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Strong lobbying from BMA reps and IROs at Local Negotiating Committees (LNCs) seems to be bearing some fruit in the South East as the majority of Trusts are now considering proposals to re-open the Associate Specialist (AS) grade as a local contract.
Almost 20 Trusts in England have already formally re-opened the grade and many others have agreed the principle. Some are implementing regrading for current staff without a formal policy. A quick search on NHS Jobs also shows a number of private providers advertising AS jobs.
East Sussex Healthcare was the first to formally re-open the grade in the South East but we are now pushing on an open door as Trusts realise that this is a win-win proposal which will help employers to retain a key, long serving and hard-working group of experienced doctors, to improve career development and potentially to improve recruitment, which would reduce agency spend.
The AS grade was closed as part of the 2008 SAS contract negotiations which also introduced a new AS contract, closed to new appointments but open to regradings up until 31 March 2009. I was closely involved in those negotiations and the closure was the most controversial aspect, an element forced upon us by NHS Employers who wanted to create a single pay spine. The problem was that they wouldn't agree to sufficiently high pay for the new Specialty Doctor grade which was intended to replace the old Staff Grade and AS grade. We assume this was to allow the Department of Health the opportunity to introduce some form of sub-consultant grade in the future. So far that has been successfully resisted but the closure has left several other issues.
The closure essentially left Associate Specialists stuck in a closed grade, with no new AS jobs being advertised. It also meant that those in the Specialty Doctor or legacy grades, who previously could apply to be regraded to AS where appropriate no longer had that opportunity for career progression.
Despite repeatedly raising the issue with NHS Employers over the last decade they have been unwilling to re-open the AS grade at a national level. Hence it is up to forward looking Trusts to do so on a local basis. Any Trust can choose to introduce a local AS grade contract which mirrors national TCS and pay. As more and more do so the pressure will grow on NHS Employers to re-open the grade nationally. The DDRB has already suggested it!
So what has been proposed?
LNCs across the South East have proposed the reopening of the Associate Specialist grade, on the national 2008 contract terms and pay. Technically this would be a local (non-standard) contract. The key request is to do this to allow for other SAS grade doctors employed at their Trust to apply for regrading to the AS grade. The second request is to allow recruitment to new AS positions. Some will initially only look at opening the grade to local regradings, others may open to wider applications. The key requirement will be to consider the criteria for regrading and ensuring this Is consistently and fairy applied.
The BMA has a model policy to aid regrading, based on the requirements of Annex 2 EL (97) 25 updated so there is very little work for the Trust to do.
What are the benefits?
I strongly believe that there would be multiple benefits for individuals and Trusts. A key benefit for both is that it would allow career progression (where these is a service need and the doctor can work at that higher level). More SAS doctors are likely to opt for additional responsibility, supporting the trust business needs.
Whilst the pay scale for AS posts is higher than that of Speciality Doctor, it is not as high as that of a consultant, and brings with it more responsibility, more independent working and wider responsibilities. AS doctors have a higher ratio of Direct Clinical Care time to Supporting Professional Activities than their Consultant colleagues. They are clearly very good value for money.
Re-opening the grade would allow Specialty Doctors on the GMC specialist register an additional option to gain experience and seniority other than applying for consultant posts. CESR application numbers have consistently grown. There are many SAS doctors now on the specialty register who would benefit from the increased level or practice, recognition and salary.
For many Trusts the key driver recently has been that it would improve recruitment and retention of a vital group of doctors. The SAS grades are an invaluable resource that is now harder to recruit to. The risk of not re-opening the grade is that where other Trusts introduce this, SAS doctors could seek to move there. Trusts need to remain competitive with their neighbours and be viewed as an exemplar employer. It is worth considering the pool of SAS doctors who might be attracted to AS posts at the Trust. If the national direction of travel (indicated by the DDRB and NHS providers and strongly advocated by the BMA) results in reopening of the grade across the UK, the Trust would be in competition with all other Trusts for these doctors, whereas reopening the grade now would potentially open opportunities for the Trust to recruit ahead of that.
What's to lose?
Trusts need to retain their SAS grade staff more than ever. Re-opening the AS grade is one of many ways to do so. We continue to push for parity of leave too (see my earlier blog) and for Trusts to sign up to the SAS charter.
This is one option but clearly a good one for all. What's to lose? Trusts could push positive changes and reap the rewards or they could get left behind. I think that common sense will win on this one.