SAS development guidance

Why developing SAS doctors matters

Sustaining high-quality patient care depends on doctors being supported in continuous learning and development. This goes beyond maintaining fitness to practise, it’s about equipping them with up-to-date knowledge and new skills to deliver the best possible healthcare.

Supporting the personal development of doctors benefits not only the individuals themselves, but also the wider health service. For SAS doctors to succeed, this means access to effective annual appraisals, study and professional leave, and mutually agreed job plans with appropriate SPA time.

Investing in development helps create a motivated and engaged workforce, which is strongly linked to better patient experience and improved service delivery.

SAS Charter and job planning

SAS Charter

To demonstrate a shared commitment to supporting and developing the role of the SAS doctor as a valued and vital part of the medical workforce, each nation has developed a charter for SAS doctor development. The charter set out what SAS doctors can expect from their employer and what the employer can expect from them.

NHS Employers has jointly published with the BMA, SAS charter resources to help employers and SAS doctors work together to assess their organisation’s progress and develop an action plan to support the implementation of the charter and incorporation of its principles into local procedures and policies. 

The charter is in the process of being updated to incorporate the 2021 specialty doctor and specialist contracts and we expect a revised version to be published in 2025.

Job planning

SAS doctors are contractually entitled to job plans that are mutually agreed and relevant to their roles. Job plans should be completed in good time and be reviewed at least once a year. Their personal development plan (PDP) from the relevant year’s appraisal should be considered at the time of job planning to ensure that the job planning process facilitates clinical development fulfilling aspirations within the PDP. Employers are responsible for ensuring that there are processes in place to record the discussions and outcomes following national TCS and guidance.

Job plans are contractually required to include SPA time, which will allow doctors to undertake development activities which can include audit, clinical governance, training and research in addition to the activities required for revalidation. Job planning should be undertaken in a spirit of partnership and balance the needs of patients, the employer and the wider NHS with the needs of individual doctors to undertake the agreed range of clinical and professional activities required for them to develop in their career. Within this context, it is expected that all parties will participate openly in the process and actively consider alternative ways of working to enable service improvements to be introduced. 

It is important that the activity delivered by doctors is aligned with the content of their job plans. The job plan sets out the scope of a doctor's work – that is, the combination of clinical and professional activities expected of their role – and their appraisal will consider activity delivered against this (see below).

See the SAS job planning guide for more information about job planning.

Appraisal and CPD

Appraisal

SAS doctors should have adequate time and support to allow them to fully participate in the annual appraisal process. This includes them being afforded the opportunity to gather sufficient evidence of the entire scope of their work.

Appraisal and revalidation requirements of SAS doctors are identical to all doctors that are not in training and therefore they should be recognised as being of equal importance and receive an equal amount of SPA time to engage with those processes.

The appraisal meeting is important to help agree and monitor professional and personal development. The process helps to identify learning needs and provide time for reflection of individual practice and performance. The Academy of Medical Royal College's (AoMRC) guidance on supporting appraisal for SAS doctors (PDF) can be used as a resource by the appraisers for an effective appraisal, irrespective of one’s specialty.

Continuing professional development (CPD)

Continuing professional development is vital for SAS doctors to keep up to date with their skills and competencies. There are many ways SAS doctors can develop, either through their own personal learning or via facilitated development sessions or away days.

The General Medical Council (GMC) continuing professional development guidance sets out:

54. Employers and contractors of doctors’ services are responsible for making sure their workforce is competent, up to date and able to meet the needs of the service. They should maintain and develop the skills of all of their medical staff whether they are consultants, staff grade ¹ , specialty or associate specialist (SAS) doctors, sessional general practitioners (GPs), locum doctors or trainees. They should also facilitate access to the resources (including the time to learn) that will support this.

CPD opportunities should be equitable irrespective of the grade with a mix of formal and informal learning, for example:

• reflection on data from audits, assessments, and feedback
• training courses
• peer reviews or peer tutoring
• specialty networks or programmes run by medical royal colleges
• collaborative working with other more senior clinicians for at least one session a week
• secondments or opportunities to act up into more senior roles for periods of time when required (for example, to cover absent colleagues).

SAS doctors have a contractual right to SPA time in their job plan, which covers participation in continuing professional development activities. SAS doctors are allowed up to thirty days of study leave (pro rata) in any period of three years, which could be used to undertake training that might support their professional development as per the TCS.

