England lagging behind on regrading senior SAS Doctors
30 June 2026
New data collected by the Association has raised questions about England’s approach to regrading SAS doctors. The data obtained via Freedom of Information reveals that England is making slower progress than other UK nations in moving experienced SAS doctors onto specialist contracts designed to recognise senior clinical expertise.
The reported data collected by the Association of Anaesthetists found that just 6.7% of England's SAS workforce are employed on specialist contracts, despite specialist grades being introduced in 2021 to provide a clearer career pathway for experienced doctors.
The reported data shows that 71% of SAS doctors in England remain on specialty doctor contracts, with 8% are employed on associate specialist contracts and 4% on staff grade contracts.
In contrast, Wales has achieved significantly higher levels of regrading to specialist roles, while Scotland has also begun taking steps to move doctors onto the new contracts. In Wales, 14% of SAS doctors are employed on specialist contracts, designed to recognise senior clinical expertise - the highest proportion among UK nations. Via Freedom of Information research the Association of Anaesthetists found that a further 69% of doctors were employed on specialty doctor contracts. The data also recorded Wales has the lowest proportion of locally employed doctors (LEDs) among UK nations, with LEDs accounting for only 11% of the combined SAS and LED workforce.
The findings suggest that England has not embraced the opportunities created by the 2021 SAS contract reforms to the same extent as other parts of the UK, despite employing by far the largest SAS workforce.
The research also revealed that locally employed doctors (LEDs) account for almost 30% of the combined SAS and LED workforce in England, highlighting the growing importance of doctors working outside formal training pathways and nationally recognised career structures.
The findings come despite repeated commitments from government and NHS leaders to improve career progression opportunities for SAS doctors.
In response to a parliamentary question about regrading, Health Minister Karin Smyth MP said:
“While there are no specific plans to introduce a separate regrading policy similar to those in Scotland or Wales at this time, we are considering how best to support appropriate career progression for specialty doctors in England, including through ongoing conversations with the British Medical Association. The specialist grade was introduced in England in 2021 as part of reforms to improve career progression opportunities for Specialty, Associate Specialist, and Specialist (SAS) doctors. Employers are able to create specialist posts where there is a service need, and individuals, including speciality doctors, should be able to apply for these roles through open, competitive recruitment. As set out in the National Health Service 10-Year Health Plan, the Department is committed to supporting the continued expansion of the specialist grade where appropriate, to ensure SAS doctors have clear and fair pathways for progression.
Dr Emma Wain, Chair of the Association of Anaesthetists SAS Committee, said:
““It is disappointing that the NHS in England has not followed other nations in introducing a regrading process for specialty doctors to apply to become specialists. We are missing a valuable opportunity to allow SAS doctors to work at a level that will maximise benefits to patients and the NHS as a whole. In addition, whilst we welcome the window of opportunity announced by NHS Employers for LEDs to move onto SAS contracts, we would ask that this is made permanent so that all doctors can benefit from a job that allows for career development and progression.”