Staff grade, associate specialist and specialty doctors (SAS) are a highly skilled and diverse group which forms an increasingly important part of the healthcare team in delivering safe and effective patient care. SAS-grade doctors typically have four years post-qualification experience with at least two years’ experience in a specialty and provide specialist care, often within multidisciplinary teams. However, they are neither consultants nor in a formal training programme.
The four SAS-grade doctor charters for England, Northern Ireland, Scotland and Wales were developed in 2014. They were developed collaboratively by the British Medical Association (BMA), NHS Employers, Health Education England, NHS Scotland, the Welsh Assembly and the Academy of Medical Royal Colleges. The charters provide a framework for how to deploy and support SAS doctors across healthcare services.
The Royal College of Radiologists (RCR) is supportive of the SAS-grade role, and the value of the role as part of the wider healthcare team. In our position paper from January 2020, we committed to:
- supporting the professional development of all SAS-grade doctors, including those who wish to pursue a Certificate of Eligibility for Specialist Registration (CESR)
- developing attractive clinical roles to increase the SAS presence in our clinical teams (such as our credential for breast clinicians)
- ensuring the wellbeing and support work stream includes every doctor, regardless of grade
- working with all four nations and arm’s length bodies to enhance and support the SAS-grade role
- engaging with SAS-grade doctors to ensure their inclusion within the wider work of the RCR
- developing roles for SAS doctors in education, leadership to fulfil the commitments in the 2010 publication of ‘Maximising the potential: essential measures to support SAS doctors’.
The SAS-grade RCR membership is relatively small, however it is increasing. As per the 2020 RCR census there are 85 SAS-grade clinical oncology members, and 86 SAS-grade clinical radiology members.
The new contract negotiations in England and Wales
A contract agreement for England and Wales has been reached which covers a new three-year agreement from 1 April 2021 to 31 March 2024. The purpose of the new contract is to increase the attractiveness of SAS-grade roles by improving opportunities for career progression and development, review the pay structure, provide additional clarity around SAS-grade roles, and to put in place resources to support the current workforce.
Key features of the new contract are:
- the introduction of a new Specialist grade. The ambition is to provide opportunities for meaningful career progression for SAS-grade doctors and to support them to work to the top of their licenses. The creation of these roles will be led by employers to meet local service demand;
- a reformed Specialty Doctor pay structure, including a multiple-year pay increase of 3% investment per year over three years. The new pay structure will enable SAS-grade doctors to access the top of the pay scale more quickly than the current system, increasing the career average earnings;
- a new shorter pay progression system that will link progression to the development of skills, competencies and experience;
- additional safeguards and provisions to support the health and wellbeing of SAS doctors; and
- guidance for a new SAS advocate role to promote and support SAS doctors’ health and wellbeing. 
These developments are important as while the SAS-grade doctors are an integral part of the healthcare team, support for these professionals have historically been managed at a regional level and has consequently been unevenly funded and championed. Now there will be opportunities for professional development. The new contract aims to bridge the well recognised and acknowledged shortcomings reported by those in these posts and makes the SAS grade as a viable career option.
A greater clarity and awareness around SAS-grade roles on a local level, and additional safeguards and provision to support SAS-grade doctors could also aid with workplace concerns that were identified by the General Medical Council (GMC). In its first workplace experience survey for SAS-grade doctors the GMC found that 30% of SAS-grade doctors said they had been bullied, undermined or harassed in the last year.
SAS-grade roles could additionally be supported by the continuation of the SAS tutor role. This role was introduced in England in 2008 to support SAS-grade doctors in their continuous professional development. However, the provision of SAS tutors is unevenly provided across organisations and the adequate provision of SAS tutors, and funding, would be a positive step in supporting the SAS-grade professionals’ continuous development.
The new contract has introduced a new SAS advocate role. This will be a local trust based role in addition to the existing SAS tutor and local negotiating committee representative. The job description is being developed and this role will help staff to understand and feedback policies and processes, and inform the employer about how these practices are working on the ground. They should help SAS doctors share their experiences and improve their visibility within the organisation. SAS advocate would bridge the gap between SAS doctors, employer, LNC representative as well as external reps such as college representatives.
These changes apply to England and Wales, with the exemption of local variations in how the pay structure is calculated. Negations are currently ongoing in Northern Ireland, and the Scottish Government has decided to pursue a Scottish specific reform of the Speciality Doctor grade in due course.
The RCR fully supports the implementation of a revised contract for SAS-grade doctors and for it to deliver on the promise of giving greater recognition to their roles and responsibilities. This includes to support SAS-grade doctors to work to the top of their licences. Providing additional structure around career progression and opportunities and support for SAS-grade doctors is paramount in ensuring that SAS-grade roles continue to remain an attractive career choice, and to support the existing workforce in delivering safe and effective patient care.
-  The Royal College of Radiologists (2020) Harnessing the experience and expertise of staff and associate specialist (SAS) doctors (PDF)
-  Health Education England and NHS Improvement (2019) Maximising the Potential: essential measures to support SAS doctors (PDF), p.12