Genetic counsellor

Genetic counsellors help patients and their families understand inherited health disorders and make informed decisions about their care and future

As a genetic counsellor, your role is to interpret and explain the results of genetic tests to patients to help them understand the medical implications of a diagnosis, such as:

• how the condition develops
• how heredity contributes to their condition
• the likelihood of passing it on to relatives
• the options available for managing or reducing future risk.

You'll support patients and their families in making sense of this complex genetic information and will guide them through emotionally challenging decisions.

Your work is central to helping people adjust to the diagnosis of a genetic condition or to the risk of developing or passing one on. This includes offering clear, empathetic communication and ongoing support at every stage. You may also act as the patient's advocate within the healthcare system so that they receive appropriate care.

The role attracts graduates interested in genetics, healthcare and direct patient interaction and who want a role that combines both scientific and people skills in a health setting.

Genetic counsellors are different from counsellors, who typically work in mental health settings and follow a different training pathway. Find out more about the role of a counsellor.

Responsibilities

As a genetic counsellor, you'll need to:

• manage your own caseload of patients through face-to-face, phone and video appointments
• take and interpret family and medical histories to assess the likelihood of a genetic disorder occurring, as well as recurrence and carrier risks
• determine the most appropriate genetic tests for each individual based on their history and symptoms
• arrange and coordinate genetic testing for patients and, where necessary, for their relatives
• interpret genetic test results and explain them clearly and sensitively to patients and their families
• provide accurate information on the options open to the patient and their family, which may include reproductive and risk-reducing options
• use counselling skills to support patients adjusting to a diagnosis or risk of a genetic condition and who may have difficulty in accepting the clinical diagnosis
• provide information to help patients navigate ethical, social or psychological concerns
• educate patients about inheritance patterns, testing options, condition management, prevention strategies, support resources and relevant research
• refer patients for relevant screening or further medical assessment based on their genetic risk
• refer patients to additional sources of support such as therapeutic counselling, psychiatric support or social services, where appropriate
• provide support to families who are bereaved, for example due to the termination of a pregnancy
• keep accurate patient records and write follow-up letters summarising appointments and test results
• work as part of a multidisciplinary team that includes genetic consultants, clinical scientists and other specialists to ensure coordinated and appropriate care for patients.

Experienced genetic counsellors may also need to:

• design and carry out audits of clinical genetics services to support quality improvement
• conduct research and present findings to colleagues and other relevant professionals in the wider healthcare system
• mentor and supervise junior or trainee genetic counsellors and students
• provide training, mentoring and clinical supervision to non-genetics medical and nursing staff who are using genetic technologies in their work
• use their expertise to support specialist clinical teams in areas such as cancer, cardiology, neurology, ophthalmology and reproductive medicine
• act as the on-call specialist for urgent or complex referrals to the genetics service.

Salary

• Salaries for trainee genetic counsellors typically range from £38,682 to £46,580 on Band 6 of the NHS Agenda for Change pay rates.
• Salaries for qualified genetic counsellors range from £47,810 to £54,710 (Band 7).
• In more senior roles, such as principal genetic counsellor, consultant genetic counsellor, lead genetic counsellor or head of service, salaries can range from £55,690 to £125,637 (Bands 8a to 9). At the most senior levels, you will usually have responsibility for areas such as management and service improvement or research and teaching.

The NHS offers a pension scheme and sickness and maternity benefits. Salaries in London attract a high-cost area supplement.

Genetic counsellors employed outside the NHS may not have the same terms in relation to salaries, pension provision or benefits.

Salaries vary depending on where in the UK you work.

Figures are intended as a guide only.

Working hours

You'll usually work a 9am to 5pm day within a 37.5-hour week. Start and finish times may be flexible depending on the department. You may need to do some out-of-hours work when necessary.

Part-time work and job share opportunities may be available.

What to expect

• You'll typically work as part of a multidisciplinary team that includes other specialist medical and nursing staff such as clinical geneticists, molecular geneticists and clinical scientists.
• Consultations usually last around 45 minutes (but can range from 30 to 90 minutes) and you're likely to see between seven and ten patients a day, depending on the complexity of the case and patient needs. It can get very busy, and a heavy workload is typical.
• The work can be emotionally demanding as patients may be highly distressed. It can also be rewarding, however, as you support patients and their families through difficult situations.
• There are currently around 300 genetic counsellors in the UK, so there is a relatively small number of jobs available. Jobs are usually available in medium-sized or large hospitals.
• Clinics may be spread across different hospitals in your region so you will usually need to travel during the working day.

Qualifications

Most new entrants to genetic counselling have a degree in genetics, biological/biomedical sciences or nursing, although degree areas such as social sciences and psychology may also be relevant.

There are three qualification routes available to become a genetic counsellor in the UK. One option is to take a Masters in genetic counselling accredited by the Genetic Counsellor Registration Advisory Board (GCRAB). For an up-to-date list of courses, see GCRAB-accredited courses.

After completing the course, you'll have the skills and knowledge needed to apply for a Band 6 trainee genetic counsellor post in a genetics service. The training period lasts two years full time and you'll work under the supervision of an experienced GCRAB-registered genetic counsellor.

On successful completion of the training period, you can apply for GCRAB-registration as a genetic counsellor. The register is maintained by the Academy for Healthcare Science (AHCS), which is accredited by the Professional Standards Authority for Health and Social Care (PSA).

