This shortcoming is evidenced by the perceptions and mindsets of those who hold significant control over NHS workforce strategies. This article critically examines how certain dominant groups of doctors within the NHS have been influencing policy changes.
By D Naeem Aziz FRCP, RCP London SAS Lead, Clinical Director and SAS Advocate.
In this article, I will analyse a key document illustrating the damaging effects of protectionist attitudes among dominant groups within the NHS on SAS Doctors’ career paths and the broader NHS workforce strategy. Following the introduction of the SAS contract reforms in 2021, the BMA Consultant Conference took place, providing critical insights. The agenda from the conference, held on May 21, 2021, forms the basis for this compelling review.
Read the published document on the BMA website. Click here
The document mentions SAS (Specialty, Specialists and Associate Specialist) doctors on pages 11 and 12. Below is a summary that focuses on the comments about SAS doctors and analyses the concerns raised in the provided context.
Comments About SAS Doctors
Proposed Title for New Senior Specialty Doctor Grade (Motion A52CC21, Page 11):
- There were concerns that the title “Specialist Doctor” might be misleading for patients, as it does not indicate that the doctor is on the specialist register.
- It was proposed to either change the title to “Associate Specialist” or revise the entry criteria to include specialist register membership.
Consultant Confusion and Workforce Impact (Motion A37CC21, Page 11):
- The term “Specialist” may be misleading since it overlaps with terms used for consultants and trainees, like Specialist Trainees and those on the Specialist Register.
- The motion criticised the BMA for moving forward with the new designation without sufficient consultant committee input and proposed alternatives like “Senior Staff Doctor.”
Consultants’ Role and Title Protection (Motion A44CC21, Page 12):
- The motion emphasised that altering the designation to “Specialist” diminishes the significance of the “Consultant” role, as the term consultant is associated with individuals listed on the Specialist Register.
- Concerns have been expressed regarding employers’ potential obfuscations in workforce planning, highlighting the imperative for the BMA to reconsider its decision to safeguard the confidentiality of consultants’ identities.
Analysis of Consultant Comments
Over-Protectionist Approach
- Reflection of Over-Protectionism: The concerns appear to stem from an overly protectionist viewpoint. Consultants are apprehensive about compromising the unique identity of their roles by linking the “Specialist” designation with SAS doctors, who may not fulfil the same specialist register criteria.
- Implications for SAS Specialists: This position risks undermining the new SAS Specialist role by focusing on preserving traditional hierarchical distinctions instead of acknowledging the evolving roles and contributions of SAS doctors.
Protecting Consultant Interests
- Focus on Image Over Welfare: The evidence reveals that consultants are deeply committed to preserving their traditional image and identity, but this dedication may cost the support they offer SAS doctors. By prioritising their interests, consultants risk neglecting the pressing workforce and patient care needs the NHS faces. It’s essential to shift this focus to provide the comprehensive support necessary for a healthier healthcare system.
- Potential Neglect of SAS Doctors’ Support: The calls to reverse title changes or impose stricter requirements suggest a hesitation to integrate SAS specialists more fairly into the workforce hierarchy.
Broader Implications for the NHS
- The discussion about titles and designations may distract from essential issues such as resource allocation, workforce wellbeing, and the sustainability of the NHS system. This is particularly significant as SAS doctors assume increasingly vital roles in service delivery.
Changing NHS workforce dynamics
We must consider the evolving dynamics of the NHS workforce, which render the historical alignment of senior roles exclusively to consultants unfeasible and unsustainable. This misalignment directly contributes to broader failures within the NHS.
The General Medical Council’s (GMC) 2024 Workforce Report offers a detailed analysis of the changing medical workforce in the UK, especially SAS doctors. Key findings include:
Significant Growth in SAS and Locally Employed (LE) Doctors:
- From 2019 to 2023, the number of LE doctors in England and Wales rose significantly, increasing by 75% from 21,000 to 36,831. This growth was much faster than the increases seen in the specialist register, which grew by 13%, and the GP register, which saw a 9% increase during the same period. GMC UK
Predominance of International Medical Graduates (IMGs):
- A significant number of SAS and LE doctors are trained internationally. In 2023, two-thirds (66%) of LE doctors and over four-fifths (81%) of SAS doctors in England and Wales held primary medical qualifications outside the UK. GMC UK
Challenges in Career Progression and Recognition:
- Despite their increasing numbers, SAS and LE doctors often encounter barriers to accessing training and career development opportunities. The report highlights the need for equitable career pathways to improve job satisfaction and retention. GMC UK
Implications for Workforce Planning:
- The GMC warns that underutilising the skills of SAS and LE doctors could negatively affect patient care. The report emphasises the need to reevaluate training and support structures to ensure that these doctors are fully integrated into the healthcare system and valued for their contributions. GMC UK
Discussion
The GMC’s 2024 Workforce Report emphasises the rapid growth and rising importance of SAS (Specialist and Associate Specialist) and LE (Locally Employed) doctors within the UK medical workforce. It highlights the need for targeted support, equitable career opportunities, and systemic changes to utilise their potential to deliver high-quality patient care fully.
This evidence-based approach suggests that the protectionist stance and remarks made by consultants in 2021—at a time when their support was crucial for implementing meaningful reforms to the 2021 SAS contract—are a direct reason for the limited uptake of new specialist-grade positions in the NHS. It is widely known that nearly all senior clinical management roles in the NHS are predominantly held by consultants. If any of them are hesitant about the title “Specialist,” it is unlikely they would support this role.
Although this statement may be controversial, unlike the comments made by the consultants in 2021, it is rooted in facts rather than opinions.
In my Blog published by NHS Employers during the 2024 SAS week
My time serving as a SAS advocate | NHS Employers
I addressed the need for the NHS to consider appointing senior SAS doctors to senior management roles. This change could help tackle existing issues and ambiguities and better align the NHS’s medical workforce to meet future challenges. Instead of focusing on the traditional rhetoric surrounding the specialist or GP registers of the GMC, both of which consistently fall short in attracting enough doctors to fill workforce gaps, it is crucial to explore new approaches.
Data from the GMC in 2024 clearly shows that most doctors employed in the NHS fall into the SAS or LED categories, with most SAS doctors being highly experienced.
NHS leaders and policymakers can maintain a failing approach or provide better support for SAS doctors, ensuring their inclusion in the workforce is meaningful, targeted, and conducive to delivering high-quality care. It is essential to move beyond concerns about titles and outdated protectionist stances that ultimately let the NHS and its patients down.
Based on recent evidence and data analysis from the GMC, a compelling argument exists for modifying the GMC medical register to include a system that identifies senior SAS doctors and accredits their acquired competencies, similar to the processes used for the specialist or GP registers. Without implementing such a system, a protectionist stance will persist, leaving the NHS uncertain about effectively utilising the skills of experienced SAS doctors.
