Essentials of SAS wellbeing – recognition, valuing contribution, developmental opportunities to thrive

In recent years, national organisations have called for better recognition of and support for the SAS workforce. In collaboration, the Academy of Medical Royal Colleges (AoMRC), Health Education England, NHS Employers and the BMA produced the SAS charter [1], the SAS development guide [2], and Maximising the potential: essential measures to improve support and development opportunities for SAS Doctors and Dentists [3].

The SAS development guide, published in 2017 and updated in 2020, describes actions that can be taken to ensure how different groups can work together to provide the best practice for SAS development to be applied consistently [2].

The 2020 Wellbeing of the SAS workforce statement from the AoMRC states principles to identify problems and proposes solutions regarding working lives, work conditions, teamwork, recognition, and developmental support for the improved wellbeing of the SAS workforce [4]. These principles were adapted from the GMC's 2019 report Caring for doctors, caring for patients [5]. The summary below includes recommendations from both of these documents.

Autonomy and the need to have control over working lives

The GMC report recommends implementing compassionate leadership models that give all doctors more say over workplace cultures, the opportunity to contribute ideas, adopting minimum standards for rest and food, and a flexible approach to rostering. The review also found that many clinical teams and employers have already implemented local solutions to wellbeing issues. However, recommendations made in the report need to be consistently applied throughout the health care system. A mutual job planning process, annual appraisal, support through the revalidation process with allocated time, and flexibility in work patterns are recommended.

Belonging and the need to be connected and feel valued

The GMC report identified the need for creating supportive and inclusive working environments as the key to promoting doctors' wellbeing. Team members should feel involved, respected, and supported. The AoMRC recommends that the SAS workforce feel valued and connected to local and national organisations. Every member of the team will have different strengths, and it is essential to value and respect their contribution. Quality Assurance programmes should ensure that feedback is sought from the SAS workforce regarding their working conditions and team working. Engagement of SAS doctors with local and national meetings via LNC representatives, local medical committees and SAS Tutors should be encouraged. Doctors need to feel that they are part of a just and compassionate culture, and should receive appropriate and consistent support.

Expertise – competence – skillset – workload

The AoMRC recommends that NHS Trusts use their endorsed BMA template for autonomous practice. The GMC report highlighted that it is essential to ensure that workloads are manageable and avoid excessive work demands to ensure delivery of high-quality patient care; doctors need to be continuously enabled to grow as practitioners, developing and learning new skills.

Developmental support

Continuing Professional Development is vital for SAS doctors to keep up to date with their skills. SAS doctors should have access to both generic and speciality-specific CPD opportunities. The AoMRC recommends that SAS doctors should be allowed to develop extended roles. SPAs for carrying out non-clinical duties and developing non-clinical skills would benefit both the individual and local service needs.

Recognition

Better recognition is needed for the valuable contribution made by the SAS workforce. The AoMRC recommends that SAS doctors should have access to opportunities to develop in extended roles, teaching and research. Regular monitoring of these principles by NHS organisations, and national surveys such as the NHS Staff Survey, are recommended to understand better the views and needs of the SAS workforce.

The GMC survey of 2019 showed that about 41% of SAS doctors had difficulty accessing CPD opportunities, 6.5% of SAS doctors had no SPA time, and 58.4% had only one SPA [6]. This is below the AoMRC recommendation for SPAs for revalidation. A majority 54% of Trusts gave feedback to NHS Employers that the most common issue affecting the motivation and morale of SAS doctors was recognition, followed by pay at 46%.

Summary

The SAS workforce is one of the strong pillars of the NHS. Although the 2021 SAS contract reforms have allowed some progress in the right direction regarding SAS work life and wellbeing, there is still a long way to go. Individual wellbeing affects not only the individual, but also the organisation and patient care. National organisations have made valuable recommendations for improving SAS wellbeing, but implementation across the NHS is now essential.

Reshma Khopkar
SAS Committee Member on Membership Services and Wellbeing, Association of Anaesthetists
Associate Specialist, LNC Member, Royal Berkshire NHS Trust

References

1. British Medical Association. The SAS charter, 2022. www.bma.org.uk/advice-and-support/career-progression/sas-development/the-sas-charter (accessed 27/6/2023).
2. NHS Employers. SAS doctor development guide, 2020. https://www.nhsemployers.org/publications/sas-doctor-development-guide (accessed 27/6/2023).
3. Health Education England. Maximising the potential: essential measures to support SAS doctors, 2019. www.hee.nhs.uk/sites/default/files/documents/SAS_Report_ Web.pdf (accessed 27/6/2023).
4. Academy of Medical Royal Colleges. ‘Wellbeing of the SAS workforce, 2020. https://www.aomrc.org.uk/wp-content/uploads/2020/11/Wellbeing_SAS_workforce_301120.pdf (accessed 26/6/2023).
5. General Medical Council. Caring for doctors. Caring for patients, 2019. https:// www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf- 80706341.pdf (accessed 26/6/2023).
6. General Medical Council. Specialty, associate specialist and locally employed doctors work-place experiences survey: initial findings report, 2020. www.gmc-uk.org/-/media/documents/sas-and-le-doctors-survey-initial-findings-report-060120_ pdf-81152021.pdf (accessed 27/6/2023).

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