Gautam is a chartered accountant and a former senior audit partner at KPMG London. From 2000 to 2003 he was chairman and chief executive of KPMG’s practice in India, which he helped to establish. Gautam is a non-executive director of Moxico Resources plc, Great Ormond Street Hospital for Children NHS FT and Hoptroff London Ltd. He is a member of the finance and audit committees of the National Gallery, having previously been a trustee and chair of these committees, and Treasurer of Booktrust.

Gautam was also a non-executive director of Barts Health NHS Trust from April 2012 to March 2022 as well as the Board’s vice-chairman and senior independent director. He was formerly a non-executive director of Barts and The London NHS Trust from September 2010 to March 2012.He has also been a founder board member of the UK India business council and the international board of AMREF Health Africa, the chair of the audit committee of The Law Society, and a member Governing body and Treasurer of the School of Oriental and African Studies.