Graduates with a relevant degree can apply for a place on the NHS Scientist Training Programme (STP) in genomic counselling. Successful applicants will be employed in a three-year, full-time, workplace-based training post on Band 6 of the NHS Agenda for change pay scale. As part of your training, you'll complete a Masters degree in genomic counselling. After successful completion of the STP, you'll be eligible for registration as a clinical scientist with the Health & Care Professions Council (HCPC) and will be able to work as a Band 7 genetic counsellor in a genetics service. HCPC-registered genomic counsellors may also apply for AHCS registration through the GCRB if they want to.

A third option is open to professionally qualified and registered nurses or midwives with previous senior experience, who have completed training in counselling skills and human genetics. As with the Masters route, you'll be expected to work in a Band 6 pre-registration genetic counsellor post for two years, after which you'll be able to apply to register with the GCRAB.

Skills

You'll need to have:

• excellent communication skills to explain complex genetic information clearly to patients and their families
• strong interpersonal, active listening and counselling skills to build rapport, show empathy and handle sensitive conversations
• analytical and critical thinking skills to interpret family history and risk factors
• the ability to interpret scientific papers and genetic test results, and make informed clinical decisions, sometimes based on conflicting information
• clear and accurate report-writing skills
• effective planning, time management and organisation skills to manage a caseload of patients
• research skills to support evidence-based practice and contribute to service development
• the ability to reflect on your own practice
• strong teamwork and collaboration skills to work within a multidisciplinary healthcare team
• the ability to work independently and manage your own caseload
• numeracy and IT skills, especially in using databases, electronic patient records and word processing
• emotional resilience and the ability to stay calm and focused under pressure
• a flexible and adaptable approach to work to meet the evolving needs of patients and services.

You will usually need a full driving licence to travel to other hospital sites or make home visits.

Work experience

You'll need relevant caring experience to get a place on a genetic counselling course/training programme. This helps you understand the emotional demands of the role and decide whether it's the right career for you.

Relevant experience can be gained through:

• working in a healthcare role (for example, nursing, midwifery or social work)
• supporting children or adults with complex or additional needs (in schools, care homes or the community, for example)
• volunteering with counselling services, support charities or in genetic clinics (if possible)
• working or volunteering with organisations that support individuals and families affected by inherited conditions
• providing care for a vulnerable child or adult in a personal or professional capacity.

Experience in active listening, communicating sensitively and offering emotional support is particularly relevant. You're unlikely to get a place on a course without some caring and/or counselling knowledge and experience.

If your degree didn't include genetics or counselling modules, it's recommended you get some basic training in these disciplines before applying for courses. You can also contact your local NHS genetics department to ask about shadowing opportunities.

Find out more about the different kinds of work experience and internships that are available.

Employers

There are around 300 genetic counsellors in the UK and approximately 7,000 worldwide.

Most genetic counsellors in the UK are employed in the NHS and work within regional clinical genetics services, typically based in medium to large hospitals or specialist centres.

There may also be some opportunities in the private sector.

It's also possible to follow a research career, working in a university or research institute.

Look for job vacancies at:

• AGNC Jobs
• NHS Jobs
• NHSScotland Jobs
• Jobs.hscni.net - health and social care jobs in Northern Ireland.

You may also find roles advertised on university websites or via recruitment agencies specialising in healthcare and life sciences.

Professional development

Continuing professional development (CPD) is an essential part of continuing registration with the GCRB and HCPC and helps develop your professional knowledge and competence as a genetic counsellor. You'll be expected to undertake a certain amount of learning activity relevant to your area of practice each year. Some examples of learning activities are:

• relevant courses and conferences, e.g. the annual conference organised by the Association of Genetic Nurses and Counsellors (AGNC)
• seminars and online learning modules
• study days, journal clubs and lectures
• regional or national meetings held to discuss and agree on the functioning and organisation of genetics services
• time spent writing publications or policy documents
• undertaking research.

You must also undergo clinical and genetic counselling supervision. Clinical supervision involves reviewing and discussing cases and working practices. During counselling supervision meetings you'll meet a trained and experienced supervisor for guided reflection on your work and exploration of the interaction between you and your patients. The aim is to improve your practice and enhance the quality and safety of patient care.

Genetic counsellors who qualified as clinical scientists may apply to train to become a consultant clinical scientist via the Higher Specialist Scientist Training (HSST) programme.

It's also possible to take further qualifications in areas such as counselling or teaching, or to take a research PhD. You could also do training in leadership and management.

Career prospects

There is a structured career path within the NHS from trainee genetic counsellor to genetic counsellor, then on to principal or lead genetic counsellor and, ultimately, to consultant genetic counsellor.

Progression is based on gaining clinical experience, undertaking further training (including leadership, education or specialist areas) and demonstrating competence at increasingly advanced levels. Promotion is based on merit, and you may need to move to other hospitals to access senior posts.

Principal genetic counsellors have advanced expertise and take on greater clinical, supervisory or educational responsibilities. Consultant genetic counsellors have a lead role locally and nationally in a field of expertise or contributing to policy and service development. However, opportunities to become a consultant genetic counsellor are rare and exist only in some of the larger or specialised clinical genetics services.

You can also develop your career by becoming involved with profession bodies such as the AGNC or the GCRAB, by serving on committees or advisory panels, for example.

Some genetic counsellors choose to pursue careers as researchers, either combined with their clinical practice or exclusively doing research. There are also opportunities in areas such as education and training, policy and ethics, private practice, professional regulation and service management.