Contract SAS doctor

Last updated:

Autonomy for SAS grade doctors - LNC briefing on referrals and coding

The NHS e-Referral Service, the successor to ‘Choose and Book’ in England, went live in June 2015.  The new system supports referrals to secondary care and allows users to choose the date and time of an appointment.  The Service retains the patient coding functionality, as before, which enables the coding of named clinicians, such as SAS doctors.

NHS Employers support the principle of coding patients under the person responsible for their care, which is often an SAS doctor.  The BMA SASC (staff, associate specialists and specialty doctors committee) and NHS Employers have raised the issue of accurate patient coding across the UK.  In some hospitals where patients are under the care of an SAS doctor, this is accurately reflected in the local records.  However, this can be sporadic and therefore SASC have been working to ensure this becomes common practice across the whole of the UK.

  • Why is accurate patient coding important?

    Accurate patient coding is important for a number of reasons:

    • for patients and their families to know the name of the senior doctor in charge of caring for a patient
    • a reliable record of activity is important for revalidation
    • for appraisal and pay progression to accurately audit who has undertaken what work
    • for staff morale and job satisfaction.

    Following a request by the Secretary of State for Health in England, the Academy of Medical Royal Colleges published guidelines in June 2014 for clinicians regarding the ‘name over the bed’ initiative which makes doctors accountable throughout a patient’s treatment in hospital.  

    The move followed one of the Francis Report's key recommendations that if a named clinician were accountable throughout a patient's treatment in hospital then patient safety and the overall quality of care could be improved. The GMC also published guidance to support doctors who take on the role of a responsible clinician.

  • What can LNCs do?

    The BMA believes that patient safety can be improved through accountability of healthcare provision in the workplace by:

    • coding patients and hospital activity against the clinicians who provide the service
    • taking forward the concept of a named clinician with delegated responsibility for the patient
    • taking steps to ensure that all SAS doctors have access to appropriate clinical data systems 
    • mandating the availability of individual outcome data for appraisal and revalidation.

    The implementation of the named clinician initiative for all patient admissions as recommended by the Academy of Medical Royal Colleges is down to local organisations and therefore the LNCs play an important role in ensuring that this is implemented.  

    The new NHS e-Referral Service has the facility to code work to the names of SAS doctors and it is important that LNCs and individuals work with their employers to implement this into local IT systems.

  • Who is responsible for patient care?

    A patient is the responsibility of the NHS employer and ultimately its chief executive.

    The chief executive may delegate this responsibility as they wish, including to a SAS doctor.

    When delegating such responsibility the key consideration is assessing the expertise and experience of the doctor who will undertake the patient’s care and their ability to work without or with minimal supervision. Furthermore, the employer and manager needs to be satisfied that a doctor is able to supervise junior members of staff if necessary. 

    It is therefore possible for a senior SAS doctor to receive direct referrals and have patients under their named care, depending on the circumstances of the referral.

  • Can the e-referral service be configured to allow referrals to a SAS grade doctor?

    The e-Referral Service can be set up to allow referrals to SAS grade doctors.  The easiest way to do this is to set up 'generic' or 'pooled' services with named clinicians, including SAS doctors, being listed individually as part of the service definition. Named clinicians can be selected for a service within the ‘Service Personnel’ section of the service description in the Directory of Services (DoS).  Clinicians must be registered with smartcards and added to a workgroup associated with the service within the DoS.

    Referrals can be directed to any of the clinicians in a pooled service or directed to a specific time slot with an individual in that pooled service. Specific appointment slots for those named clinicians will need to have been previously allocated on the hospital Patient Administration System (PAS).  

    Most PASs have this functionality, however, the provider of the service would need to identify if its PAS has the ability to link to the e-Referral Service to allow this to happen. If the PAS is unable to support the ‘Named Clinician’ functionality then a hospital will be supported in finding other ways of managing referrals until its PAS is compliant. 

    Contact the NHS e-Referral Services Implementation team by email for further assistance.

    To enable such functionality it is important that employers have a robust and accurate DoS to ensure that referrals into those services are appropriate. If a service accepts referrals to a named clinician on paper, then it should accept them via the e-Referral Service.

    For guidance on the use of the Named Clinician functionality, please read:
    Creating and Maintaining Services on the Directory of Services. (PDF)

  • How should patients be coded if a SAS doctor is solely responsible for their care?

    It is critical that all patient care is accurately coded so that any SAS input to a patient's clinical pathway is recorded, whether or not this is a direct referral.

    The NHS requires input of accurate data to reflect clinical activity and trusts now have a financial incentive to ensure that coding is accurate, comprehensive and timely.

    Where a SAS doctor is undertaking autonomous practice, coding will help to strengthen the data collected.  This is something that should be done with the support of the trust and department.

    There are several ways to accurately record patient care and outcomes depending on the local IT system in use.

    There is normally a way to record this element of a patient's care although sometimes this may require a simple tweak to the system by an IT professional.

    The Health and Social Care Information Centre has confirmed that for local recording, organisations can record patient care under a SAS doctor using local codes. However, currently these will need to map back to national codes for reporting purposes.

    As the NHS Data Dictionary language is yet to be updated, for the purposes of national reporting in England, it is the 'Consultant Code' that must be recorded and a SAS doctors name should be introduced as a consultant episode.

    Guidance from the Academy of Medical Royal Colleges specifies that the term consultant also refers to certain senior doctors with appropriate competencies, to include those in Staff, Associate Specialist and Senior Specialty Doctor (SAS) grade posts.

    When the sole responsibility for the patient is retained by the SAS doctor the 'Consultant Code' should be that of the SAS doctor, using their General Medical Council Reference Number.