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The role of staff grade and associate specialist doctors in UK hospitals

February 2006

Who does what in hospitals?

There is little information in the public domain about the particular workloads of different groups of hospital doctors. Hospital episode statistics, published by the departments of health, include information on finished consultant episodes, but provide no further information about other grades of staff involved in patients’ care.

Staff grade and associate specialist (SAS) doctors make up a large proportion of hospital doctors. The Department of Health has estimated that there are approximately 12,500 doctors working in the SAS group.

In 2003 the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) published ‘Who Operates When’ in NHS hospitals in England, Wales, Northern Ireland, the Isle of Man, Guernsey and Jersey and the Ministry of Defence and the independent sector 448 NHS hospitals (93 per cent of all NHS hospitals) and 109 independent sector hospitals (63 per cent of all independent sector hospital) participated in the data collection exercise. The report provides data on the contribution made by SAS doctors to the provision of healthcare in the UK. The figures are limited to the surgical specialties and anaesthetics but are the first to look at operations performed by SAS doctors.

NCEPOD has shared data with the BMA on the grades of senior surgeons and anaesthetists present for operations during the day on weekdays (08:00 to 18:00) in the period March-April 2002 (Table 1). The data shows that although the senior surgeon present for most daytime operations was a consultant, staff grade and associate specialist surgeons were the senior clinicians for over 7,500 daytime operations, accounting for around 12% of the total. In addition a SAS doctor was the senior anaesthetist present for 13% of daytime operations.

Table 1 – Grade of senior surgeon and anaesthetist present for weekday daytime operations, March-April 2002

	Grade of senior surgeon present for weekday daytime operations		Grade of senior anaesthetist present for weekday daytime operations
	Number	% of total	Number	% of total
Consultant	40,620	66%	34,959	62%
SAS	7,545	12%	7,281	13%
SpR	6,349	10%	3,410	6%
Senior House Officer	1,132	2%	2,254	4%
Other	3,246	5%	2,556	5%
(blank)	2,381	4%	6,263	11%
Total	61,273	100%	56,723	100%

Number of doctors in the SAS group (England)

English Department of Health workforce statistics (September 2004) were used to establish the number of doctors working in the SAS group in England, which includes staff grade doctors, associate specialists, hospital practitioners and clinical assistants. This information was then used to look at the contribution made by the SAS group to the total workforce, excluding doctors in training.

Table 2 shows that specialties such as general medicine (80%), accident and emergency medicine (49%), general psychiatry (33%) and oral surgery (42%) have a particularly high level of involvement from SAS doctors. This information is represented graphically in Graphs 1 and 2.

Table 2 – Numbers of SAS doctors by specialty (England)

Specialty	Total number of SAS doctors  includes SG, AS, CA and HP fte	SAS group doctors as a % of all doctors excluding doctors in training
Accident and emergency	565	49
Additional Dental medicine specialties	21	37
Anaesthetics (inc. Intensive care)	925	18
Audiological medicine	9	18
Cardiology	145	18
Cardiothoracic surgery	23	9
Chemical pathology	9	5
Child and adolescent psychiatry	68	12
Clinical genetics	7	7
Clinical oncology	68	16
Clinical pharmacology and therapeutics	4	9
Clinical radiology	37	2
Dermatology	153	29
Endocrinology and diabetes mellitus	47	9
Forensic psychiatry	73	26
Gastroenterology	68	10
General Medicine	370	80
General Psychiatry	863	33
General surgery	443	22
Genito-urinary medicine	165	36
Geriatric medicine	283	25
Haematology	117	17
Histopathology	23	2
Immunology	3	6
Learning disabilities	110	36
Medical oncology	66	28
Neurology	31	7
Neurosurgery	8	4
Nuclear medicine	4	9
Obstetrics and gynaecology	436	25
Occupational health	23	25
Old age psychiatry	236	33
Ophthalmology	465	39
Oral & maxillo facial surgery	171	42
Oral surgery	24	52
Orthodontics	48	23
Otolaryngology	224	31
Paediatric dentistry	5	20
Paediatric surgery	11	10
Paediatrics	693	29
Palliative medicine	34	19
Plastic surgery	41	15
Psychotherapy	7	7
Rehabilitation medicine	32	23
Renal medicine	34	10
Respiratory medicine	43	7
Restorative dentistry	21	26
Rheumatology	58	12
Trauma and orthopaedic surgery	494	25
Urology	149	24
Other	152	54
All surgical specialties	1,219	23
All surgical specialties combines data for: Cardiothoracic surgery, General surgery, Neurosurgery, Oral & maxillo facial surgery, Oral surgery, Paediatric surgery, Plastic surgery, Surgical Dentistry, Trauma and orthopaedic surgery

For graphs of SAS doctors as a percentage of all hospital doctors (excluding trainees) and total number of SAS doctors please view the full Word document at top right of this page.