What makes a good department? A SAS perspective
After being asked to describe a ‘good department’ from the perspective of
a specialty doctor, it struck me that every department is different, just as the
needs of every anaesthetist are different. What follows therefore, are general
observations and suggestions that apply to all departments. If there is a theme
to be had, it is that meeting the individual needs of individual doctors makes
them happier and more productive. It is also usually the right thing to do.
In the typical department nationally, specialty doctors and
associate specialists (SAS doctors) make up around one fifth
of the permanent anaesthetic team. Some SAS doctors may
be relatively inexperienced, requiring supervision and support
to develop their own practice. Other SAS doctors may have
experience and autonomy on a par with their consultant
colleagues, with corresponding needs. Some SAS doctors
will work with some supervision through their careers, while
many will develop greater autonomy. This autonomy should be
appropriately recognised, with work attributed and coded to
the doctor that carried it out. Some SAS doctors will choose to
seek entry to the specialist register via a Certificate of Eligibility
for Specialist Registration (CESR), and this too should be
The good department recognises the value of individuals at
all stages of their careers, supports them and treats them with
As valued members of the department, SAS doctors
should be involved in departmental planning, recruitment and
service development. Inclusivity is important and too often
forgotten. Does your department have ‘consultant meetings’?
Are your SAS doctors welcome at these meetings? If so,
shouldn’t these meetings be called something different?
All SAS doctors have the same rights to job planning and
requirements for appraisal and revalidation as consultants.
There is no reason why the process for job planning SAS
doctors, or the resulting job plans, should differ greatly from
consultants in the same department. Such job plans should
contain a mutually-agreed balance between fixed sessions
and flexibility, as well as between daytime working and out-of-hours activity. Any arrangements for reducing out-of-hours
commitments on the grounds of advancing age should apply
equally to SAS doctors and consultants alike. Paraphrasing
Animal Farm, in the good department all anaesthetists are
equal, with no group more equal than others.
Appropriate paid SPA time should be included in the contract
for Continuing Professional Development to support appraisal
and revalidation, with a minimum 1 PA. If additional ‘core’ SPA
time is the norm for consultants in a department, it should also
be the norm for that department’s SAS doctors. Additional
roles should carry additional SPA time. Access to office facilities,
appropriate IT and administrative support should likewise be
the same. These things should be true of every department, not
just the good ones.
The good department must create ways of working that allow
each anaesthetist to flourish and carve out an individual niche,
based on their individual talents and expertise.
can play valuable roles in both clinical and non-clinical settings,
and in the good department, they are encouraged to do so.
Nationally, SAS doctors are subspecialty leads, educational
supervisors, appraisers and mentors. Extended roles involving
leadership, education or research for anyone with the aptitude
should be the norm, not the exception. Failure to recognise this
results in frustration from all quarters, and prevents even the
good department becoming the best it can be.
Robert James Fleming
Specialty Doctor and elected board / council member at the
Association of Anaesthetists