Until early 2023, Ms Jane Shearer’s clinical position was described in two ways: associate specialist in oral and maxillofacial surgery and specialist in oral surgery.
Any dentist wanting to join one of the General Dental Council (GDC) 13 specialist lists, akin to being on the specialist register of the General Medical Council (GMC), must complete specialist training to achieve a certificate of completion of specialist training (CCST). In addition, there is a non-CCST mediated entry route (equivalent to a Certificate of Eligibility for Specialist Registration (CESR) in medicine), however this has been paused. Read Hesham Emam’s story to understand what it means to develop a special interest in oral surgery.
When Jane qualified as a dentist, there was no specialist training pathway. At that time, there were two specialist lists: one for surgical dentistry and another for oral surgery. Ms Shearer, like many others, was grandfathered onto the surgical dentistry list (ie joined the list exempt from the entry regulations later introduced). She joined the specialist list in oral surgery, in 2002, via the assessed application route (similar to CESR). “I had to prepare all my evidence. I had to go to the GDC and present my evidence in their courtroom” says Jane. She adds: “It was quite a difficult thing to do. It took a lot of work.”
Jane says the support she received from Joe McManners, Consultant in Oral and Maxillofacial Surgery (OMFS), was valuable in enabling her to compile the dossier of evidence she needed. Joe, now retired, has supported several dental colleagues to join the specialist list in oral surgery, including attending hearings at the GDC offices in central London. Regarding Jane, he recollects: “She did it all herself. As far as I was concerned, it was just normal encouraging. She was the person who drove all this.” He described Jane as “a very educationally driven person.”
Jane became one of the first members of the British Association of Oral Surgeons. Several years later, the specialist list in surgical dentistry merged with the specialist list in oral surgery.
Entry to the specialist list did not lead to a consultant position, as it might have in medicine. Most posts for consultants in oral surgery are in dental hospitals. Jane worked for a decade as a Staff Grade in OMFS, followed by 19 years as an associate specialist. In January 2023, just over twenty years after joining the specialist list in oral surgery, Jane became a consultant in oral surgery.
SAS experience in dentistry
Reflecting on her position as an associate specialist, Jane says: “I had my own clinics, I had my own theatre lists, and I was an educational supervisor for two core trainees, but I would say that you’re always a little bit vulnerable and if a new consultant joined the team, they could decide to take my theatre list or change my job plan.” She worked without consultant oversight in terms of her own lists, provided she practised within her competencies. She worked under the guidance of a consultant on oral and maxillofacial cases. She highlights the role played by consultant colleagues in determining the level of independence given to SAS doctors and dentists, with some consultants very supportive and trusting of SAS colleagues, while others are more hierarchical. The senior management team in Forth Valley was said to be very keen on enabling SAS doctors and dentists to work at the top of their licence.
Joe highlighted the tensions associated with this specialty, which can add further complexity for SAS dental surgeons. These tensions arise between single-qualified dentists and OMFS surgeons dual-qualified in medicine and dentistry, with concerns over creeping into each other’s territory. “There’s enough work for everyone,” says Joe.
Job planning should be a tool to prevent new consultants from taking lists or clinics from SAS doctors and dentists, says Jane; however, she observes that job planning is not happening routinely, partly due to COVID-19. There are other aspects that undermine the position of SAS dentists. “I don’t have my own desk, and my SAS colleagues don’t have desk or office space at all,” says Jane. She would like all permanent medical and dental staff to have the same rights – after all, they all see patients, dictate letters and have administrative tasks to complete. She is optimistic that change is happening.
SAS Educational Adviser
NHS Education for Scotland (NES) established the SAS Doctors and Dentists Development Programme in 2012. “The SAS development programme has been an amazing thing for SAS in Scotland,” says Jane. Each health board region has a SAS Education Adviser. Jane is the SAS Educational Adviser for NHS Forth Valley.
Since taking up this post in 2013, she has established her role, met with the clinical directors in the hospital and raised awareness amongst consultants regarding available funding to develop SAS staff and support their training. “There’s definitely an incentive for them to engage with us because we’ve got something that they want,” she says.
