SAS advocates should not be necessary - but they are

It might seem bold, even contradictory, for someone who champions SAS doctors to say this, but SAS advocates should not be necessary. And yet, here I am, writing as one. So please, read on. 

Specialty and specialist (SAS) doctors are a vital part of the NHS workforce, but their roles, contracts and career pathways remain poorly understood. I’ve campaigned for years to improve the working lives of SAS colleagues, and they are highly visible in my own organisation. Still, I was taken aback when a consultant in another specialty turned to me and asked bluntly: "Imran, what is a SAS doctor anyway?"

This wasn’t a junior colleague unfamiliar with the term; this was someone who had worked daily alongside SAS doctors in their own department. 

The persistent problem of invisibility 

As SAS doctors, we often find ourselves explaining repeatedly who we are and what we do. It’s tiring and it can be embarrassing. 

During the WHO safety team brief, when colleagues introduce themselves, it is rare for a SAS anaesthetist or surgeon to specify their grade. And when they do, it often leads to confusion amongst the multi-professional team. 

Even after years in a SAS role, I am frequently asked by nurses: “So when are you becoming a consultant?”  It’s well-intentioned but reflects a deep-rooted assumption that a consultant post is the only satisfying career destination. 

Even clinical managers often misunderstand SAS doctors’ needs and ambitions. They know we’re essential to maintaining safe services, particularly out of hours. However, they don’t always recognise that we can and should progress. This contributes to the under-utilisation of the specialist grade and the lack of development opportunities.  

Many SAS doctors work in isolation, sometimes as the only SAS in their department, or some as the only SAS in their specialty. We’re often mislabelled as “middle grades” or “staff grades”, terms that either erase our potential or refer to contracts that closed nearly two decades ago. 

We’re a diverse group, in ethnicity, social background, country of qualification, neurodiversity and gender. These different characteristics can make us more vulnerable to being undermined or bullied at work. Much of this goes unseen by those who haven’t lived that SAS experience. 

In my own trust, colleagues rarely speak openly about the barriers they face. Many accept poor behaviours as part of the job. Escalating concerns can feel intimidating and futile, especially when leadership doesn’t understand the issues.  

Why the SAS advocate role matters 

All of this is exactly why the SAS advocate role is such a positive force. 

As an advocate in my own trust, I’ve worked to bring SAS doctors and their contributions into the spotlight. We’ve celebrated exceptional SAS doctors with awards, including Clinical Trainer of the Year. SAS colleagues have hosted staff webinars to highlight who we are and what we do. I meet regularly with medical workforce and senior leadership to press for better opportunities. 

Here’s what I have focused on: 

Impact on my organisation 

This work has made a difference. Our SAS workforce feels more recognised, valued and engaged.  Our trust has made the #SASsix campaign a board-level EDI priority. We’re contributing to a project board working towards better SAS careers. SAS doctors are applying for senior leadership roles, and more colleagues feel empowered to speak up.  

I know there’s still more to do. For some, the impact hasn’t yet reached them. Without the SAS advocate role, it’s hard to envisage how we will make further progress.  

The power of the SAS advocate network 

One of the most valuable parts of this journey has been the support from the SAS advocate network. Around 80 of us share ideas, advice and passion. We meet virtually and in person but the most useful is the peer support – being able to reach out to knowledgeable SAS leaders who understand the challenges is invaluable.  

Engaging local SAS colleagues remains the biggest challenge. Advocates across the country have tried creative approaches, especially during SAS Week where there’s friendly competition to host the most inspiring events.  

Why every trust needs an advocate 

Some trusts still haven’t appointed SAS advocates. In today’s financial climate, it’s tempting to question the value of funding these roles. But those making these decisions often don’t see the daily realities SAS doctors face. 

If a trust is content with its SAS doctors being under-recognised, disengaged, bullied and not fulfilling their potential, then perhaps the role will not be a priority. But no SAS tutor or SAS LNC representative has the capacity or remit to do what a dedicated advocate can.  

In an ideal world, SAS doctors wouldn’t face discrimination or exclusion. Sadly, that is not the world we live in. Until it is, SAS advocates are essential – not just for colleagues, but for the NHS as a whole.