SAS doctors have been taken for granted
SAS doctors are an essential part of the NHS workforce – without them, it would unravel. Yet their pay, recognition and opportunities for progression do not reflect the value of these highly skilled doctors.
The Government’s pay uplift for SAS doctors in England for 2025/26 was only 4%, leaving real-terms pay erosion at a staggering 24% compared with 2008/09 levels. Worse, the Government recommendation to the pay review body (DDRB) for 2026/27 is a 2.5% award, suggesting another real terms pay cut. Working in an over-stretched system, medical professionals are certainly not working less than they did in the early 2000s, but they are being effectively paid less for it. This has led to a feeling of being devalued.
The issue is compounded for SAS doctors by a lack of recognition. Despite the role they play in the NHS and the tireless work they provide in patient care and improving services, SAS doctors can often be left to feel like a forgotten workforce. Their expertise and skills are woefully undervalued. Their efforts and experience can be dismissed, or otherwise ignored, simply due to their grade. Their career progression is also stunted by the lack of specialist posts, and a struggle to access development opportunities, including leadership roles.
We have been in dispute with the Government since the 2025/26 pay award and have reintroduced the rate card. In July, having had no response to our calls for negotiations, we were forced to survey our members about their willingness to take industrial action. 82% or respondents told us they would be ready to act over their pay and recognition. We met with the Secretary of State in September and sent him a briefing about the issues facing SAS doctors, but he has not responded since and is yet to set up further meetings.
What we are fighting for
We are pushing for SAS doctors to be paid fairly, and receive the recognition they deserve. We are determined to ensure that they are finally seen for the invaluable workforce that they are and treated accordingly.
In the BMA survey of SAS doctors in England during autumn 2024, we asked what they wanted the BMA to focus on. Their top priorities were:
- improving pay
- creating more specialist roles
- involvement in leadership roles
- improving access to the Portfolio Pathway.
This shows that SAS doctors understand their worth, and believe it is high time others saw it, too.
We are calling for:
Fair pay
SAS pay erosion still stands at 24% even after an insufficient 4% uplift last year. The recommendation of 2.5% made to DDRB by the Government deviates from the path toward pay restoration and shows we are once again being taken for granted. We want to see SAS doctors’ pay restored to its 2008 levels and to stop the devaluation of our profession.
True career progression
2021 negotiations between the BMA and Government led to the introduction of the specialist grade – allowing SAS doctors with years of skills and experience to be recognised as senior doctors, and in turn improving the capacity and performance of the medical workforce.
However, many SAS doctors are still not being given the opportunity to progress to specialist posts and there has been no progress toward setting up a mechanism for specialist progression in England – despite mechanisms being established in Scotland and Wales.
As a result, SAS doctors in England are currently struggling to access the few posts that have been created, and have to compete with other grades to access them. SAS committee have been advocating for the creation of more specialist posts, including through the SAS implementation group, but as long as specialist posts are created purely at the employer’s discretion, these efforts can only go so far without structural change at a national level. We want the experience of specialty doctors to be recognised with automatic progress to the specialist role, creating a single pay spine in the SAS contract.
We are also campaigning for SAS doctors to have other development opportunities to use their full potential. We want to see increased SPA time to allow SAS doctors to pursue development opportunities, and enhanced access to leadership roles – with regular data collection to analyse how many SAS doctors are in leadership roles.
Proper recognition
SAS doctors’ time should be properly valued – we are calling for all SAS doctors’ PAs and OOH work to be fairly remunerated. In and out of hours, no SAS doctor should be disadvantaged when it comes to pay – whether it’s compared to other contracts or to their consultant counterparts. We also want to see a reversal of the extension of plain time for SAS doctors on the 2021 contract, meaning work done between 7pm and 9pm on weekdays should be considered out of hours.
We believe being a SAS doctor should and can be a choice that is just as rewarding and valued as other medical career paths. We believe SAS annual leave should match that of consultants – especially for SAS doctors with more than seven years' experience, who often are given less entitlement than their senior consultant colleagues.
Far too many locally employed doctors (LEDs) who meet the criteria for a SAS role are trapped in locally employed contracts. Our SAS pay deal in 2024 included a process to give LEDs the option to move to SAS contracts, and our implementation group has been working hard to ensure this would materialise. We are still awaiting confirmation from the Department of Health and Social Care and remain committed to improving the situation for our LED colleagues.
What you can do
We are in dispute with the Government. While we hope that we will not need to escalate further than our indicative ballot, we encourage SAS doctors to support the campaign and ensure you are prepared for any further escalation by:
- updating your details to ensure you are receiving our communications about the next steps
- signing up to be an 'active member'
- using the SAS BMA rate card for any extra work undertaken for your NHS employer
- joining the BMA and encouraging your colleagues to do so.
Resident doctor strikes
Due to the refusal of the Government to come to the negotiating table and present them with a credible offer to address jobs and pay, the resident doctors committee have voted for renewed strike action, to take place from 17-22 December. We support the resident doctors in their fight and urge you to take the necessary steps to support and protect them.
We have produced guidance for SAS doctors working during periods of industrial action by resident doctors, so that you can understand your rights and responsibilities. This includes updated information about the derogation system and a template letter to use should you have concerns about patient safety. If you choose to cover additional work during the strike, we recommend that you negotiate payment at an appropriate rate using our SAS doctor rate card for extra-contractual work.
Effective action by the resident doctors benefits the profession as a whole. If we stand together, we will win together.
Campaign resources
Download campaign materials to download and share on social media.
Background: The 2024 England pay deal
Pay
In 2024, following months of negotiation, the BMA and Government agreed a pay deal for SAS doctors in England. The deal was made after we lodged a formal dispute, a successful ballot for industrial action, and following months of negotiations. It was also made without taking a single day of strike action. The deal has led to real improvements for SAS doctors and has gone some way to address over a decade of real terms pay erosion. The deal:
- realigned 2021 specialty doctor and specialist pay scales, lifting basic pay for everyone on the 2021 (open) terms and conditions
- provided a consolidated £1400 pay uplift to each pay point on the closed contracts (on top of the 6% awarded by the DDRB for 2023/24)
- as well as provided several non-pay commitments.
Following the deal, the BMA have continued to work with NHS Employers, NHS England and DHSC on the implementation of all aspects of the deal. One major outcome from this included the creation of revised contract transfer guidance, which includes a clause calling for backpay for those whose transfer takes longer than 35 days (through no fault of the doctor in question).
Read the contract transfer guidance
The revised offer to SAS doctors in England
BMA strike fund
A strike fund is available to subsidise members in serious financial difficulty who otherwise couldn’t afford to take part in strike action.
The strike fund is supported through voluntary donations to make available to doctors in need.
