The FAQs for the new SAS contracts have been agreed and updated with the British Medical Association (BMA).
These frequently asked questions (FAQs) on the specialty doctor and specialist grade contracts have been updated in agreement with the British Medical Association (BMA).
1.1 Will ESR be ready for implementation of the changes to pay by April 2021?
We are working with colleagues from ESR to ensure that the system will be prepared and ready to support the changes to pay as part of any implemented deal. ESR have assured us that the system will be ready to pay staff the new pay rates in April.
1.2 How much investment has been made available for reform?
Investment has been agreed to cover the reforms to pay and TCS for SAS doctors currently on national contracts who transfer to the new specialty doctor and specialist contracts. The total investment in contract reform is equivalent to up to 3 per cent per annum on average per person for full-time equivalent doctors who transfer to the new contracts. This includes changes to pay and TCS.
The investment will cover three years (2021/22 to 2023/24 inclusive) and is of a similar level per person to investment made for other recent NHS contract reform agreements, such as for Agenda for Change (AfC) staff and doctors in training. As the investment is for SAS doctors currently on national contracts who transfer to the new contracts, the total level of investment will be dependent on the number of staff transitioning to the new contracts, following the choice exercise between 1 April and 30 September 2021.
The level of investment will vary per person as each doctor who chooses to transfer will have an individual pay journey with certain changes to their pay scale. Doctors who choose not to transfer to the new contracts will be covered by the standard pay review body process for determining annual pay uplifts, including the standard route of funding.
1.3 How is the funding it distributed to employers?
NHSEI will confirm SAS reform funding amounts and timings for 2021/22 in due course, following the government’s response to the independent recommendations of the Doctors’ and Dentists’ Review Body (DDRB) and decisions on the wider system financial planning process for October 2021 to March 2022.
1.4 Will it be for employers to fund the new specialist posts themselves or will this be funded centrally?
Employers will be expected to use their overall allocations to fund new specialist posts themselves. The modelling for the SAS deal took into consideration the expected creation of new specialist grade posts in organisations using workforce data from the past 10 years and a survey of employers describing their intended use of the new grade.
1.5 How is the one per cent held back from the last DDRB round included in the cost envelope?
In the first year, the three per cent incorporates the one per cent carried over from the government response to 2019/20 DDRB recommendations.
1.6 Does the additional funding take in to account the reduction in the number of pay points and the faster progression?
Yes, all aspects of reform have been fully considered in the cost modelling of the proposed deal.
1.7 What will happen at the end of the three-year period?
The default position for pay awards from 1 April 2024 would be a return to the standard process of the government responding to pay recommendations from the DDRB.
1.8 Are Scotland, Wales and Northern Ireland going to have the same deal?
Negotiations occurred on a three-country basis between England, Wales and Northern Ireland. Whilst all three deals are underpinned by the same principles, there are slight variances between each deal. Scotland is negotiating their own deal for SAS contract reform.
2.1 Will all staff be better off financially under this agreement?
The funding represents the level of investment being offered for contract reform as a whole, some of which has been focused on making changes to the existing pay scale.
This happens gradually over three years, using temporary transitional pay scales to reduce from eleven pay points down to five in the specialty doctor scale. The overall level of funding is applied differently to different points on the scale. Individual pay journeys are detailed in the framework agreement.
2.2 What happens to incremental dates under the proposed deal? Will these be changed?
No, everyone will retain their existing incremental dates but this will now be called the pay progression date. For new entrants to the NHS, their pay progression date will be the date that they commenced employment in the grade.
2.3 Where should we place doctors who are appointed to a role from abroad on the new pay scales?
As was already the case under the 2008 specialty doctor contract, employers may set basic salary at a higher pay point than the bottom of the pay scale to recognise non-NHS experience in the specialty at an equivalent level. It will be for employers to determine whether an applicant’s experience is equivalent to that of the specialty doctor or specialist roles, in line with existing national guidance for the roles.
2.4 We are looking to appoint a doctor to the 2021 specialist grade contract who is currently a specialty doctor at the top of the 2008 specialty doctor pay scale and paid more. Where should we place them on the specialist grade pay scale on appointment?
This issue results from higher than assumed national pay awards being applied by government to those doctors remaining on the closed 2008 specialty doctor contract in response to DDRB recommendations.
