As a SAS grade doctor you may be capable of taking decisions and carrying responsibility without direct supervision, which is known as autonomous working.

An overview of autonomous working

According to SAS contracts and NHS guidance, SAS doctors are eligible to work autonomously because they are:

• working on a high grade and will have acquired a high level of specialist knowledge and expertise. This high level working offers the capacity and opportunity to work independently
• taking a broader role in the organisation through other activities such as teaching, auditing, training and developing local services
• providing experience, specialist care, often within a multi-disciplinary team
• managing complex cases and spending time and effort reflecting on and reviewing patient care activities so that quality and safety improve continuously.

Requesting to work autonomously

Taking on an autonomous role is a significant undertaking and should be considered carefully but, if you are confident and experienced in a particular area, it is worth exploring.

Things to consider when requesting to work autonomously:

• approach your line manager first
• there could be practical job planning issues to consider which will need planning
• consider the workload and any support you might need and how it could work on a day to day basis
• consider a review mechanism and regular catch ups with the consultant
• prepare evidence which supports that you are carrying out work to a high standard already
• speak to colleagues about your work and abilities to get an idea of their view, can they support your request?
• it is possible that the consultant and other colleagues will not agree that you are ready to work autonomously. 

Situations that may arise

Your line manager suggests you should no longer be working autonomously

This should be discussed in a job plan review before your current practice is changed. Job plans should be agreed on an annual basis as a minimum, but SAS doctors or their clinical managers may call for an interim review at any time.

It is important that you highlight any relevant experience as autonomous work is one area that could demonstrate progression for purposes of threshold two. Your employer should be assisting you to develop and to meet threshold criteria.

Your existing job plan remains in contractual force until change is agreed in a job plan review or until after the conclusion of the appeals process if necessary.

Can SAS doctors accept direct referrals?

This should be discussed in a job plan review before your current practice is changed. Job plans should be agreed on an annual basis as a minimum, but SAS doctors or their clinical managers may call for an interim review at any time.

It is important that you highlight any relevant experience as autonomous work is one area that could demonstrate progression for purposes of threshold two. Your employer should be assisting you to develop and to meet threshold criteria.

Your existing job plan remains in contractual force until change is agreed in a job plan review or until after the conclusion of the appeals process if necessary.

How patients should be coded if a SAS grade doctor is accepting direct referrals

The BMA would urge that all patient care should be more accurately coded so that any SAS input to a patient's clinical pathway should be recorded whether or not this is a direct referral.

The NHS requires input of accurate data to reflect clinical activity and trusts now have a financial incentive to ensure that coding is accurate, comprehensive and timely.

Where a SAS doctor is undertaking autonomous practice coding it will help to strengthen the data and is something that can be done with the support of the trust and department.

The Health and Social Care Information Centre has confirmed that for local recording, organisations can record patient care under a SAS doctor using local codes. However, these will need to map back to national codes for reporting purposes.