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LNCs across the South East call for Trusts to re-open the Associate Specialist grade
Strong lobbying from BMA reps and staff 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 twenty 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.
Who are SAS Doctors?
SAS doctors and dentists are a diverse group with a wide range of skills, experience, and specialties. They work as staff grade doctors, associate specialists, specialty doctors, hospital practitioners, clinical assistants, senior clinical medical officers and clinical medical officers. They make up a significant part of the medical workforce. The need to recognise and develop this group of doctors to aid the NHS in recruitment and retention has been acknowledged by NHS Employers, HEE, the Royal Colleges and the BMA. Recent publications and guidance for NHS Trust Boards on this is available here.
What are LNCs proposing to support SAS doctors?
At Trusts across the South East and across the UK BMA Local Negotiating Committees (LNCs) have been requesting three things to support SAS Doctors:
We believe this is a potential win-win situation, which should help Trusts to recruit and retain a key, long serving and hard-working group of experienced doctors, to improve career development (where there is a business need and criteria are met) and potentially to improve recruitment, which would reduce agency spend.
Just over a year ago I posted a previous blog about the two additional days leave and am pleased to report some successes in the South East. You can see these in the comments on that post.
However, this blog concentrates on the other suggestion to aid SAS recruitment and retention; re-opening the Associate Specialist grade.
Background and Contractual position
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. The new Specialty Doctor grade contract was introduced for new starters (subsuming all the previous grades). I was closely involved in those negotiations and the closure of the AS grade was the most controversial aspect, an element forced upon BMA SAS negotiators by NHS Employers who wanted to create a single pay spine. Part of the problem was that NHS Employers 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. 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 (in accordance with Annex 2 EL (97) 25) no longer had that opportunity for career progression. The 2008 AS contract and terms and conditions and associated pay scales remain in place, and are updated nationally as appropriate but dwindling numbers are on these contracts.
The BMA proposal is to reopen the Associate Specialist grade, on the national 2008 contract terms and pay. The key request is to do this to allow for other SAS doctors employed at the Trust to apply for regrading to the AS grade. The second request is to allow recruitment to new AS positions. The BMA has a model policy to support regrading, based on the previous regrading requirements which has been shared with Trusts.
Why isn't this happening at a national level?
We hope it will. It is BMA Policy and has been raised repeatedly with NHS Employers over the last decade. Since the AS grade was closed, it has become increasingly acknowledged that this is an unsatisfactory situation. There is growing support for the proposal but at the moment NHS Employers maintain the position that the grade isn't necessary - an obvious error that fails to recognise the massive retention and morale issues amongst the SAS grades.
Last year the DDRB officially backed the reopening of the AS grade. The DDRB report 2017 says:
“6.36 NHS Employers told us it had maintained regular contact with the BMA SAS Committee and continued to explore how SAS doctors and employers could work in partnership to support and enhance the important contribution that SAS doctors make. The new guidance for trust boards would suggest that board members consult regularly with SAS doctors to better understand the work they deliver and any necessary support they need. It would also suggest that boards could ask their medical directors to report on a range of measures to ensure that the trust was making best use of the skills and abilities of the SAS workforce. Plans should be developed and implemented at trust-level to address any issues of concern. NHS Employers reiterated that SAS doctors felt undervalued and were unhappy with pay. There was an issue with how to promote the development of SAS doctors; while some were able to progress to consultant roles, many felt they were doing most of the work of consultants without the appropriate remuneration.
6.37 NHS Providers was of the view that SAS grade contract reform was necessary, given their crucial role and the lack of adequate development opportunities for this group. Officials noted a lack of recognition of these doctors. In their opinion reopening the now closed Associate Specialist (AS) role would be one method of making SAS roles more attractive, along with better support and appreciation of SAS doctors.”