The 2021 TCS does contain additional benefits for doctors and any pay disparity is likely to diminish over time (subject to future pay awards). However, if the disparity in pay is causing problems with recruitment, then employers can consider the application of a short-term non-pensionable recruitment and retention premia (RRP) for any new starters affected by this issue. In such circumstances doctors should be placed at the start of the specialist pay scale and a RRP agreed to ensure the doctor is paid no less than their previous specialty doctor salary. Employers need to be mindful of any local RRP policies in place and only use RRP when all other avenues to rectify a recruitment challenge have been exhausted. Employers should state the timeframe of the RRP in the doctor’s contract and evidence the recruitment challenge posed by the multi-year pay deal as a justification for the temporary enhancement.
We would encourage employers to consider a trade union agreement, following consultation, and seeking their own legal advice when developing a local policy to mitigate the pay disparity for affected staff .
3.1 How does pay progression work during the three years of the deal?
Due to the transitional nature of the pay scale over the three years of the deal, SAS doctors pay changes every year rather than every three years as intended in the final pay structure from 23/24 onwards.
For this reason, parties agreed to not introduce the pay progression review meeting element of the new contract until 1 April 2023. This is in order to make the process less burdensome for both employers and SAS doctors during the transitional period.
For the first two years of the deal, employers should continue to use their local processes to manage pay progression against the pay progression requirements that are set out in the respective specialty doctor and specialist grade contracts. Staff will retain their existing incremental date throughout transition, but this will now be called their ‘pay progression date’. On this date each year, it is expected that SAS doctors will move to the next pay point reflecting their additional complete year of experience, unless as is the case now, a doctor has not met their pay progression requirements.
Employers should continue to manage progression as per their local arrangements and progression can be withheld if the required standards set out in Schedule 13 are not met.
In the third year of the deal, starting on 1 April 2023, the new pay progression review meeting arrangements will start, and automatic progression in ESR will be turned off. Employers must follow the new process outlined in schedule 13 of the TCS.
3.2 Is it expected that staff will successfully progress through their pay progression points?
Yes. Employers should plan and budget on the basis that all SAS doctors are expected to progress on time. The exception will be where an individual has not met the criteria for progressing to the next pay point, and there are no mitigating factors sufficient to justify this. Schedule 15 covers situations where progression may be delayed. Employers have a responsibility to ensure that doctors have the support needed to enable them to meet the requirements for incremental and career progression.
3.3 If automatic annual progression in ESR is being turned off, is it possible to turn it back on again locally?
No, not once it is turned off. Automatic progression will continue to be available in ESR up until 31 March 2023. From 1 April 2023, automatic progression will end for all SAS doctors on the 2021 contracts and employers will have to follow a process to ‘switch on’ pay progression for individuals.
3.4 What happens if someone is off on sick leave or maternity leave when their pay progression is due?
The law prevents anyone from being treated less favourably in certain circumstances, for example if they are on maternity leave. Schedule 15 sets out the process to follow when a SAS doctor is absent from work when their pay progression is due.
3.5 How long should it take to progress from the bottom to the top of the specialty doctor or the new specialist pay scales?
The minimum length of time it should take to progress from the bottom to the top of the specialty doctor pay scale is 12 years, subject to individuals meeting progression criteria. For the specialist grade, this is six years subject to meeting progression criteria.
3.6 Can organisations let SAS doctors get to top of the pay scale more quickly than the minimum periods set out?
No, allowing people to progress more quickly would undermine the principles of the pay system and place additional unfunded costs on to the employer.
3.7 How will the new progression system work when SAS doctors move employers?
A SAS doctor’s pay progression date will remain the same and move with them to the new employer. If a doctor moves to a new employer shortly before pay progression is due, the new employer will be expected to carry out the review required, within three months of the date that the doctor begins work for the new employer. If progression is granted, pay shall be backdated to the pay progression date. ESR will ensure relevant information is recorded on to the system and included in Inter-authority transfer (IAT) information.
