SAS doctor action

SAS doctors are not able to take part in consultant industrial action as they are employed on SAS contracts so must attend work as normal and continue their regular contractual duties.

Christmas day service

The BMA has been clear in the run-up to its ballot that they intended ‘Christmas day’ levels of care as the form of industrial action they would take. This means that emergency care will continue to be provided, but elective/non-emergency work will need to be cancelled. Employers have been given advance notice of the dates of industrial action. This means there has been ample time for all planned activity to be cancelled in advance and to minimise disruption to patients.

Acting-up/providing cover

Formal arrangements

It is unlikely that formal acting-up arrangements will be put in place for SAS doctors during consultants’ industrial action.

It is unlikely especially when planned action by consultants will only be relatively short (i.e. two days). Please bear in mind:

• The 2008 contracts for both specialty and associate specialist doctors stipulate a minimum 14 days qualifying period before individuals can be paid for acting-up (in the arrangements set out under Schedule 28).

• The 2021 contracts for specialty and specialist doctors explain individuals would not normally act up (in the arrangements set out under Schedule 19) for a continuous period of less than a month (unless mutually agreed). As per the 2021 TCS, if any acting-up arrangements are agreed, payment should be at the rate of pay they would receive on appointment to the consultant or specialist grade and start from the first day of acting up duties.

For further information see our guidance on SAS doctors acting up in England.

Providing cover in an informal capacity

It is possible that SAS doctors will be asked to provide cover in a more informal capacity. The 2008 Specialty Doctor and Associate Specialist contracts, as well as the 2021 Specialty Doctor and Specialist contracts, state that individuals “will be expected to be flexible and to cooperate with reasonable requests to cover for their colleagues’ absences where they are safe and competent and where it is practicable to do so” (Schedule 3, paragraph 3). The emphasis on safety and competency is paramount: SAS doctors are also under the GMC obligation not to work outside their competency.

Your NHS employer may request that you provide cover for absent consultant colleagues on the day of industrial action, provided you have the clinical competencies to do so.

What you'll need to consider

If you are asked to cover for absent colleagues, you will need to consider:

• If you are capable of providing this cover

• If, outside of your own personal capability, it is safe to provide this cover (as both your own and supporting services are likely to be severely disrupted by consultants’ absence – see below)

• If this cover will adversely impact your job plan (as where cover adversely impacts your job plan and/or opportunities, a temporary job plan will be agreed for the period of cover)

Employers have been given advance notice of the dates for industrial action to make appropriate arrangements around activity in the days leading up to the days of strike so any additional work must be agreed in advance wherever practicable.

Both 2008 and 2021 contracts underscore that, should providing cover be impracticable, the employing organisation (and not the doctor) will be responsible for sourcing alternative cover. The SAS doctor, however, has the responsibility of bringing the need for this to the employer’s notice.

SAS doctors doctors should not be expected to assume additional consultant responsibilities simply because they are experienced or available and must not be pressured into covering consultants, especially if they have concerns around patient safety. If you feel you are being pushed to do so, contact the BMA through our employment webform.

If you do cover a colleague, we would advise that you get the informal cover arrangements put it in writing, so there can be no disputes after the action ends.

Compensation for providing cover

As explained above, while a temporary job plan can be drawn up for temporary cover, SAS doctors are unlikely to get acting-up payments or access the acting-up allowance for work undertaken during the consultants’ industrial action.

However, when SAS doctors work outside their contracted hours they should receive either an equivalent off-duty period or remuneration.

We would advise members to use appropriate extra-contractual rates for these purposes – members may wish to check with their LNC chair to see if there are any agreed rates in place in their trust for SAS doctors undertaking extra-contractual work.

We advise SAS doctors to ensure that such extra-contractual work is paid at the BMA minimum recommended rate and to decline the offer of extra-contractual work that does not value you appropriately. 

Delivering a safe service

SAS doctors who work autonomously

If you are a SAS doctor who already works autonomously, and this is formally recognised in your job plan (e.g. activity is listed under your name) it is possible your trust will ask that this activity goes ahead during the industrial action. As an autonomous practitioner you would be contractually obliged to provide this service as long as it is safe to do so. (see our guidance on autonomous working if you are unsure whether your autonomous work is being properly accounted for). It should however be noted that existing clinical autonomy does not automatically create an obligation to undertake additional consultant responsibilities during industrial action.

SAS doctors who do not work autonomously

If you are a SAS doctor who does not already work autonomously (either partially or completely), you should not be pressured into working without supervision or to take on responsibilities not agreed in your job plan. There is a difference between autonomous practice and doctors receiving inadequate supervision. Taking on autonomous work is a significant undertaking that should be considered carefully, agreed and formally recognised as part of existing job planning and appraisal discussions. As such, employers should not be using strike action as the grounds to introduce new autonomous roles, remove established supervision arrangements or transfer consultant-led responsibilities to SAS doctors.

Even if you consider yourself capable of taking on autonomous duties, your service may not be able to function as normal due to staff shortages during strike action and so it is inadvisable to begin autonomous work duties during strike periods.

Any SAS doctor being asked to work autonomously by their employer or that is seeking to work autonomously should usually do so under a clear, formalised agreement. See further guidance on becoming an autonomous worker.

Elective or non-emergency work

As mentioned above, a SAS doctor’s established autonomy alone is not sufficient justification for continuing elective services as consultant substitution. For any elective or non-emergency work to go ahead on the days of action, a full risk assessment would be required in advance on a case-by-case basis. This would need to include an assessment of emergency escalation and the support specialities that may be required should a complication occur, the availability of cover, and subsequent risks.

Patients undergoing surgery or an invasive procedure should be appropriately consented and informed that the consultant strikes are occurring and there will be reduced support available in the event of complications.

Raising concerns

If you do not think your service can run safely, either because consultant supervision will not be in place, or because other services – such as radiology or pathology – will not be functioning as usual, you have a duty to make this clear to your employer and you shall not be subject to any detriment for raising such concerns. We also ask you to raise the matter with the BMA using our employment advice webform if you are being pressured to work without adequate supervision, or outside of your competencies, or in an environment you believe is unsafe.

Cancelling leave

Employers should only cancel leave as a last resort

Employers have had advance notice of strike days and should make arrangements which don’t involve cancelling annual leave to ensure continuation of services to patients. As such, it should not be necessary for employers to try to cancel your leave. As above, there may be limits to the work that you are able to deliver on days of action anyway, in which case cancelling leave would be largely self-defeating.

Seeking to cancel annual leave should be a last resort only after all other options have been considered and exhausted. If your employer seeks to cancel pre-booked leave, you should get in touch with BMA advisers via our employment advice webform. 

Employers can cancel pre-booked days of study leave to meet service requirements

However, an employee who has their study leave cancelled has a good argument for asking for reimbursement of any reasonable losses they suffer. As above, this should only be considered as a last resort after all other avenues (such as cancelling routine activity) have been exhausted.

SAS pay campaign

While SAS doctors cannot take part in this round of industrial action, we are aware that members have concerns about their pay and working conditions, and the UK SAS committee are committed to addressing these.

Read more on what we are doing to improve pay and recognition for SAS doctors in England.