not everyone's just stepping up if they ask you about a stepping up question. Whereas in a substantive interview, they wouldn't be able to ask that sort of question because it has to be applicable to every candidate.

And I suppose along with that also goes the follow up or the nudge, which they don't do in substantive interviews. They'll just ask you a question, you'll talk, it'll be over. They'll ask you the next one.

Whereas I think in a locum, they could be like, oh, that's interesting. Tell me more, or I'd like to hear a bit more about this. And so two people going into the same locum interview could have very different experiences.

Whereas two people going into the same substantive interview should have the exact same experience. Yeah, exactly. Cool, okay.

So next up, we're gonna look at a golden example, an example that one of our students have put to us and we'll kind of see whether we think it's a good example. So I'm just gonna have a look. So what we've got, this is an example for MDT working.

So I'll read it and then you can say what you think. So the example here is we've got a patient who's referred to the hospital palliative care team and they were thought to be approaching end of life. But it was a sort of sensitive situation because there was a young patient with a long ITU admission.

They were wanting to speak to them about organ donation. And so the student liaised with the ITU consultant, the ITU nurse and the organ donation team. They got the palliative care team.

And so it's this kind of explanation about how all of the team members, MDT members got together to get a clear plan for looking after the patient for approaching them about organ donation and supporting the family. And then followed up with the family afterwards. So it's a description of how the team worked well to look after this very sick patient in this difficult situation.

So what do you think, Becky, about this being an example of, tell me about a time when you worked well in an MDT? I mean, undoubtedly they did work very well in this MDT and they probably got a great outcome for the patient. There was quite a lot to kind of grips with in there, wasn't there? Quite a lot of kind of working out what happened, where did the MDT element come in and so on. And I think that actually what we're looking for, and it comes back to what we just said about why are they asking you this question in the consultant interview? And I think what they actually want to hear is how can you work with the MDT on a much more senior, higher thinking level than probably, as we just said, a good registrar could have done this.

And undoubtedly this is great patient care, but you're missing an opportunity to demonstrate what you understand about system and process, what you understand about working together in a collaborative way with the multidisciplinary team to achieve change on a much bigger scale. So often people have got a project or one of their USPs or a change management project or a quick of some description that really, really demonstrates multidisciplinary team working. And I think that would work better than something like this.

What do you think? Yeah, I mean, it's not, you can't say this is wrong. Like you said, it is technically good MDT working, but yeah, I think it's a common difference when final year trainees go for interviews versus established consultants, which is this is like a final year trainee mentality, which isn't, it's not a bad thing. You know, it's great, it is great care, but in your interview, that's not what you're wanting to show.

It's not that, yeah, I can treat this patient really well. It's that actually as a team, I am part of a team delivering great quality care to our population as a whole. And so that's the difference between choosing one patient example versus taking a step back and choosing a big project, a project that you did, one of your USPs and thinking about how that works well in an MDT.

Yeah, I mean, I would say you'd score points if you answered it this way, but you've probably missed the opportunity to score full points by just not thinking about actually what do they need to hear from me about my ability to work with a multidisciplinary team at this level. Yeah, and also when most people then, when that clicks, that actually could talk about a project that you've done, it's great because you're able to talk about one of your USPs. And so it's something that you know you're proud of and you wanted to share.

And now you're getting to talk about it more and actually feels much better than just saying I'm doing my job really well because that's what it is, is managing a difficult case. This is a sort of more complex long-term case, whereas it's common as well in acute specialities where you just say, well, I managed a really sick patient in a recess while I was the team leader. But that is what you should be able to do because you've finished your training now and you're ready for the next step.

Yeah, okay. So we'll say probably not use that one and think of something else, I think. Yeah, okay.

And then next up, we have got the interview question of the week. So this is thinking about how to answer, how you would answer, how we would answer a question. So this week we've got, the question is, what can you do to improve equity for patients? What do you think about that? This is a question that one of our students got in an interview.

I like it as a question, actually. I think it gives people a chance to kind of show some, you know, nice breadth in their practise. I think it's also more commonly that people are being asked questions about equality, diversity and inclusion.

And so it's really useful to have an example about this kind of thing up your sleeve. And so I think there are a few different ways that I'd think about this. I think it's a really nice opportunity for you to show that you've got some knowledge about the local population or the patient group that you serve within your department.

There may be some really obvious barriers to equity for some of your patients. So, you know, have you got a very diverse patient group around your hospital? Are there lots of patients where there's a language barrier? Is it a deprived area where it's quite difficult for lots of your patients to get to you because of transport costs and things like that? It's actually a really nice way for you to show that you understand your population and the things that you personally do to address those areas of inequality. And then you can build on that by talking about projects that you might have done to address that.

