Stepping into the role of chair of BMA Cymru Wales has shown me the sheer pace and breadth of the work taking place across the profession. There is a phenomenal amount happening, with issues and queries arriving thick and fast.

It has also reinforced something I have seen throughout my career: the vital contribution made by specialist, associate specialist and specialty doctors across Wales.

My vision as chair

As chair, I want BMA Cymru Wales to be firmly rooted in doctors’ workplaces and responsive to the issues they face. For SAS doctors, that means improving working conditions, tackling discrimination and ensuring they receive the contract, grade, pay and development opportunities their work deserves.

It also means strengthening SAS representation on local negotiating committees. The more SAS doctors who become members, representatives and workplace leaders, the stronger our collective voice will be and the better placed we will be to secure lasting change.

Embedded in their teams

Much of my experience has come through working with SAS colleagues as local representatives and clinical leaders.

These doctors are diligent, committed and deeply knowledgeable about their workplaces. Many have chosen a different route through medicine because it suits their lives, interests or caring responsibilities. They enjoy their work, want to become exceptionally good at it and do not necessarily want to follow the traditional fast conveyor belt towards becoming a consultant.

This can often be stigmatised as a lack of ambition. It is not; it is a different and equally valid form of ambition. SAS doctors are often settled within one workplace and develop a detailed understanding of their departments, colleagues and patients. They provide continuity in teams where resident doctors may rotate frequently. They are often highly visible on the clinical frontline and can become excellent workplace leaders because they understand both the day-to-day pressures and the bigger picture.

A career pathway, not a career ceiling

One of the most persistent misconceptions is that SAS roles are static. Too often, doctors are presented with a binary choice: either remain in formal training or take a SAS role and stall their career development. That is not how the SAS pathway should work.

A doctor may choose a SAS role for a short period or for the rest of their career. They may pursue research or clinical academic work, progress from specialty doctor to specialist, return to formal training in future or use the portfolio pathway to join the specialist register. None of these choices needs to be binary or final.

These routes can complement one another. Doctors should be able to move between them as their circumstances and ambitions change.

A SAS post can provide a firm foundation for development. It offers greater stability, the chance to become established within a team, a negotiated job plan, time for professional development and more control over the direction and pace of a career. For doctors who want to step away from constant rotation and the enormous burdens it generates, it can be an excellent option.

Stability should come with development

Choosing stability must not mean accepting fewer opportunities.

SAS doctors need properly negotiated job plans, supporting professional activities time, appropriate study leave and budgets, and meaningful access to training and development, including regrading and the portfolio pathway. They should not simply be used to cover gaps or make resident doctor rotas work, nor should employers overlook their experience and seniority when setting rates for extracontractual work.

The same need for security and development applies to LEDs (locally employed doctors). Too many LEDs, many of whom are international medical graduates or from ethnic minority backgrounds, remain on repeated fixed-term contracts for years without a clear route to progression or security for their jobs and visas.

All locally employed doctors should be on permanent contracts by default and, where doctors have acquired the relevant level of experience, they should have a route onto the SAS contract. That brings important benefits, including a proper job plan, protected development time and access to professional support. BMA Cymru Wales is working to secure these changes. Doctors should not be treated simply as a convenient way to fill temporary gaps in the workforce.

Recognising work at the right level

Good progress has been made by the Welsh SAS doctors committee on specialist regrading, but we need to keep pushing. If a locally employed doctor is working at specialty doctor level, that should be recognised. If a specialty doctor is working at specialist level, they should have a fair route to the specialist grade. Doctors doing work at a particular level should be given the appropriate title, contract and pay.

We must also continue tackling the discrimination experienced by too many SAS doctors and LEDs. That includes the stigma sometimes attached to SAS careers, differential attainment and concerns about disproportionate referrals to the regulator.

Improving equality and inclusion, restoring senior doctors’ pay and ensuring good working conditions are essential to recruiting and retaining the doctors Wales needs.

What would success look like?

In five years, I would like to see a larger SAS workforce and much greater movement through its career pathways.

That means more LEDs moving into secure specialty doctor posts, more specialty doctors progressing to specialist roles and more specialist doctors joining the specialist register where that is their ambition.

It also means SAS doctors being properly valued within their workplaces, with employers recognising their skills, seniority and leadership. We should be able to demonstrate real progress in reducing discrimination and ensuring that doctors receive the grade and pay appropriate to the work they perform.

BMA Cymru Wales will continue to support the work of the Welsh SAS doctors committee and local representatives. We want strong SAS representation across our local negotiating committees, with more doctors supported to become active in their workplaces.

The more SAS doctors who join together, speak up and become representatives, the stronger our collective voice will be. That is how we will secure lasting improvements.

SAS Week is an opportunity to recognise the experience, commitment and leadership of SAS doctors across Wales. I want to thank them for the contribution they make every day to their patients, colleagues and the wider NHS.

Deiniol Jones is chair of BMA Cymru Wales