Supporting reality to match the rhetoric: introducing the SAS six
Specialist, associate specialist and specialty (SAS) doctors, and locally employed doctors (LEDs) are the most rapidly rising group of doctors on the medical register. We are projected to be the largest cohort before the decade is out (source: the 2023 GMC workforce report). Doctors might choose or find themselves in these roles for a myriad reasons, and we include doctors at all career stages and working at all levels of seniority.
The 2021 SAS contract update reintroduced a senior role for SAS doctors to progress to, with the creation of the specialist contract. Additionally, recent positive changes to the Certificate Eligibility for Specialist Registration (CESR) route to the specialist register, now called the ‘portfolio pathway’, should allow doctors greater flexibility to join the specialist register and potentially apply for a substantive consultant role. This should be the best time in history to choose a SAS route to progress your career, and doing so should be a viable career choice, as reflected in the title of an excellent paper produced by the Academy of Medical Royal Colleges (AoMRC).
“Despite all this rhetoric, we know that many SAS doctors still experience frustration in achieving fulfilling careers.”
A lot of important work has been done in recent years to support these careers to be all they can be, so that everyone might achieve their full potential as a doctor. Existing publications include a British Medical Association (BMA) SAS charter in each nation, the multi-organisation SAS doctor development guide and a library of valuable documents produced by the AoMRC. More recently, these have been joined by some specialty specific guidance and strategy produced by Royal Colleges and membership organisations, including the Royal College of Surgeons, the Royal College of Anaesthetists, the Association of Anaesthetists and the Royal College of Physicians, to name just a few.
Despite all this rhetoric, we know that many SAS doctors still experience frustration in achieving fulfilling careers. National surveys conducted by the General Medical Council (GMC) and others show that progress is slow. There are senior destinations for a SAS career which should be attainable, but doctors may currently find their careers stifled rather than supported. It appears that national papers aren’t having the impact in the workplace that they should. This too is reflected in an existing AoMRC paper, aptly named the SAS workforce - rhetoric vs reality.
“the SAS Collective started as a group of SAS doctors… wanting to shift the culture and make reality match the rhetoric.”
The disconnect created by this implementation gap has significant implications for the current and future NHS workforce. Our group is demonstrably the most diverse group within the medical workforce, and these things are therefore undeniably equality, diversity and inclusion (EDI) issues. As a result, parity for SAS doctors has also featured as one of the domains for the Medical Workforce Race Equality Standard (MWRES) action plan.
With all of the above well known to us, the SAS Collective started as a group of SAS doctors each with experience of SAS representation at local, regional, or national level, wanting to shift the culture and make reality match the rhetoric. To that end, we have collectively created a grassroots campaign, the ‘SAS six’, focussed around the right contract for the work done, support to develop within a SAS career, and the opportunity for senior doctors to become leaders and educators.
This is a campaign by SAS doctors, for SAS doctors.
The #SASsix policy calls are:
- Every early career SAS doctor should have access to an educational supervisor.
- All SAS doctors should have equity of access to professional development opportunities relevant to their stage of career.
- All specialty doctors who meet the required capabilities should have the opportunity to become specialists.
- Senior SAS doctors should be offered the opportunity to be educators at every level on a par with consultants e.g. educational supervisors, clinical supervisors, directors of medical education.
- All extended roles in leadership and management should be open to all substantive medical staff that is, consultants and appropriately experienced SAS doctors.
- All LEDs employed for more than two years within one NHS employer should be offered the opportunity to transfer to the appropriate SAS contract.
We believe these things are specific, measurable, achievable and relevant to the careers of SAS and locally employed doctors. We believe these things could make an enormous difference to doctors, trusts, and ultimately patients. In a workforce and productivity crisis, we believe these things are vital, and we want them to now become normal.
The SAS Collective has been active on social media, raising awareness and gaining engagement. We have hosted several tweet (X) chats, with diverse panels of national stakeholders, with representation from the GMC, the BMA, Royal Colleges, NHS employers, and individual trusts. The metrics we have collected afterwards suggest we are being seen, and that our impact is a positive one.
The SAS six campaign has now been endorsed or supported by the HCSA, Medical Protection, the Association of Anaesthetists, the Royal College of Anaesthetists, the Royal College of Physicians, Medical Education Leaders UK and the Medical Women's Federation.
More importantly, employing trusts are starting to adopt the SAS six as a roadmap to implementing the existing rhetoric. The first two to do so were Northumbria Healthcare NHS Foundation Trust, and Barking, Havering and Redbridge University Hospitals NHS Trust.
Since this blog was written for SAS Week we are pleased to announce that Lewisham and Greenwich NHS Trust, Portsmouth Hospitals University NHS Trust and Isle of Wight NHS Trust have announced their formal support and adopting the SAS six. We are hopeful that these will be the first of many.
Any organisation who wishes to adopt the SAS six, and join our campaign, is welcome to do so. We believe that such an announcement represents an organisation is seeking to meaningfully invest in their LEDs and SAS doctors. We are happy to work with you to make this happen. Together, we believe positive change is possible.
On behalf of the SAS Collective:
Dr Robert James Fleming
Dr Imran Sharieff
Dr Lily Read
Dr Joanne Younge
Dr Michelle Hatch
Dr Mithun Barik
