SAS careers

The specialty doctor grade was introduced in April 2008. The entry criteria are set out in Schedule 1 of the specialty doctor terms and conditions of service.

A doctor appointed to this grade shall have completed at least four years’ full-time postgraduate training (or its equivalent gained on a part-time or flexible basis), at least two of which will be in a specialty training programme in a relevant specialty or as a fixed term trainee in a relevant specialty; or shall have equivalent experience and competencies.

The same entry requirements apply to dentists.

The specialist grade was introduced in April 2021 to offer career progression for specialty doctors. Specialist grade doctors provide expertise in a specialised area (a specific specialty or a generalist service) and can manage the full range of presentations in their specific area of practice. The entry criteria to the specialist grade are set out in Schedule 1 of the specialist grade terms and conditions of service.

A doctor appointed to this grade shall have completed a minimum of twelve years’ (ten years in Scotland) medical work (either continuous period or in aggregate) since obtaining a primary medical qualification, of which a minimum of six years (five years in Scotland) should have been in a relevant specialty in the Specialty Doctor and/or closed SAS grades.

Equivalent years’ experience in a relevant specialty from other medical grades including from overseas will also be accepted. They must also meet the requirements of a Specialist grade generic capabilities framework. There are equivalent entry retirements for dentists seeking appointed to this grade.

Specialist grades are expected to focus mainly on providing direct clinical care but will also have further development opportunities such as management, additional responsibilities, research, and clinical academia (NHS careers).

As the title suggests, LE doctors are employed locally by a healthcare organisation on a local contract, often for a non-permanent post. The terminology for LE doctor posts is diverse and can include: clinical fellows (FT3 level and ST5 - 8 Level), trust grade registrars, trust grade associate specialists. Unlike SAS doctors, they do not have nationally agreed terms and conditions. Many have recently completed their foundation training and will return to formal training, and some may move on to a SAS contract in the future (GMC, 2020); others are senior doctors employed in senior roles. Like SAS doctors, LE doctors are not on the General Medical Council (GMC) GP or specialist registers and are not in national training programmes, and they are similarly diverse in terms of their experience and skills.

SAS

• 6.8% reported more than 7 years postgraduate medical training
• 70.6% reported more than 15 years practising clinically
• 52.8% reported that they had access to an SAS tutor, adviser or equivalent
• 71.4% had an agreed job plan
• 80.2% train others as part of their job
• 30.9% would consider joining a formal training programme in future
• 25.6% reported they work completely autonomously without supervision (56.7% partially autonomously)
• More likely to value a supportive environment, more specialty training and working with greater autonomy

LE doctors

• 22.8% reported more than 7 years postgraduate medical training
• 20.8% reported more than 15 years practising clinically
• 47.6% Trust doctor (e.g. staff doctor, hospital practitioner), 43.7% fellow (e.g. clinical, teaching)
• 54.5% had an agreed job plan
• 50.7% train others as part of their job
• 37.2% would consider joining a formal training programme in future
• More likely to value more training related to specialty, a supportive environment, and more CPD opportunities

Note: this data is specific to surgeons, not all SAS doctors. 

Source: RCS England analysis of the GMC data via its online reporting tool (version 1.4 released 7 May 2020)

_{Source: General Medical Council (2020). The state of medical education and practice in the UK: The workforce report 2022.}

"No access for teaching or training opportunities. The trust not following the RCS England guide for SAS job planning. No protected theatre time. No access for endoscopy. Not following the SAS charter. No assigned supervisor. Raised concerns regarding theatre time, surgical skills will rust. Raised concerns regarding job planning."

"Not enough support from the Consultants and not structured training - this is a UK problem."

"The persistent attitude towards SAS staff in general is appalling. As a senior and experienced associate specialist, it is disappointing to be regularly referred to and treated as a junior doctor, both by management or other colleagues. To not be invited to any of the managerial or consultants meetings, and not to have out opinions heard or considered in any way."

"As a non trainee we face a lot of challenges to get theatre training and it takes a lot of effort to convince consultants to train me/us. Also, I think it depends on the trust, some trusts treat non trainees better than others! Honestly, I do not think it should be that hard or trust dependant, it should be part of the job plan for every SAS doctor (particularly) if they (are) applying for CESR pathway, we need more support to complete it."

It's sad to say but where we are now is we need recognition, we need reward, we need wellbeing, and we need SAS Advocates. We are getting there, but right now you do as you are told" - Dr Ujjwala Mohite, Chair BMA SAS committee

"We have to help them get on to the specialist register if they want to do that. They shouldn't have their ambitions limited by the grade that they are in." - Professor Pushpinder Mangat, Medical Director, Health Education and Improvement Wales

"There are about 20%, maybe 25%, who want to go back into training or do the CESR route - and we're going to make it less complicated for people to get onto the specialist register...looking at experience rather than equivalence" - Professor Dame Carrie MacEwen, Chair, General Medical Council

"SAS are not empowered. A disadvantaged group cannot speak for itself" - Dr Waleed Arshad, Associate Specialist and Immediate past chair, AoMRCSAS Committee

"I've said to a lot of SAS doctors, your weakness is the lack of a national organisation" - Professor Partha Kar, Medical Director Workforce Race Equality Standards (MWRES)

"A lot of work is still needed to ensure all SAS doctors are systematically job planned and appraised - these are key pillars of the SAS Charter" - Ellie Pattinson, Workforce Lead, NHS Employers