Since then the Secretary of State has lent his backing and given a commitment in principle to re-opening the AS grade to improve recognition and reward for SAS Doctors as part of an overall reform of the SAS contract and the Royal College of Anaesthetists and Association of Anaesthetists also recently published a joint statement in support of the re-opening of the grade.
Clearly, we are moving in the right direction; albeit slowly, but for now it is up to forward looking Trusts to open the AS grade 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.
So what's the holdup?
As with everything a lot of the problem is down to money. But we believe this shouldn't be a barrier and have tried to demonstrate to Trusts that regrading is actually very cost effective. It is difficult to quantify the total cost to Trusts, as applications to regrade are considered individually on their own merits, and based on a business case and the needs of the service, so is not automatic. There are too many variables to accurately predict how many will pass the strict regrading criteria.
The key difference between the AS grade and other SAS grades is enhanced duties, and autonomous / independent working. The pay scale for the AS grade sits between that for Specialty Doctor and Consultant (with some overlap in both cases). To move through the thresholds in these pay scales requires participation in job planning, objectives, appraisal and increasing responsibility / wider roles. So whatever the (minor) cost for Trusts it is well worth it!
What are the benefits for Trusts?
We 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 undeniably very good value for money.
Re-opening the grade would allow the growing numbers of Specialty Doctors on the GMC specialist register an additional option to gain experience and seniority other than applying for consultant posts. There are many SAS doctors now on the specialty register who would benefit from the increased level or practice, recognition and salary.
Where is it happening?
Many places! We don’t have complete data on where policies to reopen the grade have been introduced formally and informally, however formal policies have been agreed based on the BMA model at the following Trusts:
So far most of these progressive Trusts are in the South West but we know that many other Trusts are considering this including in the Kent Surrey and Sussex and nearby areas, and 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.
The latest to announce regrading in the South East are Queen Victoria Hospital NHS FT and Virgin Care. Both organisations announced last month that they will reopen the AS grade for regrading and recruitment. The decision also confirms that this will be in accordance with the 2008 terms and conditions of service.
At Kent Community Hospital NHS Foundation Trust the LNC were advised earlier this month that, following BMA lobbying over the last year, plans were progressing to re-open the AS grade locally. Those in the grade at KCH NHS FT will be known as 'Medical Specialists' but will mirror Associate Specialist TCS and pay scales. The Trust are currently awaiting College approval for the Job Descriptions and hope to be able to advertise before the end of the year.
We have also seen a draft regrading policy for East Kent Hospitals University NHS FT (EKHUFT) which we hope will be formalised soon. Again, that policy is based on the BMA model and current national AS TCS. EKHUFT is the largest employer of SAS grades in the South East so it is only right that they blaze the way on this.
There are many options for Trusts in relation to this proposal, including reopening the AS grade for internal regrading applicants and potentially for new appointments, or just opening it for internal regrading applications. The key requirement will be to consider the criteria for regrading, ensuring this is consistently and fairy applied, and having a clear business need and transparent policy.
Get on with it!
The BMA and LNCs have called for the reopening of the AS grade to allow regrading applications to be considered, and to allow recruitment directly to the grade. We believe this is a win-win situation, which should help Trusts to recruit and retain a key, long serving and hard-working group of very experienced doctors, to improve career development (where these is a business need and criteria are met) and also potentially to improve recruitment, which would reduce agency spend.
If the national direction of travel indicated by the Secretary of State's commitment, DDRB view, BMA lobbying and recent Royal College statement results in reopening of the grade across the UK, each Trust will be in competition with all other Trusts for these doctors, whereas re-opening the grade now in individual Trusts across the South East would potentially open opportunities for the Trust to recruit ahead of that, remain competitive with their neighbours and be viewed as an exemplar employer. Cynical but true.
Trusts need to retain their SAS grade staff more than ever. Re-opening the AS grade is one of many ways to do so. One option but clearly a good one for all. Get ahead of the curve and get on with rewarding and recognising our dedicated SAS workforce!
Sussex Community also adopted regrading soon after East Sussex.