SAS IN
NORTHERN IRELAND

“There are so many different reasons why people choose a SAS career, be that family, childcare, geographical stability. I chose it because of the patient-facing aspect. I have a colleague who chose it because he’s on an annualised contract, and he works on cruise ships four months per year,” says Dr Leanne Davison, chair of the British Medical Association (BMI) Northern Ireland SAS Committee. SAS by choice is a recurring theme in discussions with SAS doctors working in Northern Ireland. “SAS is a career choice. We need to properly educate students, trainees and colleagues, starting in medical school, that it is a fulfilling and viable career choice,” says Dr Claire Brady, SAS Lead, Southern Health and Social Care Trust.

There is no workforce strategy specific to SAS doctors in Northern Ireland, says Philip Rogers, Director of Workforce, Northern Ireland Department of Health. However, the Department is keen to consider the potential of this workforce to address gaps in consultant posts and to look beyond a traditional consultant-led model in the context of service transformation. Chris Wilkinson, Head of Pay and Employment, Department of Health Northern Ireland, says the central question is this: “Can we develop the SAS cohort of doctors into a different type of service that’s going to drive through improvements in patient outcomes?”

Key to unlocking the potential for SAS doctors in Northern Ireland is ensuring they receive professional development support. Unlike the arrangements in England, Scotland and Wales, there has been no Associate Dean for SAS doctors within the Northern Ireland Medical and Dental Training Agency (NIMTDA). While Health Education England (HEE, now part of NHS England), Health Education and Improvement Wales (HEIW) and NHS Education for Scotland (NES) all have structures in place to support SAS development, equivalent infrastructure has been lacking in Northern Ireland. Discussions are continuing, and progress is reported to establish equivalent support (including an Associate Dean for SAS doctors) in Northern Ireland.

The Department of Health in Northern Ireland has asked trusts to identify SAS Leads and provides funding to release some programme activities (PAs) to enable SAS doctors to participate in professional development. Chris Wilkinson meets regularly with the SAS Leads, who work collaboratively to identify courses to benefit SAS within each region. The courses are then funded by the Department of Health.

Leanne Davison says the NHS in Northern Ireland has generally been slow to recognise the leadership potential of SAS doctors, although all trusts have now trained SAS doctors to be appraisers.

Dr Stephanie Warne, SAS Lead, Western Health and Social Care Trust

In December 2022, RCS England held a workshop attended by medical directors, deputy medical directors and other medical leaders, and SAS leads across Northern Ireland. A recurring theme was that the SAS workforce is a hugely untapped resource and to support this, the following actions are needed:

• Move away from a focus on grade (‘gradism’) and give attention to skills, knowledge and experience.
• Find ways to encourage and empower SAS doctors.
• Change the mindset and culture around this workforce, which too often is undervalued, with unspoken barriers and little parity of esteem.
• Make clear the power of using personal development plans in job planning meetings.
• Support SAS doctors to start well with bespoke inductions and meetings with clinical leaders to identify their skills and aspirations.
• Understand the spectrum of ability, including assessing SAS competencies when they first start in the same way as for doctors in training.
• Invest in the development of SAS doctors as permanent members of the team.
• Involve SAS doctors in quality improvement, research, teaching and education, leadership and management.
• Facilitate active engagement by SAS in decision making departmental and strategic levels.
• Address the gap in terms of Associate Dean for SAS doctors in Northern Ireland.
• Identify niche opportunities for SAS doctors to respond to service needs and develop independent practice (e.g., aortic valve clinic, vasectomy clinic).
• Offer substantive SAS jobs to long-term locums and LE doctors who meet the criteria.
• Medical schools should include SAS careers as a viable option amongst career choices.
• Use new contracts as a springboard for progression.

Workshop participants made personal commitments designed to help unlock the potential of the SAS workforce. Some of these commitments are shown here.

Dr Leanne Davison, BMA Northern Ireland SAS Committee

Dr Paula Scullin, Deputy Medical Director, Belfast Health and Social Care Trust

Dr Craig Renfrew, Associate Medical Director, Medical Education and Training, South Eastern Health and Social Care Trust