SAS and Specialty Doctors

SAS and Specialty Doctors

The NHS employs a significant number of doctors who are neither consultants nor trainees. These are collectively known as SAS (Staff Grade, Associate Specialist and Specialty Doctors) grades, and they make up approximately 22 per cent of the non-trainee anaesthetic workforce. The term 'SAS doctor' includes staff grade, associate specialist and specialty doctors. All have a minimum of two years specialist training but many are highly skilled and experienced.

SAS doctors are employed on several different types of contract. Some (eg Staff Grade, Associate Specialist and Specialty Doctors) are based on nationally-negotiated terms and conditions, with minimum entry qualifications and defined salary scales. Other contracts (such as Trust grades) are non-standard and are locally agreed.

Some SAS doctors are relatively junior and inexperienced. They may be unfamiliar with the particular case mix that they are required to treat, or the way in which the hospital operates, especially if they have not previously worked in the UK. These doctors need to be closely supervised by a Consultant, often on a case-by-case basis. This supervision may be direct or indirect, depending on the clinical situation.

Other more experienced SAS doctors have the expertise and ability to take responsibility for patients themselves, without consultant supervision, under certain circumstances. These circumstances need to be considered and agreed at on an individual basis. The ability to work autonomously depends upon the training and experience of the doctor, the range and scope of their clinical practice, and evidence of satisfactory practice reviewed at annual appraisal. Autonomous working can also be discussed within job planning meetings.

    To help summarise the broad experience ranges, Dr Lucy Williams created the following document

    Your story, your opinion

    The SAS Committee is keen to involve our SAS members and fellows with the College and would like to encourage you to write an article for submission to the Bulletin. Articles need to be constructive and ideally include useful information that is of interest to a wider audience. With a slot in each Bulletin dedicated to SAS and Specialty Doctors, it is your opportunity to let us know more about the work you do and the challenges you face.

    Please submit your article to sas@rcoa.ac.uk. Articles will go directly to the Committee who will review them first, before submitting selected articles to the Editorial Board of the Bulletin.

    Details about the length, style of article and deadlines are available via the Bulletin pages on the website.

    If you would like to be more involved in the work the College is doing, please see our Get Involved page.

    I have now been a specialty doctor for six years, and what has surprised me most about the role is how expansive and filled with possibilities it can be.

    Dr Robert Fleming
    Specialty Doctor in Anaesthesia

    Your membership as an SAS doctor

    The College is by your side, supporting you throughout your career, as an SAS doctor you are entitled to the same benefits as a trainee or consultant member. This includes access to the Lifelong Learning platform, and access to the CPD Diary.  

    As with our trainee members you are also able to vote in our Council and Committee polls, ensuring that your voice is heard across the college. There is SAS representation on each of the boards and committees, as well as having a dedicated SAS Committee.

    As well as receiving the College’s Bulletin magazine, and peer review journals the BJA and BJA Education, you also have access to educational material, resources and events, quality and safety standards and guidance, plus a wide range of other benefits. 

    For additional information on the benefits of membership and application forms please see below

    SAS Anaesthetists – Securing our Workforce

    The College carried out its most recent survey of SAS doctors in 2016.

    Launched at the College's 2017 Summer Symposium, the report SAS Anaesthetists – Securing our Workforce provides findings from the survey, and outlines what steps will be taken by the College to further understand and promote the interests of SAS colleagues within the healthcare system.

    The Joint SAS Working Party is in the process of analysing the results, but for now these are some of the headline points;

    • 55% SAS doctors surveyed obtained their PMQ in non- EU Countries
    • Majority (63%) of SAS doctors are on a 'specialty doctor' type contract
    • 90% of SAS doctors have substantive posts
    • 47% chose to be an SAS doctor because of better work life balance
    • 87% have at least 1.0 SPA in their job plan.

    An article written by Dr Lucy Williams on the SAS Survey results was published in the May 2017 issue of the Bulletin

    Read the full report here

    Professional development, CPD and revalidation

    All doctors are required to develop and maintain their professional skills for the benefit of patients and to take part in appraisal and revalidation. The College supports the Academy of Medical Royal Colleges (AoMRC) SAS Charter for SAS Doctors as follows:

    The above documents outline the requirements for all SAS doctors to have:

    • appropriate contract, job plan and activities. The job plan must contain appropriate SPA time for the role together with adequate resources for CPD. This may change over time and should be reviewed as appropriate
    • access to resources such as office accommodation and technology, secretarial support, effective induction
    • sufficient breadth and depth of clinical work and relevant professional activities to maintain relevant competencies.

