Watch our five-minute video and listen to Dr Radhakrishna Shanbhag discuss autonomous working for SAS grade doctors.
Listen to Dr Sara Landy, member of the BMA Northern Ireland SAS doctors committee, talk about her work as an associate specialist in dermatology and experience as an autonomous SAS doctor:
"Working autonomously is not a right which should be taken for granted for SAS doctors but a privilege that is often hard won through determination, hard work and demonstration of competencies. It is dependent not only on your skills... but also on local governance structures and the support of your department and employer."
Dr Amit Kochhar, Co-chair SASC UK
This guidance has been prepared to help clarify arrangements for employers and as a tool for members when seeking to demonstrate an increasing ability to take decisions and carry responsibility without direct supervision or when defending current work arrangements when an employer is seeking to make a unilateral change.
The 2008 SAS Terms and Conditions of Service state that individual accountability arrangements must be agreed as part of the job plan:
9. The Job Plan will set out the doctor's accountability arrangements, both professional and managerial.
This is elaborated on further in a statement agreed in the contract negotiations with NHS Employers and the devolved administrations:
At the top of the grade doctors will have acquired a high level of specialist knowledge and expertise and have the capacity and opportunity to work independently within agreed lines of responsibility and may also take a broader role in the organisation through other activities such as teaching and audit.
And more recently in UK job planning guidance:
SAS doctors provide experienced, specialist care, often within a multi-disciplinary team. This includes management of complex cases and spending time and effort reflecting on and reviewing patient care activities so that quality and safety improve continuously. SAS doctors are also involved in teaching, training, researching and developing local services as appropriate to their skills and experience.
Associate specialists and senior specialty doctors will "have acquired a high level of specialist knowledge and expertise and have the capacity and opportunity to work independently within agreed lines of responsibility and will also take a broader role in the organisation through other activities such as teaching and audit." It is expected, therefore, that senior SAS doctors will be provided with the opportunity to engage in independent practice.
Where a SAS doctor is of the view that he or she has demonstrated the ability to take decisions and carry responsibility without direct supervision, this should be raised as part of job planning discussions.
Employers have a responsibility to support SAS doctors in developing their skills and experience to allow them to require less supervision and take on more responsibility as they progress through their careers as Specialty Doctors or Associate Specialists.
Guidance template for the development of autonomous practice for SAS doctors and dentists
(Please note this template does not apply in Northern Ireland or Scotland)
Schedule 4, paragraph 9 - 2008 Associate Specialists and Specialty Doctors Terms and Conditions of Service
UK Job Planning Guidance for SAS doctors - NHS Employers, BMA, NI DHSSPS, Welsh Assembly Government and the Scottish Government (November 2012)
Paragraph 18 - BMA and NHS Employers - Final Summary Agreement. Specialty Doctors and Associate Specialists - Contractual Arrangements (November 2006)