In addition, professional leave can be agreed to accommodate any external NHS duties.

Role of the SAS tutor and the SAS advocate

SAS tutor

The SAS tutor sits on local SAS doctor committees and local negotiating committees (LNC). This post was created to support and guide SAS doctors on education, training and career development. 

They are responsible for working within and reporting to those in the Trust’s education directorate to oversee the development needs of SAS doctors. SAS doctors who wish to discuss professional development such as the Portfolio Pathway or job planning can contact the SAS Tutor in addition to their line manager.

We would recommend that trusts appoint a SAS tutor to promote and support SAS doctors with professional development processes. Although not mandatory, it is desirable to have a SAS doctor in this role. 

SAS advocate

The SAS advocate works with the SAS tutor to improve the overall SAS doctor experience, but takes on more of a holistic role. The SAS advocate is responsible for promoting a high standard of health and wellbeing for SAS doctors and improving the recruitment, retention and visibility of SAS doctors. The SAS advocate reports to the chief medical director/officer and works with LNC representatives to raise the profile of SAS doctors and feedback any issues.

The SAS advocate acts as a champion for the grade and is the liaison between the SAS workforce and the employer. The SAS advocate understands their workforce and its wellbeing and development needs more than anyone else. For example, when vacancies arise in a trust, it is best practice to involve the SAS advocate in the appointment process with an option of using it as an opportunity for the trust to create a specialist post.

We would recommend that trusts appoint a SAS advocate in addition to the SAS tutor role. For more information, see our guidance on SAS advocates and how they are distinguished from SAS tutors.

Autonomy and coding / tariffs for clinical activity

Autonomy

Autonomous working means the capability of making medical decisions for patient care and carrying full clinical responsibility without direct supervision when working within one’s competencies. It could be defined as an individual’s self-governance that, with engagement from senior management, peer support and recognition, enables doctors to independently provide safe and effective patient care.

In the interest of patient safety, all NHS staff are subject to some form of supervision, whether from peers or lead clinicians. The terms and conditions do not prevent SAS doctors from working independently and ensuring staff are used to their full potential is beneficial for the employer, individual doctor, and patient care.

The specialist grade is expected to work autonomously to a level of defined competencies, as agreed with local clinical governance frameworks.

Many SAS doctors already work as autonomous practitioners. There are several benefits to encouraging and enabling autonomous practice, where it is appropriate. These can include:

• recognition of the high level of clinical skills and professionalism in the SAS doctor grade
• provision of personal and professional development opportunities for SAS doctors within the trust/organisation
• the opportunity to have greater medical engagement of SAS grades
• support for the recruitment, retention and motivation of highly skilled clinicians
• empowerment of doctors to work to their highest potential, benefiting the service and patients
• improved governance and accountability.

In practice, the level of supervision will depend on several factors, including personal competence and agreed accountability arrangements for all aspects of the role.

All specialist doctors can work autonomously to a level of defined competencies, as agreed within local clinical governance frameworks.

Specialty doctors at the highest level will have gained specialist knowledge and expertise. They may seek to work autonomously within established boundaries of responsibility, with such agreements being determined locally and according to local practices.

Where SAS doctors are working as autonomous practitioners, this should be formally recognised through coding of clinical activities. This can then be referred to as accurate data to aid the revalidation and appraisal process.

Trusts’ clinical governance arrangements should reflect this guidance, and trusts should have an autonomous working policy in place. Those SAS doctors who would wish to develop into autonomous practitioners should be encouraged to do so and these aspirations should also be incorporated into both their job planning and appraisal processes. The Academy of Medical Royal College's (AoMRC) guidance on autonomous working (PDF) can be used alongside BMA guidance.

Coding / tariffs for clinical activity

Personalised information on activity and outcomes was a feature in Sir Keith Pearson’s review of medical revalidation. It is vital for patient safety to know how many procedures an individual doctor has done to demonstrate on an ongoing basis that they are up to date and fit to practise. It is also important for medical appraisal to accurately audit who has undertaken what work. If the numbers of procedures and outcomes are known, supervisors can support individual doctors in identifying learning through an agreed PDP to improve their practice.

Accurate patient coding is extremely important for a number of other reasons:

• it is good medical practice for patients and their families to know the name of the senior doctor in charge of caring for a patient
• it is important for appraisal and pay progression to accurately audit who has undertaken what work
• it is important for staff morale, recognition and job satisfaction.

