23 October 2024 by Kelly Ameneshoa @ Kings Fund
This article from The King’s Fund reflects on the experiences of Specialty and Specialist (SAS) and Locally Employed (LE) doctors in the NHS. It highlights the significant contributions of these doctors, who make up over 25% of the NHS workforce, and discusses the challenges they face, such as lack of recognition, career progression barriers, and experiences of discrimination and bullying. The article also emphasizes the need for better support, induction, and career development opportunities for SAS and LE doctors to ensure their retention and progression within the NHS.
Introduction
Specialty and specialist (SAS) and locally employed (LE) doctors make up a significant percentage of the NHS workforce yet are often underappreciated within the health care system. In 2023, we discussed some of the challenges facing SAS and LE doctors and called on the NHS to better support this group of doctors. In this long read we share the reflections of a small group of SAS and LE doctors we spoke to in early 2023 about their experiences. We surveyed 11 SAS doctors – some from The King’s Fund’s Emerging Clinical Leaders programme and some who attended a regional teaching day. We undertook in-depth semi-structured interviews with four SAS doctors and three LE doctors.
Why people choose to work as SAS and LE doctors
Doctors we spoke to explained that the SAS contract provides an opportunity to develop a fulfilling career based in one area of the UK and tailored to personal life circumstances. SAS doctors do not have to rotate through different hospitals in the same way that NHS England trainee doctors have to, can negotiate personalised work schedules, and are able to develop a portfolio career with broad interests. This has the potential to improve work–life balance for these doctors.
Professional Summary: “Reflections of SAS and Locally Employed NHS Doctors” by The King’s Fund
By: Dr N Aziz FRCP, RCP London SAS Lead
https://orcid.org/0009-0000-7544-2469
This document delves into the experiences of Specialty and Specialist (SAS) and Locally Employed (LE) doctors in the NHS. It highlights their substantial contributions, the challenges they encounter, and strategies for better integration and support. Below is a professional summary of our key findings.
Definition and Role
SAS Doctors
: These professionals bring significant clinical expertise but often pursue non-traditional training pathways, bypassing the standard route to consultancy roles within the NHS.
LE Doctors
: These practitioners work under locally negotiated contracts and frequently include internationally trained doctors aiming to establish themselves within the NHS workforce.
SAS and LE doctors comprise over 25% of the NHS workforce, underscoring their vital role in delivering healthcare services.
Benefits of SAS and LE Roles
Work-Life Balance
: The flexibility of these roles allows for better personal and professional equilibria.
Integration for International Doctors
: These roles provide a pathway for international doctors to transition into the NHS.
Stability
: Non-rotational positions offer consistent career opportunities in the long term.
Challenges Encountered
Recognition and Respect
- Despite their extensive experience, these doctors often face a lack of acknowledgment of their seniority and expertise.
- Commonly misperceived as “junior” staff.
Career Development
:
- Limited access to professional training, leadership positions, and opportunities for career advancement.
- Competition with NHS trainees often exacerbates this disparity.
Induction and Support
:
- International medical graduates frequently experience insufficient induction processes, complicating their adjustment to the NHS.
Racism and Discrimination
- Reports of bullying and discrimination are prevalent and are often linked to ethnicity, gender, and accents.
Systemic Barriers
:
- Complex bureaucratic processes hinder the transition from LE to SAS
- Challenges in attaining recognition through portfolio routes like CESR (certificates of eligibility for specialist registration).
Proposed Solutions
Enhanced Induction Programs.
- Develop comprehensive onboarding initiatives for international medical graduates.
Recognition of Senior Roles
- Acknowledges SAS doctors as senior professionals capable of independent practice.
Training and Leadership Development
- Ensure better access to training, mentorship, and leadership opportunities to foster career growth.
Address Discrimination
:
- NHS trusts and national organizations must take proactive steps to eliminate workplace discrimination and promote equality.
Promote Inclusion Initiatives
- Implement measures such as the NHS Diversity and Inclusion Plan to create a more equitable work environment.
Call to Action
The NHS and its affiliated organizations are urged to take decisive steps to support SAS and LE doctors. This support is critical for retaining these professionals, optimizing their contributions, and improving patient outcomes. Programs like SASsix and initiatives by Royal Colleges serve as valuable examples, but broader and sustained efforts are required.
This report emphasizes the necessity of cultural and systemic changes within the NHS to fully harness the potential of doctors with SAS and LE.
