Chapter 4 – Sources of support
By: Dr Rob Fleming
SAS anaesthetists should each have the opportunity to progress their careers and meet the level of their individual potential. Departments and organisations should be supportive of this progression and inclusive of their SAS workforce. No one should ever feel alone in a career as an SAS anaesthetist. Within departments and organisations, there should be named individuals empowered and responsible for providing support. Likewise, regionally and nationally there are structures that exist to represent SAS doctors and support their interests. This chapter will provide an overview of this support and these structures.
Sources of support within your department/organisation
Anaesthetic Department: SAS clinical lead/SAS mentor
The ‘Good Department’ chapter of the Royal College of Anaesthetists Guidelines for the Provision of Anaesthetic Services (GPAS) makes several recommendations about support for SAS anaesthetists. This includes that departments should have an SAS clinical lead, and an SAS mentor. In addition to this, some organisations offer educational supervisors to their Specialty Doctors, which would be particularly valuable to those earliest in their SAS careers.
SAS clinical lead
The SAS clinical lead should have ‘clear and agreed responsibilities’ relating to the department’s SAS doctors. It seems reasonable that the SAS lead anaesthetist should be an SAS anaesthetist. Aspects of management falling under the remit of the SAS clinical lead might include overseeing out-of-hours rotas that include SAS anaesthetists. This should ensure that these rotas are compliant with the protections contained within the 2021 SAS contracts. To achieve this, they may also be involved in group job planning processes. Other responsibilities might include ensuring adequate supervision arrangements exist for non-autonomous SAS doctors, and being involved in recruitment of new SAS doctors to the department.
The SAS mentor should be named, trained and have responsibility to ‘oversee the wellbeing, career needs, educational and professional needs of the SAS doctors in the department.’ It might be valuable for doctors in this role to undertake formal mentorship training. It is also important that the doctor in this role has knowledge about the opportunities contained within an SAS career, and is able to offer support and guidance surrounding career progression. As with the SAS clinical lead, it is anticipated that the SAS mentor will be a senior SAS doctor or a consultant with lived experience of having been employed in an SAS role within their career. In smaller organisations, one doctor could potentially undertake both of these roles. Adequate time should be allowed for this activity, and this should be reflected in job planning processes.
Organisation: SAS tutor, SAS advocate and SAS Local Negotiating Committee representative
Each organisation should have an SAS tutor, an SAS advocate and SAS representative to the Trust’s Local Negotiating Committee (LNC). These roles are well described within national documents relating to a career as an SAS doctor, and it might be considered a marker of a good employer that all three roles are filled. In some organisations, one doctor may be currently undertaking more than one of these roles; however, ideally, they should be distinct from one another.
Some organisations currently have a ‘SAS lead,’ which may be instead of, or as well as, one or more of these roles. It is worth exploring the situation in your current organisation and making contact with one or more of these doctors. It is easier for them to support you if they know your circumstances and issues.
The SAS tutor supports the education, training and professional development of all of an organisation’s SAS doctors. Part of their role is the promotion of a consistent approach towards professional development and to offer support and advice regarding educational needs or further training.
Because their responsibility includes SAS doctors across multiple specialties, they commonly organise courses relating to generic skills. These may include teaching, leadership and communication skills. Your SAS tutor can also be a very useful source of support on a more individual basis. The SAS tutor works within an organisation’s postgraduate medical education structures, working closely with the Director of Medical Education (DME). In most organisations, the SAS tutor has responsibility for allocating the use of the Trust’s SAS development fund.
Within a region, SAS tutors are supported by an SAS Associate Postgraduate Dean, with responsibility for the whole region. Each of these SAS Associate Postgraduate Deans is invited to attend ‘COPSAS,’ which is an advisory group and forum for sharing good practice. COPSAS is a sub-committee of ‘CoPMED,’ the Conference of Postgraduate Medical Deans.
The SAS advocate role was recommended as part of the most recent SAS contract reform in all four nations. The focus of the SAS advocate is to promote the health and wellbeing of SAS doctors, including workforce issues. The role therefore has both proactive and reactive elements. The advocate is expected to work with both the local negotiating committee and Trust board, in order to create a unified approach to the SAS workforce.
Wellbeing is multifactorial and includes self-determination within one’s working life; belonging within an organisation; maintenance and progression of professional competence; developmental support; and recognition and reward for excellence. Each of these things may involve challenging the existing culture as it relates to SAS doctors, and this is the role of the SAS advocate. The advocate is expected to be a point of contact for all SAS doctors within an organisation and to be empowered to respond to issues in a manner analogous to a ‘freedom to speak up guardian’ and/or ‘guardian of safe working,’ but specifically for SAS doctors.
In England and Wales, SAS advocates are supported by SAS advocate networks, which new advocates are invited to join.
SAS LNC representative
The SAS representative to a Trust’s LNC represents SAS doctors in relation to contractual issues. The SAS LNC representative receives training and support from a trade union, most commonly the British Medical Association (BMA). They work with the representatives from other professional groups and trade union Industrial Relations Officers (IROs), to negotiate with a Trust’s other structures on behalf of their colleagues. These doctors are supported by regional SAS committees, and by the national SAS committee at the BMA.
Sources of support nationally
In addition to the structures outlined above, SAS anaesthetists benefit from representation at both the Association of Anaesthetists and the Royal College of Anaesthetists. Each of these organisations has two dedicated spaces for election of SAS doctors to their Board/Council. Each organisation also has an SAS Committee with a number of additional appointed SAS representatives and co-opted SAS representatives from other organisations or groups.
At the Association, the SAS Committee currently includes SAS representatives from the Association’s Scottish Standing Committee (SSC), and NCHD representative from the Irish Standing Committee (ISC), the BMA and the Intensive Care Society. Members of the SAS Committee also represent SAS doctors in other committees and working parties. The intent is to ensure SAS viewpoints are heard at every level within the organisation, and everywhere decisions affecting SAS doctors are made.
Nationally there is also a network of Association ‘SAS Links.’ If your department has an SAS Link they can be a useful route to bring issues to the attention of the Association of Anaesthetists. If your organisation does not yet have an SAS Link, consider volunteering.
Other national organisations, including the Obstetric Anaesthetists’ Association (OAA), the Society of Intravenous Anaesthesia (SIVA) and the Society for Obesity and Bariatric Anaesthesia (SOBA) each has an SAS representative. If you have an interest in a particular area of anaesthesia, consider becoming involved in national representative work. If an organisation does not currently have an SAS representative, feel free to get in touch with them and ask why not!