So, you know, some of our students have done some really nice work around developing leaflets and patient information in multiple languages. One of our students had a great example about producing some culturally appropriate diet sheets for patients with diabetes, for example. That's a really great project that addresses inequality.

There are multiple different things that you can talk about. But what would you put in here, Tessa? I think it kind of ties back to what we were talking about before, doesn't it? The difference between a single encounter and a project. I do think there's a case here for an individual case because it's just a bit, it's more personal.

I think if you've done an equity project, patient equity project, definitely you should use it. But I know people often feel like they haven't done that and so it can be hard to find it. And I think you could, you can use a case.

You could use a case here. I don't know what you think. It's kind of the whole EDI discussion in an interview.

It is nice to have a bit of a personal touch to it as well. So I think if there's an example you can think of, that would be fair game to use here as well. I don't know, what do you think? I like that.

I think what I like to hear in here, that's my ideal way of answering this, would be something about a larger scale project. If the student's got that as an example. Something, you know, zoom into an individual patient.

So, you know, tell them about one particular patient that you made a real difference to by, you know, breaking down barriers for them. Is there something that you did for a neurodivergent patient or a transgender patient that was game changing for them in the way that they experienced the care that you provided? And then I also like there to be something in there about workforce. So your colleagues.

So what do you do to value diversity in your colleagues? And, you know, people have often got projects where they've developed induction programmes for IMGs or where they've done some other kind of project that celebrates diversity. And so I like to have a bit of a mix in there and I'm happy if it sort of is zoomed in on one patient and zooms out to the bigger picture as well as something to do with workforce. But this question is specific to equity for patients.

But so I guess it's can. Could you relate it to equity in the workforce, which you probably could, because equity in the workforce makes better care or EDI in the workforce makes for better care for patients. I don't know if it's too indirect.

I'm not sure. Yeah, true. I guess it depends how you frame it and how you portray that.

I guess I have had people who've talked about using their own cultural experiences in order to help relate to patients. And I think that that works well. But yeah, as you say, this is specifically about patients.

So it is important to answer the actual question. Yes. And also, I think one thing to remember is that EDI questions are very common in interviews now.

So you shouldn't be surprised or panicked when you get it. It's very likely to come up. So expect it.

I think this is a type of question. The EDI question is a type of question where it's easy to dig yourself a hole. And actually, if you think about it in advance, it's not that hard to be prepared for it.

Absolutely. Okay. What's your tip or trick of the week? Well, today we thought we'd talk about how to manage your time with your prep.

Because one of the biggest problems for people for their interview prep is they are at a very busy time of their life. Because you have probably young kids working a very busy rota, trying to manage all your sign-off admin as well, your ARCPs or get your CSER. There's a lot going on.

And so finding the time to prep can be really hard. And I think the key thing that I would say is that you have to just start rather than putting it off. And even just a small thing, if you start with a small thing, then it gets you in the zone of starting to think about it.

And what we see commonly, one of the biggest mistakes I think that we see is people waiting until they get shortlisted for interview. And so suddenly you get an interview and it's in two weeks time and you don't feel prepared and you're panicked. And that's not to say you can't get a job in that timeframe.

You can, of course, and we have people who prep effectively in seven days, but it's definitely more stressful for them. And they would certainly wish they'd have started earlier. And I think the thing is thinking about when you've done your exams, whatever your speciality exams were, how much time you put into prepping for that.

People put an insane amount of time into prepping for these exams. And actually the exams, they are important, but you can do them again the following year or four months later if you want to. But this interview, your dream substantive job, it may well only come up once in the next 10 years or the next five years.

And so once it's gone and you didn't do it, you didn't get it, it's just a massive missed opportunity. And so really it's taking the same, thinking about it in that way. It's a no brainer.

You know you're coming to the end of your training. You know you're gonna be applying for jobs. It's the time now to start thinking about it rather than waiting until the job ad comes out or you actually get an interview date.

Yeah, I mean, look, it's not a surprise that you're coming to the end of your training, is it? And actually you know that you're gonna have to do a consultant interview at some point, you know, probably in the next six months, you know, when you're coming to the end of your training. So why not start thinking about it now, you know, doing your prep step by step so that it's not a gigantic mad rush at the end. I think it just makes sense to kind of chip away at it so that it's not a huge rush.

And I think the other thing to say about this is increasingly, you know, jobs are, you know, not advertised, not advertised because there's no money. And then all of a sudden there is some money and then we're advertising it and then we're having the interview in a week. And then people are all of a sudden surprised and shocked because they haven't prepared.

So honestly, just start. Yep, agreed. Okay, so I think that brings us to the end of today's episode.

And it's been lovely chatting to you, Becky, as always. Next week, we're going to be looking at timing and how to make sure your answers aren't too long or aren't too waffly. So we will see you then.

Thanks. Great.