She arranges courses and, together with colleagues, conferences for SAS dentists and doctors. She regularly contacts the 66 SAS doctors and dentists across the health board to explore their priorities as a group. Her role also involves signposting development opportunities for SAS and sometimes being a sounding board. She says: “One of the most important things in that role is that it gives SAS doctors and dentists opportunities that they didn’t have before. We have money that they can apply for to do courses, and by organising educational events within the board, you meet people you would never have met otherwise”. She emphasises the value of having the support of peers, especially for SAS who are isolated. “For me, I think that’s been one of the most positive things about it.”
Jane’s career journey
Medical Director perspective
“I can guarantee you most health boards and most trusts are not optimising their SAS doctors. They’ve not got people working at the top of their licence and are not tapping into that potential,”
Ms Juliette Murray, deputy medical director for acute services at NHS Forth Valley.
Juliette first got to know Jane via the SAS Development Programme Board. “She is one of the most enthusiastic SAS promoters I’ve ever met,” says Jane of Juliette. In her role as deputy medical director, Juliette’s focus is on maximising the potential of what she describes as “a massively underutilised [SAS] workforce”. She says: “I’m very keen that all of our SAS doctors get the opportunity to work at the top of their licence because I think otherwise we’re missing a trick,” She describes something of “a postcode lottery”, where the role given to SAS doctors depends largely on the consultants they work with, how much autonomy they are comfortable giving their SAS colleagues, and their understanding of these roles. She says: “When you look at any department or team, consider whether you are optimising the workforce that you already have before looking to bring in new people; often, we’re not doing that.”
Juliette advises medical leaders to consider each SAS doctor as an individual, finding out what their goals are and what they are capable of. She adds: From a workforce point of view, we need to map out where all of our SAS doctors are, what level they are working at, but also we need to have more of a plan.”
She explains it is hard to make generalisations in terms of how best to utilise SAS doctors due to the breadth of experience they hold. Examples include a SAS doctor who has completed their training but has chosen not to become a consultant, and the consultant team is comfortable for this doctor to join the consultant on call. Other SAS doctors lack experience in certain areas, which prevents them from being added to the general medical or general surgery consultant on call rotas. The specialty-specific context also dictates how a SAS doctor is utilised: certain specialties tend to have fewer emergencies or less complex emergencies. She says, “The new specialist grade will help because that will make clear what the competence is for that individual and the level of independent practice associated with that.”
Juliette is supportive of SAS doctors running their own clinics and operating lists, provided they work as part of a team and are at the right level. She cites Juliette as an example of (until recently) a SAS working at consultant level, adding: “But I also have some SAS doctors that are very inexperienced and need a lot of support.”
Juliette sees no reason why SAS doctors and dentists cannot take up leadership roles. “It’s about who has the leadership skills to take on those roles, and I think it’s the same with educational supervision of trainees. It’s the same with other things that historically have been done predominantly by consultants,” she says.
Juliette and Jane work together to support SAS doctors and dentists. Juliette works at departmental level to identify gaps in the workforce and opportunities that would suit local SAS staff, while Jane supports individual SAS doctors. Juliette says, “With a little bit of support and encouragement, you can get a lot more from your workforce. You can also get a more engaged workforce because they feel listened to and valued.”
Advice for SAS doctors and dentists
- Arrange a job planning meeting, which will provide an opportunity to discuss how best to use your skills and experience within the department, and lock this down into a plan.
- Try to get involved in departmental decision making. If consultant-only meetings are held, enquire whether these could be reframed as ‘senior clinician meetings’ to include SAS.
- Encourage others to consider your role within the team as a permanent member of staff. Highlight areas where you can contribute or that will enable you to work at the top of your licence. If you need help doing this, seek support from your local SAS Lead.
- Build your network, with other SAS and the wider multidisciplinary workforce. Jane volunteers with the Forth Valley Peer Support Network and encourages SAS doctors and dentists to get involved with initiatives in their own organisations, that bring them into contact with a wide range of staff.
- Play your part in increasing understanding of SAS and the potential of this workforce, particularly with new consultants.