The NHS e-referral service has a patient coding function that enables the coding of named clinicians, including SAS doctors. In some hospitals, where patients are under the care of a SAS doctor, this is accurately reflected in the local records, however this can be sporadic. Further work is needed to ensure this becomes common practice across the UK.

Mentoring and the Portfolio Pathway

Mentoring

Mentorship is beneficial to all SAS doctors regardless of career stage as it supports both personal and professional development. It’s particularly helpful for those new to an organisation or department and those in the early stages of their SAS career.

The GMC's Good Medical Practice recommends that it’s good practice to find and take part in structured support opportunities, such as mentoring or coaching schemes. 

As set out in the AoMRC's SAS Workforce and mentorship publication, mentoring has benefits to doctors, both the mentor and mentee, their employers, the wider NHS and patients. This activity promotes a sustainable SAS career, and appropriate recognition should be given to its professional and organisational value by being included in job plans.

Many Royal Colleges offer their own mentoring and leadership programmes. Clinical leaders are encouraged to explore the possibility of mentorship for SAS doctors within departments. Senior SAS doctors can provide mentorship with the support from employing organisations.

Portfolio Pathway (previously CESR)

Although the majority of SAS doctors wish to actively pursue careers in the SAS grades and should be supported and developed in their roles within these grades, some may wish to progress their careers by qualifying for the GMC's specialist register or general practice registration via the Portfolio Pathway (previously CESR). To do this, SAS doctors need to demonstrate that they have the knowledge, skills and experience (KSE) for specialist practice in the UK. The framework for assessing KSE will reflect the high-level learning outcomes of the relevant specialty curriculum.  

Most Royal Colleges provide access to e-portfolios for SAS doctors, which are a good way to log all work-based assessments and obtain multiple consultant reports. The AoMRC has worked with the Royal Colleges to encourage access to e-portfolios for SAS doctors who require it. The AoMRC's guidance, Access to college education e-portfolios for SAS doctors, provides more information.

There are routes by which a SAS doctor can apply for specialist registration. Details of these are available on the GMC’s website.

Employers should assist and support SAS doctors in meeting the requirements of a Portfolio Pathway application. Everyone will have unique circumstances and therefore different requirements of support. This could include secondment opportunities, support when sitting exams, or arranging for the applicant to be released from their post for a period of time to undertake top-up training.

SAS dentists can apply through the Specialist List Assessed Application route to join one of the specialist lists.

Regardless of whether the Portfolio Pathway is pursued, it should be standard practice to have development conversations with SAS doctors during their appraisal, with any agreed plans documented to track progression.

Non-clinical roles

While SAS doctors often primarily focus on the delivery of direct clinical care, they can also take on non-clinical roles to the benefit of both the doctor’s personal development and the service more broadly. These roles could include:

• medical management (for example, medical director, associate medical director, clinical director, subspecialty lead, or taking a leadership role in trust clinical management meetings)
• governance leads (at departmental/divisional and director level)
• appraisers (for example appraisal lead)
• educational and clinical supervisors ²  (for example, training program director, college tutor, director of medical education)
• Caldicott guardian
• LNC SAS representative and LNC chair
• guardian of safe working hours (who is responsible for overseeing compliance with the safeguards outlined in the 2016 TCS for doctors and dentists in training)
• induction and recruitment (for example, being the point of contact on the job advertisement, being part of the shortlisting panel, and being on the interview panel)
• SAS tutors
• SAS advocates
• clinical leads in relevant specialty
• audit leads.

There are clear benefits to involving SAS doctors in these roles. For example, increasing the number of available appraisers has the benefit of increasing the flexibility of appraisal programs. SAS doctors will also be perfectly placed to understand what other new SAS doctors need in their induction. This could include providing information about the organisation, the department, or SAS development. The AoMRC has produced guidance, Leadership Development of SAS doctors which can be a useful reference document.

SAS doctors should be encouraged to apply for these roles and provided with training (e.g. to become an appraiser) as appropriate. At present, SAS doctors are underutilised in these positions ³  and efforts should be made to ensure that the NHS is both recognising and fully tapping into the skills and expertise of this cohort.

Note the above list is not exhaustive. There are no medical leadership roles that should not be equally appropriate for SAS doctors, and other opportunities for SAS involvement in non-clinical roles should be considered as they arise.

