NHS Employers national SAS survey | Association of Anaesthetists

NHS Employers national SAS survey

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 

  1. 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). 
  2. 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). 
  3. 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). 
  4. 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). 
  5. 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). 
  6. NHS Employers. SAS Charter, 2019. https://www.nhsemployers. org/pay-pensions-and-reward/medical-staff/sas-doctors/sascharter (accessed 8/8/2020).
  7. NHS Employers. SAS doctor development, 2017. https://www. nhsemployers.org/-/media/Employers/Publications/SAS-doctordevelopment- guide-FINAL.pdf (accessed 8/8/2020). 
  8. 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).

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