Priorities for Health: Staff and associate specialists
November 2006
Background
Staff and Associate Specialists (SAS) (formerly called non-consultant career grade doctors) work at a senior level in hospital and community specialties. As well as staff and associate specialist grades, this group comprises clinical assistants, hospital practitioners and other non-standard, non-training grades.
SAS doctors work in key service roles within the NHS in posts which do not require them to be on the specialist register.
There is little information in the public domain about the significant contribution made by this group of hospital doctors. Hospital episode statistics, published by the departments of health include information on finished consultant episodes, but provide no further information about the input of other grades or staff involved in patients’ care.
Staff and Associate Specialist workforce in Scotland
SAS doctors make up a significant proportion of the hospital medical workforce. The Scottish Executive estimates that there are currently around 1460 doctors working in the SAS group. The UK total of doctors in this grade is estimated at around 12,500.
- There are 812 whole time equivalent (wte) SAS doctors working in Scotland Includes Associate specialists, staff grades, senior clinical medical officers, clinical medical officers, clinical assistants and limited specialists. [reference 1], around 55% of whom are women.
- Of the 1460 doctors who work in the SAS grade, 962 (66%) work part time.
- Of the 1460 SAS doctors, 959 (66%) qualified in Scotland; 200 (14%) qualified elsewhere in the UK, 52 (3%) qualified in other EEA countries and 249 (17%) qualified from the ‘rest of the world’. In England and Wales, more than half of SAS doctors qualified from outwith the UK.
- Excluding trainees, SAS doctors account for 6% of all hospital medical specialties in Scotland. They make up 39% of the medical workforce in A&E Departments, 12% of anaesthetics, 15% of all surgical specialties and 25% of psychiatric specialties.
- An audit of tonsillectomy practice in Argyll and Clyde published in the Scottish Medical Journal demonstrated the contribution of SAS doctors in the provision of healthcare. It found that of the 1582 tonsillectomies performed between 1996 and 2000, 57% were performed by staff grades or associate specialists. [reference 2]
Associate specialists are senior hospital doctors, who have completed 10 years of medical work since qualification and have served at least 4 years in the registrar, specialist registrar or staff grade. They are technically responsible to named consultants. UK-wide research carried out by PriceWaterhouse Coopers in 2001 found that 15% of associate specialists work at a similar level to that attributed to consultants.
Staff Doctors
The staff doctor grade was introduced in 1988 to meet service requirements. These doctors must have completed three years hospital service in an SHO post (or higher) since registration. Originally a national ceiling of 10% of the consultant workforce was imposed on staff doctor numbers. There is now scope for this ratio to be exceeded if NHS Boards judge that there is good reason to do so to meet their needs. The PriceWaterhouse Coopers research also found that 3% of staff doctors work at a similar level to that attributable to consultants.
Clinical Assistants (part time medical officers)
Clinical assistant posts are part-time hospital posts that were initially intended for GPs who also wished to work in a hospital but are also held by doctors unable, for various reasons, to obtain a career grade or training post.
Non-Standard Grades
Partly to circumvent workforce planning mechanisms involving overall targets for the proportion of staff and associate specialist doctors within Boards, and also due to resource and service pressures, many employers have created new grades/titles of doctors, often with non-standard terms and conditions of service. Doctors employed in such irregular posts are currently not included in the national workforce data collection operated by the Scottish Health Statistics division of the Scottish Executive Health Department and are not protected by national terms and conditions of service. The BMA does not accept the need for such posts and has long campaigned against their use. The Scottish Executive currently estimates that there are 100 (wte) non-standard posts in Scotland.
Contract Negotiations for SAS doctors
Since May 2005, the BMA has been involved in negotiations for a new UK-wide contract for all staff and associate specialist doctors. Negotiations have concluded and the intention is that SAS doctors will be balloted on the acceptability of the new contract.
SAS doctors are the last group of NHS employed staff to benefit from modernised terms and conditions of service (following agreement on a new junior doctor contract, GP contract, consultant contract and Agenda for Change). Improvements to the working conditions of these doctors are essential to the modernisation of the NHS and will help deliver improved patient care.
The BMA believes that all doctors working in SAS grades should be able to fulfil their potential by giving them recognition for the work they do as well as opportunities for career progression.
Access to training and career progression
Traditionally opportunities for career progression within these grades have been extremely limited and very few SAS doctors are able to progress to consultant level. This is because the pathway to becoming a consultant has historically been very inflexible.
From 1997 it has been a legal requirement for all doctors to be on the GMC’s specialist register before they can take up a consultant post within the UK. Access to the specialist register has been very limited for doctors in the staff and associate specialists group under this legislation, which has now been replaced by an Order setting up the Postgraduate Medical Education and Training Board (PMETB).
PMETB is the competent authority for specialist registration and aims to broaden access to the specialist register by allowing specialist medical experience and knowledge, wherever gained, to be taken into account when assessing doctors for specialist registration. This legislation is providing a long awaited opportunity for SAS doctors to gain access to the specialist register, although there are concerns about the delays in processing applications.
Recognition, pay and conditions
At present the SAS group of doctors are under-recognised given the seniority of their commitment to the NHS and are seriously underpaid for the hours of work they undertake. SAS doctors are senior doctors who play a vitally important role in the NHS. It is essential that their contract recognises their skills and experience, their clinical responsibility, and the long and unsocial hours that they work.
1 Includes Associate specialists, staff grades, senior clinical medical officers, clinical medical officers, clinical assistants and limited specialists. Source: Scottish Health Statistics: workforce statistics NHS National Services Scotland[www.isdscotland.org]
2 Robertson A, Wallace B, White A. Four-year prospective audit of tonsillectomy practice in Argyll and Clyde. Scottish Medical Journal 2004 49(3): 70
For more information contact:
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk