Post by Deborah Udy Okusaga Akanne (@deborah_udy_okusaga)
The Consultant Interview Question That Decides The Appointment Committee Vote.
NHS consultant appointments in England are not made by a single hiring manager.
They are made by an Advisory Appointments Committee (AAC) — a formal panel constituted under the NHS (Appointment of Consultants) Regulations 1996 — which includes the Medical Director or their nominee, a lay representative, a Royal College assessor from the relevant specialty, and the Clinical Director or equivalent.
Every member of the committee has a vote. The appointment is made by consensus or majority.
This means that when you are in the consultant interview room, you are not performing for one person. You are performing for four or five people simultaneously — each of whom is assessing a different dimension of your suitability.
The Royal College assessor is scoring your clinical expertise.
The Medical Director's nominee is scoring your governance awareness.
The lay representative is scoring your communication and patient-centredness.
The Clinical Director is scoring your departmental fit.
The question that determines how the lay representative votes — and that internationally trained doctors almost universally under-prepare for — is this:
How do you ensure that patients are at the centre of your clinical decision-making?
Or sometimes: Can you describe how you involve patients in decisions about their care?
Most doctors answer this clinically. They describe their patient assessment process. They describe their communication style. They describe how they explain diagnoses and treatment options.
The lay representative — who is there specifically to assess patient-centredness — is looking for something more specific than clinical communication.
They are looking for evidence of shared decision-making — as defined by NHS England's Shared Decision Making framework, embedded in the NHS Constitution and reinforced through the National Institute for Health and Care Excellence Decision Aids programme.
Shared decision-making in the NHS context means:
The patient's values and preferences are explicitly elicited — not assumed. The clinician asks the patient what matters most to them about the outcome of their treatment, not just what symptoms they want addressed.
Options are presented with balanced information — including the option of no treatment, where clinically appropriate. The clinician does not present a recommendation and seek agreement. They present the clinical options, the evidence for each, and the patient's role in choosing between them.
The decision is documented as shared — in the patient record, with the patient's stated preferences recorded alongside the clinical rationale.
NICE decision aids are offered — these are patient-facing, evidence-based decision support tools that NICE has developed for over 50 clinical conditions. At consultant level, the panel expects you to know that these tools exist and to actively use or recommend them.
The answer that wins the lay representative's vote:
I believe shared decision-making is a clinical obligation — not a communication preference. When I meet a patient with a significant clinical finding, I begin by asking them what they already understand about their condition and what outcomes matter most to them personally. I use the NICE decision aid for [relevant condition] to support an informed conversation about their options — ensuring they understand both the clinical evidence and the practical implications of each pathway. I document their stated preferences in the clinical record alongside my recommendation — because the decision belongs to them, and my role is to ensure it is an informed one. This approach is consistent with the NHS Constitution's commitment to patients' right to be involved in decisions about their care — and it is the approach I would bring to every consultation in this department.
That answer covers: NICE decision aid awareness, patient autonomy, shared decision-making framework, NHS Constitution alignment, and documentation standards.
The lay representative scores it Outstanding. The Medical Director's nominee scores it Outstanding on clinical governance. The Royal College assessor scores it Outstanding on professional standards.
One answer. Every committee member satisfied.
📩 Consultant interview preparation is built around the full AAC composition — every committee member's scoring perspective addressed, every answer constructed to satisfy all four assessors simultaneously.
DM me "NHS" for details of my consultant-level preparation service.
Post 3 lands at 11:00 AM — and it is for the physiotherapist, OT, and AHP targeting Band 7 for the first time. The question that separates Band 6 practice from Band 7 leadership — and that every Band 7 candidate faces in their interview — has a very specific answer structure that most candidates have never been shown.
#NHSConsultant #AAC #ConsultantInterview #SharedDecisionMaking #NHSInterview2026 #IMGDoctor
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