3.8 Does an informal process or investigation into capability or conduct count as a reason to defer pay progression?
No, the pay progression criteria explicitly references formal capability processes and disciplinary sanctions, setting out the circumstances in which these can be reasons for deferring pay progression. These note that specifics of such processes are set out in local policy, though such policies will need to take account of the provisions of the maintaining high professional standards framework to which doctors and dentists in the NHS continue to be subject.
4.1 How many additional days of annual leave have been agreed?
One additional day of annual leave has been agreed for doctors who have completed a minimum of seven years’ service in a SAS grade. The annual leave entitlement now also includes the two extra statutory days that were available in England in previous contracts. These should not be given on top of the annual leave entitlement stated in Schedule 15 of the TCS.
Any locally agreed arrangements that sit outside of the national contracts remain at the discretion of the employer and it is not intended that the new contractual entitlements will replace any locally agreed arrangements relating to annual leave entitlement.
4.2 Are there any changes to supporting professional activities (SPA) time in the contract?
The contracts continue to set a minimum of one PA to be allocated to SPA time. The contracts now make explicit that this minimum of one SPA is specifically designated for job planning and meeting requirements for appraisal and revalidation.
We have produced further guidance on SPA to assist employers and doctors in jointly identifying the benefits such activity offers for individual development and supporting organisational objectives.
4.3 Should the 60 per cent in hours and 40 per cent out of hours be calculated in hours or PAs?
Schedule 4, paragraph 11 of the SAS terms and conditions states:
The majority (that is, no less than 60 per cent) of work should normally take place in standard working hours being 7am to 9pm Monday to Friday, rather than in out of hours (OOH) which is 9:01pm to 6:59am Monday to Friday and all day Saturday and Sunday, unless otherwise mutually agreed.
Where existing job plans contain in excess of 40 per cent of work in OOH, the employer and doctor will work towards decreasing the percentage each year until a limit of 40 per cent is reached, unless otherwise mutually agreed.
The 60/40 per cent split should be calculated accordingly to ensure that it meets all contractual safeguards and will be determined locally. Examples are provided below for illustrative purposes.
Job planning is based on a partnership approach and confirmation of working hours should be mutually agreed upon at the job planning meeting and then reviewed at annual or interim meetings.
Example 1 - Calculating in hours.
36-hour job plan with 12 hours worked within the hours of 9:01pm to 6:59am Monday to Friday and all day Saturday and Sunday (out of hours) and 24 hours worked within the hours of 7am to 9pm Monday to Friday.
To calculate the out-of-hours percentage, divide the out-of-hours total by the total number of hours worked and then multiply by 100.
12/36*100=33.3% As this is lower than or equal to 40% this meets the safeguard requirement.
Example 2 - Calculating in Programmed Activities (PAs).
10 PA job plan with 4 PAs worked within the hours of 9:01pm to 6:59am Monday to Friday and all-day Saturday and Sunday (out of hours) and 6 PAs worked within the hours of 7am to 9pm Monday to Friday.
To calculate the out of hours percentage, divide the out-of-hours PAs by the total number of PAs and then multiply by 100.
4/10*100=40% As this is lower than or equal to 40% this meets the safeguard requirement.
5.1 What is the entry criteria to the new specialist grade?
The entry criteria for a doctor/dentist requires:
- Full registration and a licence to practice with the General Medical/Dental Council.
- A minimum of 12 years medical/dental work (either continuous period or in aggregate) since obtaining a primary medical/dental qualification, of which a minimum of six years 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/dental grades including from overseas will also be accepted.
- To meet the criteria set out in the specialist generic capabilities framework.
The 12-year minimum is applicable to both full time and part-time employees. The requirement of a minimum of six years in a relevant specialty is not intended to advantage or disadvantage any grade of doctor. Experience of six years in a relevant specialty in any medical/dental grades including from overseas is accepted.
5.2 What is the specialist generic capabilities framework and how should it be used?
The specialist generic capabilities framework has been developed in partnership between the Academy of Medical Royal Colleges, the British Medical Association and NHS Employers. All the capabilities listed in the Framework are taken from the General Medical Council’s Generic Professional Capabilities Framework. It outlines the core capabilities and skills expected across all specialties for safe working practices at this senior level. Doctors/ dentists will need to evidence they meet these criteria in order to successfully enter the grade.