Career development and the SAS contracts

In 2021, the new specialist contract was introduced, creating a senior grade to which SAS doctors could be appointed and which appropriately recognised and remunerated them for their level of clinical experience and contribution. This once again established a clear pathway for career development in the SAS grades.

The specialist role presents the opportunity for highly experienced specialty doctors to progress in their career and work autonomously within their specialty. The scope and practice for the specialist grade, including the roles and responsibilities have been developed in partnership between the AoMRC, the BMA and NHS Employers.

Acting up clause

Schedule 19 in the 2021 specialty doctor (PDF) and specialist TCS (as well as Schedule 28 in the 2008 specialty doctor TCS and Schedule 21 in the 2008 associate specialist TCS) outlines the circumstances in which SAS doctors may be required to perform duties of a higher grade temporarily.

It is encouraged that organisations review their workforce and consider this Schedule when a colleague is absent for a period of one month or more. SAS doctors must be remunerated appropriately as set out in the Schedule.

Utilising Schedule 19 can help with temporary workforce issues, allowing existing members of staff to act up into a higher position and enabling them to develop and demonstrate their capabilities.

More information for SAS doctors acting up can be found on the BMA’s website.

SAS doctors may also provide cover for consultants as acting consultants. They do not need to be on the specialist register to do so. All SAS doctors who act up to consultant level should receive a separate, mutually agreed temporary job plan, distinct from their substantive one, and receive an acting up payment to bring their rate of pay up to the rate of pay they would receive on appointment to the consultant grade (as set out in Schedule 19 of the 2021 TCS).

Later careers and retirement

While the age profile of the SAS workforce mirrors that of consultants, their scheduled work profile can often resemble that of trainees. This can affect their work-life balance choices during their later career and influence retirement decisions.

There should be equitable opportunities for SAS doctors to consider their choices and make decisions that benefit both parties. Employers need to create a system where conversations with SAS doctors about their later careers and retirement are standard practice. 

Stakeholder actions to support the SAS workforce

Actions for NHS boards

Board members should consult regularly with the SAS advocate, SAS tutor and SAS doctors to understand the work they deliver and any necessary support they need.

Boards can ask their medical directors to report on a range of measures to gain assurance that the organisation is optimising the use of the skills and abilities of their SAS doctor workforce.

SAS doctors should have parity of opportunity with other staff groups. Through the SAS tutor and SAS advocate, boards should ensure that SAS doctors are provided the same opportunity as their other medical colleagues to take part in essential activities, including SPA, revalidation and appraisal. In addition to collecting data on this, boards must ensure that the data is analysed to identify any areas of concern. Plans should be developed and implemented to address any such issues.

Additionally, boards should embed standard processes.

Further measures for boards to consider

Beyond this, we also recommend the board ensure the following further measures.

Actions for medical directors/clinical directors/directors of education

Actions for SAS doctors

Actions for medical staffing and human resources

Development at each career stage

As part of personal and professional development, SAS doctors may wish to consider the next steps in their career. 

To help form discussions with employers we have listed some suggestions split into early, mid and late career stages; this list is not exhaustive and is to be used to support conversations, some points can refer to all career stages.

Early career

A SAS doctor at the early stages of their career (entry level – five years) will be establishing themselves within their role. You may wish to consider:

• Engaging with an educational supervisor, if not offered straight away, speak with your employer.
• Asking your employer for mentoring, coaching or a buddy system.
• Networking and making connections within your organisation, especially the SAS advocate and SAS tutor.
• Identifying your support needs and discussing these with the relevant people in your organisation.
• Planning and preparing for your appraisal.
• Preparing for revalidation.
• Developing your interests in clinical and non-clinical work and meeting regularly with your seniors to discuss development.
   

Mid-career

Mid-career SAS doctors are more established and experienced within their roles. They may be looking towards the next point in their career or looking to enhance their current skills. In mid-career you may wish to consider:

• Engaging in more learning from senior colleagues, building on existing specialist knowledge and skills.
• Undertaking additional non-clinical roles, such as an appraiser or educational supervisor.
• Undertaking audit and quality improvement work.
• Taking on management responsibilities.
• If a specialty doctor, considering gaining experience to apply for a specialist role.
• Supervising early career stage colleagues.

Late career

SAS doctors in their late career will likely be working autonomously and able fulfil a range of duties. At this stage, you may wish to consider:

• Undertaking management roles at regional or national level.
• Supervising colleagues.
• Undertaking academic research and service development.    

National resources