    CPD functionality is soon to be added to the Lifelong Learning platform, for more information on this please see our CPD pages. 

    For more information on Revalidation, please see the pages below

    Clinical work and supervision

    All doctors are required to recognise and work within the limits of their clinical competence, and to seek help from colleagues or others where this is appropriate.

    Some SAS doctors are relatively junior and inexperienced. They may be unfamiliar with the particular case mix that they are required to treat, or the way in which the hospital operates, especially if they have not previously worked in the UK. These doctors need to be closely supervised by a Consultant, often on a case-by-case basis. This supervision may be direct or indirect, depending on the clinical situation.

    Other more experienced SAS doctors have the expertise and ability to take responsibility for patients themselves, without consultant supervision, under certain circumstances. These circumstances need to be considered and agreed at on an individual basis. The ability to work autonomously depends upon the training and experience of the doctor, the range and scope of their clinical practice, and evidence of satisfactory practice reviewed at annual appraisal. Autonomous working can also be discussed within job planning meetings.

    Select below to read the full document

    Management, teaching and administration

    SAS doctors are involved with management, teaching and administration, and the College supports and encourages this. The personal skills and attributes of individuals are crucial in deciding their suitability for these roles. SAS doctors should consider applying for many of them, including:

    The College register of approved trainers has been suspended. If an SAS doctor would like to teach and assess anaesthesia trainees, they must meet the following College approved criteria for trainers and assessors. For more information, an application form and the contact details to apply to become an examiner please see our Becoming an Examiner page.

    The following criteria should be met for a consultant, locum consultant, staff and associate specialist, and trainee to act as a trainer/assessor:

    Successful completion of a trainers course [eg train the trainers];

    • Understanding of the structure of the training programme and content of the curriculum
    • Aptitude to teach
    • Regular clinical commitment
    • Evidence of recent CPD relevant to current clinical practice
    • Annual assessment or appraisal by a consultant anaesthetist
    • Willingness to complete the necessary training documentation mandated in the curriculum and by the School of Anaesthesia
    • Willingness to provide a post training session debrief including feedback on performance
    • Ability to detect the failing trainee
    • Successfully completed a course on assessment and assessment tools
    • Aptitude for assessment
    • Understanding of the assessment system described in the curriculum
    • Willingness to assess the trainee and complete the necessary documentation including a post assessment debrief.

    It is a College Tutor’s responsibility to ensure that the trainers and assessors used within the Trust meet the above criteria and whether the individual is used for training and assessment duties.

    Select here for guidance on how to become an examiner.

    Specialty/SAS doctors returning to training

    Applications from doctors who want to re-enter training after a break will be dealt with in accordance with the procedures and person specifications of the national recruitment programme.

    For those who have continued to practise anaesthesia (for instance as SDs or SAS grades) the point of re-entry will depend on the level of previous training and subsequent experience.

    For more information on recruitment and the return to work process please see below

    Making an equivalence (CESR) application

    Equivalence describes the process of assessing an applicant’s training and/or experience against the current training programme requirements as set out in the UK CCT in Anaesthetics in order to gain a Certificate of Eligibility for Specialist Registration (CESR) for the Specialist Register held by the General Medical Council (GMC).

    Applications have to be made through the GMC Certification Unit and Equivalence procedures are the responsibility of the GMC. Initial enquiries should be made to the GMC.

    Applicants are assessed by an RCoA Committee who measure an applicant’s training and/or experience against that which is expected for the award of a UK Certificate of Completion of Training (CCT) in Anaesthetics. Once this is complete a recommendation is made to the GMC.

    Before considering an application, applicants should examine in detail:

    In addition to providing evidence of training and experience, applicants are required to demonstrate possession of an acceptable test of knowledge. A list of previously accepted tests of knowledge can be found on the CESR and Equivalence section of the website. If your qualification is not in this list, evidence should be provided including a validated certificate of completion, with the full details of the curriculum and assessment criteria in force at the time of the award. This should be in English and validated by the institution.

    Dr Kirstin May wrote an article on the CESR process which was published in the March 2017 issue of the Bulletin.  

      For more information about Equivalence or to get help with making an application please see follow the link below

      Select below to find our more about the SAS Committee

      SAS Committee Secretary

      Tel: 020 7092 1552

      Email: SAS@rcoa.ac.uk