An ‘association’ to support SAS wellbeing – the SAS Advocate Network

Box 1. Founding objectives of the SAS Advocate Network

To promote the creation of SAS Advocates and link them together
To represent and advocate for SAS doctors and dentists and protect their interests
To promote the health and wellbeing of SAS doctors and dentists
To promote the use of the SAS contracts, including the creation of Specialists
To promote SAS career development
To encourage friendship among SAS doctors and dentists
To work with other organisations to further the interests of SAS doctors and dentists

An ‘association’ to support SAS wellbeing – the SAS Advocate Network

book Figure 1. Founding objectives of the Association of Anaesthetist of Great Britain and Ireland

The recent SAS contract reforms, launched in England, Wales and Northern Ireland in 2021 and Scotland in 2022, contain the potential to significantly change the nature of being a SAS doctor in the UK. This article outlines a few of these changes, and introduces a new role to safeguard the wellbeing of the SAS workforce, the ‘SAS Advocate’.

Coming first to the contractual changes, these include new protections against excessive out-of-hours working that should lead to safer and more sustainable rotas for many doctors. These new protections, similar to those found in the 2016 contract for doctors in training, complement elements of the Association of Anaesthetists Fight fatigue campaign [1], and the more recent Age and the anaesthetist guideline [2].

Secondly, the contract reform restored a senior role for Specialty Doctors to progress to for the first time since the closure of the Associate Specialist role more than a decade ago. This new ‘Specialist’ contract was created to recognise SAS doctors who are senior and experienced enough to work independently within their clinical niche. Progression to becoming a Specialist should be a natural expectation of Specialty Doctors who achieve the requirements, thereby incentivising this professional development for both the doctors themselves and their employers. This new senior contract, alongside the changes to the Specialty Doctor contract, together create an attractive alternative pathway for a career in medicine.

Thirdly, the contract reform recommended the creation of the SAS Advocate role, a new strategic position to support the wellbeing of the SAS workforce. Alongside existing SAS Tutors and SAS representatives on Trust LNCs, this provides a third pillar of support for the SAS workforce within an organisation. Some organisations may have other existing sources of support, including wellbeing leads, and it is intended that the SAS Advocate will be in addition to these roles and work collaboratively with them.

A reasonable question to pose might be why there is need of the SAS Advocate role? Sadly, there is evidence that things aren’t yet all as they should be for the group. A survey of SAS and locally-employed (LE) doctors published by the GMC in 2019 paints a potentially worrying picture, with the experiences of some SAS/ LE doctors in the workplace leaving much to be desired. These findings are echoed by the Medical Workforce Race Equality Standard (MWRES) data. Bullying and discrimination by colleagues was reported by a greater proportion of doctors in these roles than by consultants or those in formal training programmes [3]. This phenomenon has been referred to as ‘grade-ism’ in other work on this subject, and is an additional prejudice potentially holding back the careers of doctors in our workforce.

Appropriately supported, a career as a SAS doctor should allow doctors the opportunity to develop their careers within one organisation, with geographical stability and the contractual right to job planning from an earlier stage. There are many reasons why choosing such a career might therefore better suit the circumstances of some doctors, and doing so needs to be a viable choice. This is a sentiment shared by a document by the Academy of Medical Royal Colleges (AoMRC) succinctly entitled SAS - a viable career choice [4]. These contracts and accompanying national documents should allow us to develop many more doctors than we have national training numbers, creating far more senior colleagues in the longer term than we might do otherwise. Supporting every doctor to reach and work at their potential clearly benefits everyone.

However, troublesome historical tropes about these doctors being perpetual ‘middle grades’ and ‘just for service’ persist. These ideas continue despite multiple national documents on the importance of career development for SAS doctors, endorsed by the AoMRC, the BMA, NHS Employers and Health Education England. There is sadly even a national document describing how the reality for SAS doctors in the workplace does not yet reflect the contents of the other national documents. Entitled SAS workforce – rhetoric vs reality this paper was written by SAS Anaesthetist Lucy Williams during her time as chair of the SAS committee at the Royal College of Anaesthetists [5]. While some SAS doctors are supported and thrive, other are hindered from achieving their career goals. Culture, expectations and even the language used to describe the group define us.

The SAS contract reforms and the creation of the Advocate role provide an opportunity to change this culture, shifting the narrative towards the positive. By the middle of 2022 the first dozen Advocates had found one another and begun to share information and strategy, forming the ‘SAS Advocate Network’ in England. A similar network exists in Wales. As new Advocates have been appointed, we have endeavoured to find them and add them to our group, and at the time of writing there are 26 of us and growing, including a reassuring number of SAS anaesthetists. The Advocates communicate regularly by a very active and enthusiastic WhatsApp group, exchange documents and resources by email, and have regular virtual meetings. The hope is that together we can sculpt what it means to be a SAS doctor across all of our combined organisations, making the reality match the national rhetoric and making respect, recognition and professional development the norm.

With the above in mind, the Network created a list of shared objectives for the group at its first meeting held in October 2022 during ‘SAS week’ (Box 1). Those readers with an interest in the history of anaesthesia will notice some overlap between this list and the founding objects of the Association of Anaesthetists that are currently on display in the Heritage Centre of our headquarters at 21 Portland Place (Figure 1). This is not entirely coincidental. It is easy to forget that the specialty of anaesthesia once had to battle to be recognised as its own entity, and to be seen as a valid and ‘viable’ career. The work of the Association of Anaesthetists was an essential part of making our speciality what it is today, and something we are rightly proud of as an organisation.

Perhaps in years to come we will likewise look back at the achievements of the SAS Advocate Network and proudly reflect on the impact that it made to the SAS workforce. I do hope so.

Robert James Fleming
Specialist Anaesthetist, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield
Co-chair, SAS Advocate Network
Honorary Membership Secretary Elect, Association of Anaesthetists

Twitter: @RobJimFleming

References

Association of Anaesthetists. Fatigue, 2023. https://anaesthetists.org/Fatigue (accessed 2/6/2023).
Davies M, Clyburn P, Barker P, et al. Age and the anaesthetist: considerations for the individual anaesthetist and workforce planning: guidelines for the ageing anaesthetic workforce from the association of anaesthetists. Anaesthesia 2022; 77: 1259–67.
NHS England. Medical Workforce Race Equality Standard (MWRES). A commitment to collaborate - the First Five, 2023. https://www.england.nhs.uk/long-read/medical-workforce-race-equality-standard-2022/ (accessed 2/6/2023).
Academy of Medical Royal Colleges. SAS – a viable career choice, 2021. https://www.aomrc.org.uk/sas-papers-guidance/sas-a-viable-career-choice/ (accessed 2/6/2023).
Academy of Medical Royal Colleges. SAS workforce – rhetoric vs reality, 2021. https://www.aomrc.org.uk/sas-papers-guidance/sas-workforce-rhetoric-vs-reality/ (accessed 2/6/2023).

An ‘association’ to support SAS wellbeing – the SAS Advocate Network

Box 1. Founding objectives of the SAS Advocate Network