The framework is intended to support employers to create individual person specifications, which will be tailored to the specific requirements of the role. As the overarching framework is generic in content, any specialty-specific, practical or surgical skills that are required will need to be defined in the person specification. A template person specifications to help employers develop a clear description of the requirements for an individual role has also been produced.
The appointment process for the specialist grade will not be incorporated into the TCS; support on how to appoint to these roles will be provided in guidance. This will include engagement with the medical and dental Royal Colleges.
5.3 How is the entry criteria structured in the generic capabilities framework?
The entry criteria is detailed in the generic capability framework under the following themes:
- Professional Values and Behaviours, Skills and Knowledge
- Leadership and Teamworking
- Patient Safety and Quality Improvement
- Safeguarding Vulnerable Group
- Education and Training
5.4 How are the medical Royal Colleges and the faculties supporting this process?
The Academy of Medical Royal Colleges, the British Medical Association and NHS Employers have agreed to work together on the appointment of staff to ensure that the highest standards of professional medical practice in NHS employing organisations are maintained in the interests of patients and the quality of care provided by those organisations. The parties agree that independent professional medical advice has an important role to play in the ability of NHS employing organisations to make the best possible appointments to the newly formed Specialist grade.
The appointments process should include external input from the relevant Royal College, the details of which will be set out in a formal concordat jointly agreed between the parties [to follow]. The concordat will confirm the process for developing Specialist person specifications and the recruitment and involvement of Royal College/Faculty assessors in the appointment process.
5.5 How is a person specification for a new specialist grade grade created?
The clinical lead from the employing organisation should draw up the person specification using the person specification template provided, identifying more specialty-specific capabilities that may be required and the evidence needed to support these through a review of the relevant part(s) of the College or Faculty curricula. Where the clinical lead judges that further input is required, they should look to work with the College or Faculty’s Regional Adviser (or equivalent) in developing this person specification and reviewing the curricula. The clinical lead should inform the employer position on the relevant sections of the curricula and the appropriate levels of competence that would need to be reached, taking into account the advice offered by the College or Faculty’s Regional Adviser (or equivalent) where this has been sought.
Where there is an accepted national standard or statutory requirement for a specialty-specific competence (for example, child protection), this should be stipulated in the person specification and will need to be demonstrated by candidates to the appropriate level.
5.6 Determining which capabilities are ‘key’ for the post and those that are ‘required but not key’
As all the capabilities listed in the Framework are taken from the General Medical Council’s Generic Professional Capabilities (GPCs) Framework, they are required of all doctors. We expect the majority of capabilities listed will be key for the posts, but some may not be as relevant in certain roles, e.g. where there is no active involvement in formal research or teaching and training. Rather than using the language ‘essential’ or ‘desirable’ in the template person specification, all capabilities should therefore be categorised by the employer as ‘key for the role’ or ‘required but not key’. For those which are ‘required but not key’, the same depth or level of expertise may not be needed.
Capabilities listed should not be removed by employers in developing individual person specification. However, some may need to be amended or contain additions to reflect specialty-specific skills. If, in certain instances, an employer considers a capability ‘not applicable’ they should indicate this and, in the interests of transparency, explain their decision.
5.7 How should employers use the person specification template for a new specialist grade post?
The capabilities framework for the new specialist grade have been created using the General Medical Council’s (GMC) Generic professional capabilities framework. The GMC’s framework sets out the essential generic capabilities needed for safe, effective and high quality medical care in the UK and is required of all doctors.
The expectation is that the majority of capabilities listed in the framework for the new specialist grade would be considered key for the role, but it is the employer’s responsibility to ensure that the depth of knowledge and expertise required is appropriately reflected in the person specification, which will be based on the specific requirements of the post being created.
In addition to consulting the relevant college/faculty curriculum to support the development of the person specification, employers should refer to the ‘notes on person specification template - examples of specialty-specific criteria and guidance for reference’. This supporting document provides illustrative examples indicating where specific capabilities may need to be amended or strengthened for particular specialties.
5.8 When considering the capabilities in respect of professional values and behaviours, skills and knowledge there is a requirement to clinically evaluate and manage patients (ref. 1.3). What is meant by the term ‘appropriate management plan’?
This refers to the plan for treatment of the patient, and depending on the nature and responsibilities of the role, can include decisions about discharge and discharge planning, referral and follow ups as appropriate.
