The SAS grade in the 21st century

Authors: Tony Rao 

Publication date:  25 Apr 2012

Tony Rao asks three SAS doctors about their career choices

A number of high profile staff and associate specialist (SAS) doctors have shown considerable achievements in their careers. This article highlights the views of three such senior SAS doctors, all working in different specialties and roles. I asked these doctors about the circumstances leading to their becoming SAS doctors; how they thought SAS doctors were viewed by consultants and the wider NHS; how they can contribute to the NHS beyond their clinical work; whether there is a role for SAS doctors at royal college, faculty, or deanery level; and the future of a career as an SAS doctor in the NHS.

SAS and associated grades in the NHS

Clinical assistant

  • Part time medical officer appointment with responsibility for a limited range of duties

  • No specific entry requirements other than full General Medical Council (GMC) registration

Hospital practitioner

  • Principals in general practice (non-salaried GPs)

  • Full GMC registration for at least four years

  • Two years’ full time training experience in hospital specialty or a relevant specialist qualification and at least five years’ experience as clinical assistant in relevant specialty

Staff grade

  • Full GMC registration

  • At least three years’ full time core or higher training in the relevant specialty

Specialty doctor

  • Full GMC registration

  • Minimum of four years’ full time training experience in the relevant specialty

  • Two of these years should have been served in a training programme (including as fixed term specialty trainee) within the appropriate specialty

  • Equivalent service is also acceptable with the agreement of the relevant college or faculty regional adviser and of the postgraduate dean or a nominated deputy

Associate specialist

  • Full GMC registration

  • At least 10 years’ full time experience in the relevant specialty

  • Minimum of four years in senior core or higher training post or as staff grade

  • Two of these years should have been served in the appropriate specialty

  • Equivalent service is also acceptable with the agreement of the relevant college or faculty regional adviser and of the postgraduate dean or a nominated deputy

Raj Nirula

Associate specialist in urology at Princess of Wales Hospital, Bridgend; associate dean for SAS doctors, Welsh Deanery; and chairman of the BMA’s staff grade, associate specialist, and specialty doctors’ negotiating committee

As with a considerable number of SAS doctors from abroad, this grade was never a choice for me: circumstances forced me into the grade. Despite having all the qualifications, experience, and some support from consultants, other consultants thought it best for me to be their right hand man rather than necessarily support my career progression, even though I was on the specialist register. As time has gone by, I now think that I will do anything for a peaceful life.

Some consultants view SAS doctors as a pair of hands, while some give them due respect and acknowledge their experience and skills and have a good relationship with their SAS doctors; overall things are better than a few years ago. SAS doctors have to start taking a more active approach and not expect to be spoon fed. The chances are there, and those who are determined can make their own opportunities and overcome the hurdles, however difficult this may be.

SAS doctors can have a significant role at deanery and college level, but they have to be more innovative in being heard. The grade will undoubtedly expand over the years, and if fewer doctors are anticipated to come from the Indian subcontinent, it is quite likely that more UK qualified graduates will be coming into this grade, which means that it will have to be made more attractive and not pictured as a career cul de sac.

Ishtiaq Ahmad

Associate specialist in psychiatry, Birmingham and Solihull Mental Health Trust; chairman of the Specialty and Associate Specialist Psychiatrists’ Association; and affiliate representative on the central executive committee at the Royal College of Psychiatrists

The main reason for becoming an SAS doctor was that I was not fortunate enough to complete the membership of the Royal College of Psychiatrists exam (owing to the old curriculum with time limitations, plenty of negative marking, and visa difficulties). The only alternative at the time was to get out of training and accept a staff grade position. However, since moving on to a senior associate specialist position I have found it to be very rewarding.

It very much depends on where one works but, largely, SAS doctors are viewed by consultants as workhorses and there to do just clinical work. It is because of this view that the SAS grade had been neglected in relation to professional development. However, in fairness, the wider NHS and most recently the Department of Health (albeit under pressure from the BMA) have looked into the terms and conditions, bringing them in line, at least in terms of continuing professional development requirements. The NHS administration generally values the work done (value for money) by the SAS grade and considers them senior doctors able to work independently. Unfortunately, however, on occasions the opposition to further development emanates from none other than their consultant colleagues.

SAS doctors, by the nature of their clinical experience, can bring invaluable expertise to the running of clinical services at managerial level. They have the ability to plan services, responding to locally identified patient needs. They can be good clinical teachers and should have an in-depth role as educational supervisors and appraisers.

To date, I feel that the perception has been that SAS doctors at royal college level have been mostly there to make up numbers. The college could encourage participation by being more open and receptive as a body entrusted with standard setting and policy making within its specialty. It should not be contingent on whether any doctor wishes to sit a college exam—that is, mechanisms should be put in place that favour all doctors in a specialty rather than doctors who have already sat or plan to sit an exam.

As things stand, the SAS grade is here to stay. In theory, the structures of the NHS are currently built on the provision of care responding to the needs of patients. In practice, however, the Department of Health and the BMA to some extent have struggled to put this grade to the forefront for various reasons. It is hoped that after achieving a place on the specialist register, SAS doctors will be more and more involved in service planning regardless of their lack of consultant status.

Naila Kamal

Associate specialist in obstetrics and gynaecology, North West London Hospitals NHS Trust; honorary lecturer at Imperial College School of Medicine; and continuing professional development lead for SAS doctors and non-consultant grades at London Deanery

I decided to take up the post of SAS doctor largely to maintain a work-life balance and also for flexibility. SAS doctors are offered variable support, with some consultants being very supportive, the majority indifferent, and some obstructive.

Beyond clinical work, SAS doctors can improve wider competencies, especially communication skills with colleagues and also in management. Some SAS doctors tend to be timid and insecure or aggressive with a chip on their shoulder, but the majority are focused.

Unfortunately, SAS doctors rarely have a role at deanery, college, or faculty level. Some specialties are more advanced than others, and my own college has particularly good representation. An educational track record with supportive mentors and referees (as I have had) will point them in the right direction, but it is then up to SAS doctors to prove their mettle like any other senior workforce category.

The future of SAS doctors in the NHS will be as good as they make it. The opportunities open to them have never been as wide as they are now (thanks to a lot of groundwork by my predecessor at London Deanery, Tony Rao), but opportunity does not knock twice. If SAS doctors improve their continuing professional development and put themselves forward by showing an interest, with supportive colleagues who keep on lobbying for them, the SAS grade will become a competitive position to be in.

Competing interests: TR’s parents are both retired associate specialists.

Tony Rao associate dean for SAS doctors and equivalence Royal College of Psychiatrists, London, UK

Cite this as BMJ Careers ; doi: