These three titles describe the largest and least explained part of the medical jobs market: doctors employed by NHS trusts outside numbered training programmes. NHS Jobs carries these roles in volume year-round, they are the main entry route for IMGs and the main flexible option for post-F2 doctors, and yet the terminology is genuinely confusing because it is not standardised. Here is what the words actually mean, what varies underneath them, and the checklist that matters more than the title.
The terminology, decoded
Locally employed doctor (LED) is the umbrella: any doctor employed directly by a trust on local terms rather than through a national training contract. Trust grade is the older, plainer label for the same thing, historically emphasising service delivery, the ward and rota work the department needs done. Clinical fellow is the same employment category wearing better branding: usually a locally employed post with a named additional dimension, education, a subspecialty interest, research time, simulation, QI, though sometimes it is simply a trust-grade job with an aspirational title. None of these are training posts; all of them are real jobs with real learning available; and the variance within each title is larger than the difference between them, which is why the checklist below matters more than the words on the advert.
Training recognition: the honest position
Time in these posts does not automatically count toward a CCT, because they sit outside the training programme structure. What the time can do is everything adjacent: build the competences, logbook and portfolio that strengthen training applications; and, for experienced doctors, contribute evidence toward specialist registration via the portfolio pathway (the route formerly known as CESR), where documented capabilities, not post labels, are what the GMC assesses. The practical implication: in these jobs, evidence is entirely your responsibility, and the doctors who thrive treat the post as a curriculum they write themselves.
Supervision, portfolio and development
Good posts provide named clinical and educational supervision, access to an e-portfolio, study leave with a budget, and protected time for the advertised non-service component; weaker posts provide a rota. The difference is decided before you sign, not after, which is the entire purpose of the pre-acceptance questions below. Pay is on local terms, commonly mirroring the national junior doctor scales at an equivalent grade, but not guaranteed to; pension and leave follow NHS norms in most trusts; and progression is real but informal, LEDs frequently step up grades, convert to training posts, or build toward SAS and portfolio-pathway routes, on the strength of accumulated evidence rather than automatic time-served.
What to check before accepting
Ask, in writing where possible: What is the actual rota, and what banding or supplement applies? Which pay scale and point, and how do increments work? Who is my named educational supervisor, and is there timetabled meeting time? Is there a study budget, how much, and what leave comes with it? What percentage of the job is the advertised special component, and is it protected in the timetable or aspirational? Do I get e-portfolio access and appraisal support, and who employs my revalidation connection? What happened to the last three people in this post? That final question is the single most informative one available, and good departments answer it happily.
Making these jobs work for a career
The pattern among doctors who convert these posts into momentum is consistent: they run their own curriculum. Competences targeted deliberately against the specialty they want; teaching, QI and audit accumulated with evidence; exams progressed on their own timetable, which is where structured self-directed learning earns its keep, an adaptive question bank, spaced repetition and documented assessed learning replace the training programme's scaffolding almost completely for the knowledge component; and reflection and appraisal maintained to the standard a training programme would have enforced. The post provides clinical exposure and income; the development system, you bring. Our guide to exactly that system is at /blog/what-to-do-after-f2-no-training-number.
Frequently asked questions
Is "clinical fellow" better for the CV than "trust grade"?
Marginally, and far less than what you did in the post. Shortlisters read the evidence, competences, exams, teaching, audit, not the job title; a productive trust-grade year beats a hollow fellowship every time.
Are these posts suitable as a first UK job for IMGs?
They are the standard first UK job for IMGs, and a reasonable one: real supervision exists in good departments, and the checklist above is even more important when you cannot yet read between British lines. Prioritise posts that name supervision and induction explicitly.
Can I sit Royal College exams from these posts?
Yes; eligibility rules are about registration and experience, not training numbers, for the early diets of most colleges. Check your specific college's current criteria, then plan the preparation as deliberately as a trainee would.