NHS Employers national SAS survey
SAS doctors form a vital part of
the medical workforce in the NHS.
The GMC estimates that there are
approximately 26,000 SAS doctors
in the UK, constituting 20% of the
medical workforce. They consist of
a diverse group from a wide variety
of backgrounds, and bring a range
of skills and experience to the NHS.
They are of great importance to the
anaesthetic workforce also, with
the RCoA estimating that 22% of
non-trainee anaesthetists are SAS
doctors.
However, it is recognised
that the path at work for SAS doctors
does not always run smoothly,
and the 46th report of the Review
Body on Doctors’ and Dentists’
Remuneration (DDRB) in 2018
recognised the difficulties employers
faced in recruiting and retaining
individuals to these important roles
[1], and recommended that a review
into the role of the SAS doctor was
needed; this was reiterated the
following year [2].
Eighty-five percent of respondents reported difficulties in recruiting, especially to emergency medicine, general medicine, anaesthesia and paediatrics.
In October 2019, NHS Employers conducted a survey of
organisations in England to provide some insight into the
difficulties faced by employers in the recruitment and retention
of SAS doctors [3]. This survey followed the publication of
'Maximising the potential: essential measures to support SAS
doctors' by Health Education England and NHS Improvement
in February 2019, setting out support and guidance to assist
employers [4], and the Interim NHS People Plan published in
June 2019 by NHS Improvement that provided a commitment
to make the role of a SAS doctor a more attractive career choice
for those who wished to take this path [5].
The results of this survey were due to be published last March,
but given the response needed to deal with the COVID-19
emergency, the publication was delayed until 6 July 2020.
Responses were received from 64 NHS organisations in
England, broken down into 46 acute trusts, three community
trusts, 12 mental health trusts and three ‘other’ (integrated
acute and community and specialist trusts). SAS doctors made
up between 3.2 - 33.3% of the medical workforce at these
organisations, demonstrating great heterogeneity. The results,
broadly speaking, confirmed the difficulties that the DDRB
had predicted. Eighty-five percent of respondents reported
difficulties in recruiting, especially to emergency medicine,
general medicine, anaesthesia and paediatrics. The top two
reasons cited were pay and conditions, and a shortage of
SAS doctors. Forty-four percent reported difficulty in retaining
SAS doctors because of issues with career progression/
development and pay. Lack of opportunity to achieve a
certificate of eligibility for specialist registration (CESR) was also
commonly mentioned.
The BMA, in conjunction with NHS Employers, published the
SAS charter in 2014 [6]. In the six years since then, 86% of
the organisations surveyed had at least started the process
of implementation, and 51% had implemented all or the
majority of the recommendations. The main challenges to the
implementation of this charter were involving SAS doctors in
organisational structures, coding work to SAS doctors, and job
planning and development. A SAS development guide was
published by NHS Employers in conjunction with the BMA, HEE,
and the Academy of Medical Royal Colleges in 2017 [7], but
only 49% of employers had so far implemented this guidance;
the employers in this survey stated that guidance and support
on these issues would be helpful.
Providing adequate support at work for SAS doctors
Providing adequate support at work for SAS doctors appears
to be a key component of addressing some of the issues
highlighted by this survey. In 2008, as a part of the renegotiation
of the SAS contract, the Department of Health made money
available to support the development of SAS doctors. Part of
this support involves the provision of a network to facilitate
this development, in which an SAS tutor at trust level plays an
important role. The primary role of an SAS tutor is to provide
support and guidance for SAS doctors across their trust. Sixtynine
percent of the organisations in this survey had appointed
such a tutor, although 20% of respondents were unsure of
whether they had such a role in their organisation.
When the next role in your department needs allocating, why not consider if a SAS doctor could do it?
In summary, this survey elucidates the very real problems
SAS doctors face across the board in NHS trusts throughout
England. These relate primarily to concerns over pay and
conditions of service, lack of development and lack of
recognition.
NHS Employers emphasise that involving SAS
doctors in organisational structures is one of the most difficult
recommendations to implement. At a local level, this is
something that all anaesthetic departments could assist with.
