We have undertaken a four-nation research programme looking at the barriers to SAS surgeons achieving their full potential in the workplace and how we can support the NHS to support and develop this growing, and highly skilled, workforce. For this project, we undertook the following activities:

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Reviewed the relevant literature

53 published reports and guidance documents relating to the SAS workforce.

Started a national conversation about SAS issues

on social media and using existing surgical and SAS networks.

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Conducted interviews with national leaders

BMA SAS Committee, General Medical Council, General Dental Council, Health Education England, NHS Education Scotland, Health Education and Improvement Wales, Academy of Medical Royal Colleges Specialty and Associate Specialist Committee, NHS Employers, Northern Ireland Department of Health, Medical Workforce Race Equality and Standards (MWRES).

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Discovered seven case studies across the UK

covering a range of surgical specialties (including upper gastrointestinal surgery, plastic surgery, general surgery, colorectal, vascular, and urology) and involving more than 30 interviews with SAS surgeons, medical directors, divisional directors of surgery, directors of medical education, heads of service, and workforce leads.

Identified three SAS trailblazers

first SAS medical school Dean; first SAS Vice-President of a medical royal college; Lead Associate Dean for SAS doctors in the UK.

Spotlighted additional SAS stories

in clinical research and in specialty associations, two areas where SAS involvement to date has been limited.

Facilitated discussion at four national workshops

held at the end of 2022/early 2023 and attended by almost 150 medical directors, deputy medical directors and other medical leaders, SAS leads, representatives of NHS England, medical education and workforce leads from across the four countries.

The project has generated a wealth of insights around the potential, the challenges and the facilitators that can help to maximise the contributions of SAS doctors.

Project outputs:

  1. Showcasing inspiring stories of SAS surgeons.
  2. Creating online resources for SAS surgeons.
  3. Launching our SAS strategy with clear recommendations for the College and its external partners.
  4. Ensuring that SAS surgeons are front and centre in our policy and workforce discussions.
  5. Influencing medical workforce leaders to recognise their role in creating workplaces that offer SAS doctors satisfying careers.

Key themes from the SAS research project

The following themes emerged from our conversations with SAS surgeons, interviews with national leaders, and the workshops we held across the four nations:

Describing SAS doctors as ‘middle grade’, ‘non-training grade’ or ‘non-consultant grade’ undermines their value, can create unspoken barriers, and diverts attention away from what SAS doctors can do. ‘Gradism’ is associated with a lack of parity of esteem.

Some SAS doctors are working in isolated ways, on the fringes of their organisation in terms of development, networking, and engagement. Some are fearful of speaking up and lack the mechanisms for voicing their needs.

SAS doctors are often unseen in workforce plans. At an individual level, there can be a lack of planning for how best to draw on the skill set of the SAS doctor.

Doctors with vastly different skill sets are grouped together under the term ‘SAS’. Senior SAS doctors on the consultant rota will have different professional development needs to SAS doctors on the CT/ST rota, whose needs, in turn, will differ from LE doctors fresh off the Foundation Year 2 pathway.

Job planning is not happening systematically. SAS doctors highlight uncertainty over the interface between appraisal and job planning and report difficulties in enacting personal development objectives.

The specialist grade contract is underutilised, and large numbers of highly experienced specialty doctors are said to feel ‘stuck’ in their grade without opportunities to progress.

Many SAS doctors would like educational supervisors and greater training opportunities.

The pathway is complex, and support available to SAS doctors choosing this route varies according to the unit and department.

Some trusts want to code clinical activity to SAS doctors but are unclear on how to implement this; others are yet to see the relevance.

There are a range of barriers to leadership for SAS doctors, such as job descriptions focused on consultant skill sets, consultant-only department meetings, consultant-only mailing lists, insufficient SPA time, and a lack of confidence or training in leadership. Opportunities for SAS doctors should not be confined to ‘SAS leadership roles’.

SAS doctors lack opportunities to network. The absence of a single national body to represent the SAS workforce can create challenges for engagement at national level.

Commitments made by medical leaders

At the national SAS workshops we held, we asked participants what personal commitments they were prepared to make to unlock the potential of the SAS workforce. Here are some examples of commitments made:

I’m going to focus more on opportunities for SAS doctors to take up leadership roles in their clinical teams

I want to focus on how to develop SAS doctors within their roles and how to make the roles more attractive, to help us recruit in rural areas

I’m going to give more emphasis to induction and how to identify the competencies of new SAS doctors, to avoid putting the wrong person in the wrong job

I want to make sure SAS colleagues feel valued and engaged. As part of this, I want to develop the notion of the senior leadership team within the department

I’m going to continue to empower SAS doctors and give them opportunities to develop their skills. I’m going to continuously ask ‘what role could SAS doctors have?’

I’m going to approach my Medical Director about appointing a SAS Advocate