An overview of the acting up clause

‘Acting up’ refers to the act of performing the duties (e.g. clinical and managerial) of someone who belongs to a higher grade than you, while providing cover for their absence. Within the context of SAS doctors, this could be a specialty doctor covering for a specialist, or any SAS doctor covering for a consultant. 

There are specific clauses addressing the conditions of acting up in both the 2008 and 2021 SAS doctors’ terms and conditions of service (TCS). The provisions can be found in:

• Schedule 19 2021 specialty doctor TCS
• Schedule 19 2021 specialist TCS
• Schedule 28 2008 specialty doctor TCS
• Schedule 21 2008 associate specialist TCS

If you are on an older contract that pre-dates the 2008 specialty doctor/associate specialist contracts, please check your specific terms and conditions.

An acting up arrangement needs to be agreed by both the doctor providing cover, and their employer. The clauses above note that an individual who is acting up is entitled to the rate of pay of the job they are fulfilling (whether specialist or consultant). A SAS doctor acting up should also have their work recognised by a change of job title. 

Acting up provisions are designed to only be used on a temporary basis, so it is important to know what level of support you will have during the period of acting up, how long you will be provide this cover for, and what will happen when you return to your substantive position.

Things to consider before acting up

1. Acting up vs being appointed on a locum contract

When a senior doctors’ absence requires cover, an employer may either:

• seek cover from an existing consultant employee;
• engage a locum consultant (usually a SAS doctor on a fixed term contract who performs the consultant role);
• or agree to pay an acting up allowance to a current SAS doctor

As SAS doctors can be appointed as locum consultants, it is possible a SAS doctor may be used to provide cover for a senior doctor in different ways. It is therefore important to consider both the different conditions and provisions for using the acting up clause compared being engaged on a locum consultant contract so that you are able to make an informed decision about how to offer cover. 

For example, whether you act up or engage in a locum post has an impact on your contractual right to return to your substantive post. A SAS doctor who is acting up will retain their substantive role, as their SAS contract subsists, and have a contractual entitlement to return to their post once the acting up period is over. They should have this outlined in a written agreement such as an addendum to your contract issued which outlines the acting up arrangement (including the duration of the acting up and duties undertaken). 

While many locum consultants will return to substantive SAS roles after their fixed term contract has ended, they do not however have the same contractual protections to do so as an acting up SAS doctor.

Please see our guidance on locum working for SAS doctors for further information on locum consultant contracts.  

As well as a difference in contractual protections, the following conditions are required to utilise the acting up clause, that are not required for engaging on a locum contract: 

Alternative arrangements

The acting up clause can only be used if arrangements cannot be made for the cover to be carried out by another doctor of the same grade (e.g. consultant or specialist) or a locum.

Autonomous work

Acting up payments shall only made to SAS doctors taking over clinical and managerial duties and responsibilities of the absent doctor without supervision 

Type of leave

The senior doctor requires cover for reasons other than annual leave of progressional leave (such as for study, research, teaching, examining or taking examinations, visiting clinics, attending professional conferences, training). These types of leave can only be covered by another consultant or locum consultant but the acting up clause can be used to cover other types of absences such as sick leave and maternity or adoption leave as well to cover a temporary vacancy. 

Qualifying Period

The doctor is expected to be absent for the minimum qualifying duration of time (whereas there is no such minimum required for appointing a locum). The length of this period depends on a doctor’s specific TCS:

• 2021 Contracts: The acting up clause can be used when covering consultants or specialists that are expected to be absent for over a month. The period of acting up shall not be longer than 6 months unless mutually agreed between the employer and SAS doctor.
• 2008 Contracts: The acting up clause can be used to cover consultants or specialists that are be expected to be absent for more than 14 days. The acting up period shall not act up be for a continuous period of longer than 6 months.
• Those on Pre-2008 contracts should check their individual contracts for provisions.
• Local agreements may be in place for you to agree a shorter qualifying period, regardless of your contract. 

Continuity of Acting Up 

Although continuity of the acting up period will not be impacted by days where you are not required to be on duty,  if you are absent for any reasons for more than 14 days during your acting up period, you will need to work a further 14 consecutive days following this absence in order to continue receiving acting up payments again. 

2. Acting up vs Autonomous working

The acting up clause should only be utilised when it is mutually agreed that the SAS doctor shall cover the absence of a consultant or specialist. This is done through the agreement of a temporary job plan.

This is a formalised arrangement that is distinct from SAS doctors agreeing to perform autonomous practice within their current role (as a means of increasing responsibility and pursuing professional development). Please see our guidance on autonomous working for SAS doctors. 

What should acting up look like?

Job Planning 

As well as written agreement of the acting up arrangement, an acting up agreement should be formalised with the use of temporary job plan that outlines the duration of the time you’ll be acting up and the clinical and managerial duties and responsibilities of the consultant or specialist you are taking over during the acting up period. This should be mutually agreed between the SAS doctor and employer. 

As acting up requires you to carry out the roles and responsibilities of a senior doctor unsupervised, you should not be coerced to undertake work that you consider outside of your capabilities. Discussions concerning acting up should be held at job plan reviews or meetings.

Remuneration

When acting up, you shall receive an acting up allowance that would bring your rate of pay up to the level it would be if you were in a substantive consultant or specialist position. 

The rate of allowance should be determined in accordance with the national TCS (terms and conditions of service) of the grade you are covering. You will also be entitled to some of the other benefits outlined under those terms and conditions including, travelling allowance and mileage. You may locally agree further support such as extra SPA time, admin and other support with your employer.

Payment of the acting up allowance will be made from the first day of the qualifying period (i.e. the first day the senior doctor you are covering is absent) for those on the 2008 contracts, and on the “first day of acting up” for those on the 2021 contracts. The first day of acting up and the first day of the doctor’s absence should be the same day in order to prevent overdue payments.

As you will be on a substantive contract during the receipt of acting up payments, this would also result in increased contributions to your pension scheme. 

Changing your job title

If you are acting up, you should take up the title of the role you are fulfilling. By taking this title, you are gaining seniority and a level of clearance and recognition you need to fulfil the full range of duties and responsibilities the role requires.

If it is not a long term or more substantive appointment it is appropriate to have the word ‘acting’ precede your title (E.g. acting consultant).

Returning to your substantive post

When the period of acting up comes to an end, you are entitled to return to your previous post and the role.

The duration of acting up should contribute toward your progression through the pay scale. It should be also deemed as continuous service in your substantive position when determining entitlement to employment benefits, such as maternity/paternity, parental and sick leave.

If you are asked to act up for more than six months continually, you should consider the terms of this extension before agreeing this with your employer. You may also approach your clinical director about the possibility of the role being advertised as a substantive position, for example if you are covering a temporary vacancy.

Opportunities for career development

Acting up is encouraged as a means of career development. It is an opportunity for you to gain experience in a more senior role and develop your skills set.

The experience gained would support your progression through the thresholds, as well as applications for more senior posts and specialist registration via the portfolio pathway (formally CESR -certificate of eligibility for specialist registration). 

If you think you have already been working at the level of the specialist grade, read our guidance on making a case for being appointed to a specialist post. 

Job planning

You should carefully consider all the potential implications of either accepting or refusing a request to act up.

Discussions concerning acting up should be held at job plan reviews or meetings and any changes to job plans should be made by mutual agreement.

BMA support

If you believe you have taken on the role and responsibilities of an absent consultant or specialist doctor without recognition through acting up payments and require support, you should obtain as much evidence in writing regarding the agreement and contact the BMA through our employment advice support form or speak to your BMA Local Negotiating Committee SAS rep.