When the next role in your department needs allocating, why
not consider if a SAS doctor could do it? As a group, these
doctors will not necessarily promote themselves, but allowing
an individual to make a contribution by recognising their
potential rather than their grade is an important step forward
towards creating an organisation that is operating optimally. This
group of doctors is a vital part of the current NHS workforce,
and difficulties in recruitment can have very real impacts on
departments across the board; encouraging the best out
of them, and providing opportunities to flourish, may pay
dividends for individual departments struggling to recruit and
retain. In an era of rising workloads and diminishing workforce,
standing out in this way may benefit all parties. As for individual
SAS doctors, when an opportunity presents itself that you are
interested in and qualified for, then go for it. The worst that
can happen is that you don’t get it, but just by putting yourself
forward you raise your profile and increase your chances of
success on subsequent occasions.
Nationally, the BMA has entered into negotiations with NHS
Employers on a new contract for SAS doctors. The BMA’s aims
include: increases to basic pay with a simplified pay scale; and
a clear framework within the contract to allow for development and progression over an individual doctor’s career, including
development for leadership roles and contractual safeguards
to improve work/ life balance. NHS Employers have stated
that they wish to raise the profile and status of SAS doctors to
improve recruitment and retention, and to support a positive
engaged workforce. Heads of Terms for this new contract
were agreed on 8 July 2020 [8], and a provisional timetable
has been set for a contract to be agreed by the end of 2020,
which will come into effect from April 2021 subject to BMA SAS
members’ agreement. The results of the 2019 survey would
seem to confirm the difficulties that SAS doctors can face at
work, and it is to be hoped that the contract negotiators can fully
exploit the opportunity offered here.
Emma Wain
Associate Specialist, Anaesthetics
Robert Jones and Agnes Hunt Orthopaedic and District NHS
Trust, Oswestry
References
- Government UK. Review body on doctors’ and dentists’
remuneration. Forty-sixth report 2018, 2018. https://assets.
publishing.service.gov.uk/government/uploads/system/uploads/
attachment_data/file/728371/CCS0618912388-001_-_DRRB_
Annual_Report_2018_1_.pdf (accessed 8/8/2020).
- Government UK. Review body on doctors’ and dentists’
remuneration. Forty-seventh report 2019, 2019. https://assets.
publishing.service.gov.uk/government/uploads/system/uploads/
attachment_data/file/819453/DDRB_2019_report_Web_
Accessible.pdf (accessed 8/8/2020).
- NHS Employers. Specialty and Associate Specialist (SAS) doctor
survey, 2020. https://www.nhsemployers.org/-/media/Employers/
Documents/Pay-and-reward/SAS-doctors/SAS-survey-March20.pdf
(accessed 8/8/2020).
- Health Education England. Maximising the potential: essential
measures to support SAS doctors, 2019. https://www.hee.nhs.
uk/sites/default/files/documents/SAS_Report_Web.pdf (accessed
8/8/2020).
- NHS UK. Interim NHS People Plan, 2019. https://www.
longtermplan.nhs.uk/wp-content/uploads/2019/05/Interim-NHSPeople-
Plan_June2019.pdf (accessed 8/8/2020).
- NHS Employers. SAS Charter, 2019. https://www.nhsemployers.
org/pay-pensions-and-reward/medical-staff/sas-doctors/sascharter
(accessed 8/8/2020).
- NHS Employers. SAS doctor development, 2017. https://www.
nhsemployers.org/-/media/Employers/Publications/SAS-doctordevelopment-
guide-FINAL.pdf (accessed 8/8/2020).
- NHS Employers. Heads of Terms agreement on Staff, Associate
Specialist and Specialty (SAS) doctor and dentist contract reform,
2020. https://www.nhsemployers.org/-/media/Employers/
Documents/Pay-and-reward/SAS-doctors/Heads-of-Terms---SAScontract-
reform---Final.pdf?la=en&hash=7F74D9882CA9EA3F114
79B37A445E915F3D04D9B (accessed 8/8/2020).