We support the voluntary uptake by SAS doctors of senior roles or responsibility believing that such experiences are a valuable developmental opportunity and that as senior clinicians, SAS doctors have the expertise and experience to work in these roles. SAS doctors taking up these roles must however be appropriately remunerated and adequately supported.
SAS doctors should expect to take on additional responsibility throughout their careers and will need to demonstrate this in order to pass through thresholds. Many SAS doctors already work on consultant rotas or provide cover for more senior colleagues. This document tries to address the situation where a SAS grade doctor is asked to cover for a senior colleague on a more permanent basis. This would not include for periods of leave and would be for longer than fourteen days.
In many respects the Specialty Doctor Grade replaces both the Staff Grade and the pre-2008 Associate Specialist Grade and hence there is less clarity as to what level of practice a Specialty Doctor at the top of the scale would be expected to provide. During contract negotiations NHS Employers agreed that those at the top of the Specialty Doctor grade 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.’
Recognition of acting up including titles
When an SAS doctor acts up, they should take up the title of the role they are fulfilling. This is necessary in order for them to have the seniority and level of clearance and recognition needed to fulfill the full range of duties and responsibilities that the role requires.
As it is not a substantive appointment it is appropriate for the doctor to be titled as ’acting’ Associate Specialist for example.
Remuneration when acting up and return to substantive post
SASC believes that SAS doctors acting up should be appropriately remunerated. Consequently, as per the principle established in Schedule 21 of the new AS contract, if an SAS doctor was acting up as an AS or Consultant, they should receive an acting up allowance that would bring the doctor’s rate of pay up to the rate of pay he or she would receive if it were a substantive position.
The rate of the allowance should be determined in accordance with the appropriate National Terms and Conditions of Service. The doctor would also be entitled to other benefits under those terms and conditions including for example a travelling allowance and additional SPA time.
In a few cases SAS doctors acting up may suffer pay detriment. In such instances, appropriate pay protection payments should be arranged so as not to discourage the doctor from acting up. This is very much in line with the principle informally agreed with NHS Employers, that Locum Consultants should not suffer any pay detriment on appointment to Locum Consultant posts.
When the period of acting up comes to an end, SAS doctors must be entitled to return to their previous post and role and this should be agreed prior to taking up the acting up role. The duration of their acting up should contribute toward their incremental and threshold progression and deemed as continuous service in their substantive position.
Supervision arrangements and levels of responsibility
Whilst acting up, SAS doctors should receive the level of supervision commensurate with their skills and experience and should not be forced to undertake work outside of their capabilities. This is in line with the GMC Good Medical Practice guide, and the expectation outlined in the new SAS contracts, that as SAS doctors progress through the thresholds, they will demonstrate an increasing ability to take decisions and carry responsibility without direct supervision.
Opportunities for career development
Acting up is encouraged as a means for career development. It is an opportunity for SAS doctors to gain experience in a more senior role and develop their skills set. The experience gained would support their progression through the thresholds as well as applications for more senior posts and specialist registration via CESR.
Length of post and options around a substantive position
SASC supports the principle outlined in the new AS contract (Schedule 21), that SAS doctors should not be required to act up for a period of more than 6 months continuously. Continuity of a period of acting-up will not be broken by days on which the practitioner is not required to be on duty; continuity will normally be broken by absence on leave of any kind of more than fourteen days and a further qualifying period of fourteen consecutive days will be required after such absence.
If a doctor is asked to act up for more than 6 months continually, they should approach their clinical director about the possibility of them being appointed as a Locum for a period of a year/the role advertised as a substantive position (in which case they would have to apply for it in open competition) or (in the case of Foundation Trusts) being regraded and offered the post on a non standard AS or Consultant contract (if appropriate).
Job planning discussions
SAS doctors should carefully consider all of the potential implications of either accepting or refusing a request to act up.
Discussions concerning acting up should be held at job plan reviews or meetings and any changes to job plans should be made by mutual agreement. If agreement is not possible, the doctor can pursue the case through a grievance.