Community sexual and reproductive health
Community sexual and reproductive health (CSRH) is a specialty concerned with caring for the sexual health needs of men and women. Services include contraception, treatment of sexually transmitted infections and the menopause, sexual assault and unplanned pregnancies.
This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.
Nature of the work
CSRH evolved from the obstetrics and gynaecology sub-specialty of sexual and reproductive health. It was set up in an effort to improve leadership and skills in community based services and to reduce health inequalities.
Consultants in CSRH provide clinical expertise and leadership and bring a broad range of clinical skills to the workplace.
Consultants in CSRH work in a variety of settings and every consultant post is different. They may be hospital or community based but the services delivered are in multiple community settings. Some SRH consultants will work in large centres with a team of consultants and others will be single- handed in smaller centres.
Many centres now run integrated services where CSRH consultants work with consultant colleagues in genitourinary medicine (GUM) and patients attend combined general clinics offering a full range of expertise in contraceptive and sexually transmitted infections.
CSRH consultants will typically oversee the work of the community sexual health clinics and their governance. They will work as part of a multidisciplinary team to improve the sexual health of the community, often as a lead for the diverse team of professionals involved.
Consultants will undertake specialist clinics, receive referrals and oversee training within the specialty. Training will be for their own team and other providers, both statutory and voluntary, and vary in level from simple to complex sexual health care.
CSRH offers an opportunity to work with a wide variety of male and female patients often particularly caring for vulnerable groups eg young people, sex workers, prisoners, victims of sexual assault.
Consultants will undertake specialist clinics, receive referrals and oversee training within the specialty. Training will be for their own team and other providers, both statutory and voluntary, and vary in level from simple to complex sexual health care.
Female and male patients of a wide age range from 13 year olds (occasionally younger) to postmenopausal women and older men. The patients are generally without life threatening disorders and can be managed in an outpatient setting. Most people will consult about sexual health related issues at some time in their lives and most women suffer gynaecological problems which, if not life threatening, significantly affect their quality of life and as a consequence, that of their family.
Common procedures/interventions
Procedures within contraception include:
- fitting and removing intrauterine contraceptives
- fitting and removing subdermal contraceptive implants
Consultants will be referred complex cases eg where intrauterine device (IUD) fittings have previously failed or where subdermal implants are deep.
Many CSRH consultants run abortion services and undertake surgical procedures in a theatre or outpatient setting.
Procedures within medical gynaecology include:
- outpatient hysteroscopy (using fibreoptic endoscopy to view the interior of the uterus)
- endometrial ablation (using an instrument to destroy or ablate the endometrium)
- transvaginal ultrasound
- insertion of hormone implants
- early abortion with local anaesthesia
Given the increasing number of procedures that are becoming ‘office based’ and hence deliverable outside a hospital setting, this range of procedures is expected to increase.
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Pay and conditions
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This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.
Find out more about the current pay scales for doctors, and there's more information on the BMA website.
NHS Employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.
Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.
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Where the role can lead
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Read about consultant and non-consultant roles in CSRH, flexible working and about wider opportunities.
Consultant roles
You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training (CCT). You will receive your CCT at the end of your CSRH training.
Managerial opportunities for consultants include:
- clinical lead - lead NHS consultant for the team
- clinical director - lead NHS consultant for the department
- medical director - lead NHS consultant for the Trust
Most NHS consultants will be involved with clinical and educational supervision of junior doctors.
Here are some examples of education and training opportunities:
- director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards. This role may also be known as the Clinical Tutor
- training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the LETB/deanery
- associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery
SAS doctor roles
There are also opportunities to work at non-consultant level, for example as a SAS (Specialist and Associate Specialist) doctor.
SAS surgeons (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for Specialty Doctor roles. Find out more about SAS doctors roles.
The role of an SAS surgeon can vary greatly. Depending on your experience, you might work on complex surgery or relatively minor diagnostic and outpatient work. SAS doctors will frequently participate in routine and elective surgery rather than emergency work. They also train other staff.
Some surgeons are attracted to the SAS role as the hours are more regular than those of the consultant, and any on-call work and overtime beyond 7am-7pm is paid.
Other non-training grade roles
These roles include:
- Trust grade
- Clinical fellows
Academic pathways
If you have trained on an academic CSRH pathway or are interested in research there are opportunities in academic medicine.
For those with a particular interest in research, you may wish to consider an academic career in CSRH. Whilst not essential, some doctors start their career with an academic foundation post. Entry is highly competitive. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.
Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) at ST1-2 and may progress to a Clinical Lectureship (CL) at ST3 and beyond. Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.
After completion of the academic foundation trainees can then apply for academic core training posts (instead of normal core training). A PhD is often taken, either during core or specialty training.
Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).
There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.
The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.
Other opportunities
CSRH consultants may undertake research, which includes collaborating with colleagues in the UK and overseas, writing papers and presenting work at conferences.
There may also be opportunities to work in the private sector and overseas.
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Job market and vacancies
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Further information
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Other roles that may interest you
