Handbook 2: Grade, title, contract, role and scope

Medical organisations use several kinds of labels at once. A contractual grade locates a doctor within an employment framework. A local title may describe a service function. A role defines what the doctor has been appointed or delegated to do. Scope of practice describes the work the doctor actually undertakes within competence and governance. Registration describes regulatory status. These categories overlap, but they are not synonyms. Confusion becomes likely when one label is allowed to answer all the others. A senior-sounding local title does not necessarily change contractual terms. A Specialist employment grade is not the same thing as specialist registration. A doctor may practise autonomously within an agreed scope without being a consultant, while a consultant title does not independently prove capability for every leadership or management responsibility. When a question arises, retrieve the source that owns it. For employment grade and terms, use the relevant contract and appointment documents. For the current working role, use the job description, job plan, delegated responsibilities and governance arrangements. For regulatory status, use the GMC register and current guidance. For capability, use evidence relevant to the task, not a shortcut based only on title. This distinction improves safety because responsibility becomes clearer. It also improves fairness because capability can be recognised without pretending that every role is interchangeable. If the documents disagree, record the discrepancy rather than silently choosing the label that seems most favourable. Clarification should establish what is expected now, who may decide, what support is available and whether a formal amendment is required. The practical habit is to ask: what kind of statement is this? Is it contractual, regulatory, organisational or descriptive? Once the category is clear, the correct source and decision-maker are easier to identify.