5.9 What is the rationale for a minimum of 12 years medical/dental work (since obtaining a primary medical/dental qualification, of which a minimum of six years should have been in a relevant specialty in the specialty doctor and/or closed SAS grades) to be set as entry criteria to the new grade?
Employers needed to ensure that progression from the junior doctor grade to the consultant grade remains an attractive career pathway. Setting the criteria to below 12 years to enter the new specialist Grade would most likely create unwelcome incentives that could encourage juniors into that grade rather than progressing to a consultant grade. Employers also wanted to ensure that the specialty doctor is viewed as a destination grade with attractive pay scales. Reducing the entry requirement to below 12 years would mean that the specialist grade would be a financially attractive option part way through the specialty doctor grade. Additionally, entry into a consultant post requires a minimum of 10 years of experience through the training pathway. Completion of the training pathway (CCT secured) is not a requirement to enter the specialty doctor or specialist grades so it is reasonable to extend the entry criteria in recognition of the different training pathways undertaken.
5.10 If an assessor is not available how should an employer ensure that their appointment processes are robust enough to secure suitable appointments to the grade?
Input from the Royal Colleges is beneficial for all parties and should be included early in the recruitment process to secure the appropriate input and time commitment. Where no assessor is available local arrangements should be made to secure the appointment of suitable candidates.
5.11 What happens if the appointed assessor has concerns about how the employer has applied the capabilities framework to inform the development of the person specification?
Any concerns on the grounds of patient safety will need to be directed to the employer for local resolution. Since the role of the Royal Colleges is to provide advice, their views may sometimes differ from those of the employing organisation but we find that discussion should enable a mutually satisfactory agreement, facilitating a good appointment
5.12 Will a substantive specialty doctor be at risk if a specialist post is created, at their current employer, and their application for the post is not successful?
This will not be the case. As set out in FAQ 1.4 above, employers will be expected to use their overall allocations to fund new specialist posts themselves.
Discussions about the creation of specialist roles should be about the need to redesign the workforce according to service needs, not about employing fewer specialty doctors. For example, if there is a locum consultant post, this could be disestablished and a permanent specialist role established.
6.1 How do the transitional arrangements work?
the process of transition for existing SAS doctors currently on national contracts is set out in section 5 of the framework agreement and schedule 20 of the new specialty doctor and specialist contracts. Annex C of the framework agreement also includes transfer flowcharts for both of the new contracts.
We have also produced a checklist and template transfer letter to assist employers with the process.
6.2 If a doctor transfers to one of the new contracts what happens to their incremental date?
The incremental date will not change, but it will now be called their pay progression date.
6.3 Will doctors on local or trust grade contracts be able to move to the new 2021 SAS contracts?
the negotiations did not cover those doctors who are on local or trust grade contracts and the costs of transferring these doctors have not been factored in the modelling. We hope that the new contract package will be sufficiently attractive for employers to offer to those on local contracts. However, there is no obligation for employers to offer this contract to those not already on national contracts and there is no obligation for any individual to accept the new contracts.
6.4 What happens if a doctor is on maternity leave, sick leave or other approved absence during the period when the new contract is being offered?
If a doctor is absent for a significant period of time during the choice window, doctors should be given an extended period, to be agreed between the doctor and the employer, in which they can raise an expression of interest.
6.7 How will contracts for clinical medical officers (CMOs), senior clinical medical officers (SCMOs), hospital practitioners (HPs) and clinical assistants (CAs) be rebased to the new specialty doctor contract?
Full time CMOs/SCMOs work 37 hours per week so if they are wanting to transfer to the 2021specialty doctor contract, their contracts will need to be rebased to 40 hours.
For these doctors wishing to transfer to the specialty doctor TCS as full time, their basic salary on the new specialty doctor (2021) contract from 1 April 2021 would be the next highest pay point above their NHS basic salary on 31 March 2021. Thereafter, their detailed pay journey would be the same as any other specialty doctor (2008). Where the next highest pay point applies to more than one line in the pay scale in table, the doctors’ detailed pay journey would follow the first instance of that pay point. In other words, they transfer to the bottom of the next highest pay level.
If the doctor chooses to remain on a 37-hour contract their pay will be calculated at 37 hours instead of 40 (0.93 WTE) and they will be offered a proportionate number of programmed activities (PAs) and their salary will be pro-rata to that of a full-time doctor.
6.5 Can an associate specialists move to the new specialist contract (and specialty doctors to the new specialty doctor contract) after the six-month window of opportunity?
Once the choice window has ended, SAS doctors will lose their right to transfer to the new TCS. An employer and an associate specialist and specialty doctor can agree that they be allowed to transfer to the new contracts outside of the window of opportunity, provided they meet the necessary entry criteria. This transfer and the arrangements of transfer are at the discretion of the employer and the transitional arrangements set out in Schedule 20 do not automatically apply.
There are exceptions to the 6-month window for exceptional circumstance where someone is out on long-term absence during that period, such as those on sickness absence or parental leave.
6.6 As the contracts introduce NHS enhanced shared parental leave, what happens to those who go on such leave during the choice window?
If a doctor is absent from work for a significant period during the choice window, for example for reasons such as caring/ sick leave or a secondment, the principle of equal and fair treatment should be followed so that no detriment is suffered as a result. Doctors will be given an extended period, to be agreed between the doctor and the employer, in which they can raise an expression of interest to transfer to these terms and conditions.
Under the principal of fair and equal treatment, such employees will then fall under paragraph 9 of Schedule 20 which enables backdating of any additional or reduction of payment to the Effective Date due to the enhanced Shared Parental leave arrangements.
7.1 If an employer is offering a secondment opportunity to a SAS doctor, for example to allow them to gain further experience to support them in CESR processes, under what contractual arrangements should they be employed?
It will be for an employer to decide on what the terms the secondment is being offered. The simplest option, to facilitate their clinical activity and to ensure that there are no concerns about indemnity or clinical governance, is to offer an honorary contract that is aligned with the terms of the 2021 specialty doctor or specialist contracts.
7.2 How will I know the expected total SAS Doctors’ Development Fund for my organisation for 2021/22?
Employers should calculate their indicative share of the total available (£3.0m in 2021/22) using the April 2021 SAS doctor FTE included in the monthly workforce statistics published by NHS Digital.
The total FTE number of SAS doctors in scope in their organisation (across associate specialist, specialty doctor, staff grade hospital practitioner / clinical assistant) can be found in Table 3 of the NHS Hospital & Community Health Service (HCHS) monthly workforce statistics (HCHS staff by NHS England region, Organisation and main staff group - full time equivalent) NHS Digital statistics. This can then be divided by the total FTE number of relevant doctors for England to calculate your indicative share of the total available (£3.0m in 2021/22).
For example, in April 2021 there were 10,605 SAS doctors (FTE) in total in England. If Organisation A has 100 SAS doctors (FTE), the calculation would be:
- £3.0m divided by 10,605 = £282.881 (This is the result of dividing £3.0m by the precise FTE value derived from summing the precise FTE values in the NHS Digital publication).
- Multiplied by 100 = £28,288
SAS development funding was embedded in the uplift to systems’ financial envelopes in the second half of 2021/22. For different reasons, some employers may not yet have been able to use this money in 2021/22, including lack of clarity on how to calculate funding available. If these funds have not been spent by the end of the 2021/22 financial year, organisations are encouraged to have pragmatic local discussions about how they can meet this financial commitment going forward and in line with guidance.
It is important to note that this money is specifically intended to be spent on SAS doctor development and cannot be redirected elsewhere.
7.3 How will I know the expected total SAS doctors’ development fund for my organisation for 2023/24?
Funding is based on an indicative £304 per FTE, organisations can calculate an indication of the funding received by multiplying by their own staff numbers (based on the January 2023 SAS doctor full time equivalent (FTE) data for SAS doctors in scope (covering associate specialist, specialty doctor, staff grade hospital practitioner/clinical assistant).
For example, if Organisation A has 100 SAS doctors (FTE), the calculation would be:
- 100 (FTE) multiplied by £304 = £30,400.
Organisations are encouraged to have pragmatic local discussions about how they can meet this financial commitment going forward and in line with our published guidance.
It is important to note that this money is specifically intended to be spent on SAS doctor development and cannot be redirected elsewhere.