As part of the 2020/21 SAS contract negotiations, the BMA and NHS Employers agreed to the creation of a new national grade for senior SAS doctors, known as the specialist grade.

This was intended to fill the progression gap left by the closure of the national associate specialist grade in 2008 by providing SAS doctors with an alternative career pathway that can provide recognition for them as skilled clinicians. 

Roles and responsibilities

Specialists are senior clinicians and expert decision makers that work autonomously to a level of defined competencies, often as the responsible named clinician for the full range of patient care for their specialised area.

With the closure of the associate specialist grade and absence of any formal contractual means of regrading or progressing directly from the specialty doctor grade to the specialist grade, we are conscious that many specialty doctors may currently be working at a senior level of responsibility and competence without appropriate recognition and renumeration. These blurring of boundaries between the roles and responsibilities of specialty and specialist doctors allowing them to renumerate Specialist roles and responsibilities at the level of a Specialty doctor additionally risks employers feeling little incentive to create a Specialist post.

We have produced a comparison table that sets out the differences between the specialty doctor, specialist and consultant roles to help you understand what roles and responsibilities should be expected of each.

Applying for a Specialist Role

In order to become a Specialist, you must:

• Have full GMC registration 
• Have completed at least 12 years medical work (either continuous or aggregate) since obtaining a Professional Medical Qualification (PMQ), of which at least 6 years should have been in a relevant specialty (including equivalent overseas experience)
• Meet the criteria set out in the Specialist grade generic capabilities framework

As it currently stands, Specialist posts are created at the discretion of the employer, where they have identified a specific workforce need rather than an automatic re-grading once you meet the criteria. Specialty doctors on the 2021 and 2008 contracts will therefore have to apply for specialist grade roles as and when vacancies become available.

This is also the case for locally employed associate specialists appointed (e.g. Trust associate specialists), as they will be on local contracts. If you are seeking appointment to the new specialist grade, you will also need to use the approach set out in this guidance.

All Specialist roles should first be advertised internally within employers in the first instance. However, despite many Specialty doctors already working at Specialist level, there may be a limited number of Specialist vacancies to apply to and you may need to demonstrate to your employer that there is a clear workforce need for a specialist post to be created. Advice on evidencing your roles and responsibilities when applying to vacancies and/or demonstrating a workforce need for the creation of a Specialist role can be found in the next section. 

Switching onto the 2021 Specialist Contract

Associate Specialists can also request to move on to the 2021 Specialist contract. The BMA and NHSE have jointly produced a specialist grade appointment guidance for existing associate specialists on the 2008 national contract who wish to transfer to the specialist contract.

Further guidance on the benefits and downsides to moving from a 2008 to 2021 contract can also be found on our website here.

Demonstrating a workforce need

In creating the specialist role, the BMA and NHS Employers have focused on the requirement for employers to identify a specific workforce need. 

When an employer identifies such a need, they are expected to use their overall allocations to fund new specialist posts. The creation of new specialist posts was factored into the overall cost modelling for contract reform.  This would mean opening a competitive and transparent appointment process for SAS doctors.  

Government have made a commitment to ensure a more streamlined and predictable pathway to become specialists, which we are working hard with them to materialise, however as Specialist posts are currently created at the discretion of the employers, there may be a need to push for the creation of these roles at your Trust.

As outlined by the role comparison table, each grade of doctor has distinct roles and responsibilities. By demonstrating that you are delivering activities at a specialist level, you are proving that your employer does indeed have a clear workforce need for such a post. If you were not undertaking this senior-level work, they would need to create a post to ensure that it was being done.

If you are interested in applying to a Specialist role vacancy or think that you are already currently working beyond your level as a specialty doctor, and should be given the opportunity to be appointed to a specialist post, here are the steps you can take: 

• Understand the differences between the specialty doctor and specialist roles
• Identify any current roles and responsibilities you share with the specialist grade
• Ensure all autonomous work is reflected in your job plan – any autonomous work you deliver should be recorded in your job plan so that you can easily evidence your case for becoming a Specialist. Further guidance on autonomous work can be found here. 
• Review your job plan, and dispute if necessary – please see below for further advice on this
• Reassess any acting up arrangements – please see below for further advice on this 
• Seek support from your SAS advocates and LNC reps to make a case for the creation of specialist roles in your Trust.
  
  

Job planning

You may need to make use of contractual job planning processes to highlight the senior level activity you are undertaking and dispute whether it is appropriate to continue.

You are entitled to request an interim review of your job plan, rather than waiting for your annual meeting to take place.

In that meeting, you can discuss possible changes to duties or responsibilities. If your employer is not willing to pay you at the correct rate of pay, you can request that the more senior activities be removed from your job plan.

Your employer is not obliged to agree to remove these activities from your job plan, but they may be willing to offer more appropriate remuneration in line with what a specialist would expect to receive for them.

If you are unable to reach agreement, you may wish to explore whether a resolution can be reached through the mediation and appeal processes as set out in your contract. This would provide you with further opportunities to state your case, though there is no guarantee that the panel will decide in your favour.

You can also seek to raise a grievance with your employer about undertaking work equivalent to colleagues employed in more senior roles without receiving the same recognition and reward.

Read our detailed guidance on the job planning process.

Acting up

You should not undertake any work identified as being expected of a specialist without it being appropriately recognised or remunerated.

If this occurs or a need for you to do this arises in your workplace on an indefinite basis, the employer should address this through creating a specialist post to fulfil that work.

Where these responsibilities have arisen from the absence of a senior colleague, contractual acting up arrangements of a change in job title and remuneration should be agreed between the employer and doctor. These arrangements should be for a limited period of time only. However, we know that some employers try to use acting up arrangements to cover workforce gaps, which is not the purpose of these provisions.

If a doctor is acting up for a prolonged period of time, this is another indication that the employer has a clear workforce need to create a specialist post. Furthermore, if you are being paid appropriately under acting up arrangements, that means there is no financial incentive for employers not to create such a post.

If your employer asks you to undertake additional activities and responsibilities that can be identified as being at a specialist level, you should only agree to undertake them if they are to provide extended cover for an absent senior colleague and are remunerated through the arrangements set out in the acting up payment schedule.

Read our detailed guidance on SAS doctors acting up.

What to do next

Once you have identified the aspects of your current role that you think are more closely aligned to those of the specialist grade, you should produce a document setting these out, highlighting the relevant parts of the generic capabilities framework that they relate to, and explain in detail what these activities involve.

This should be initially submitted to your line manager, with a suggestion of entering into a job plan review, but you may wish to escalate it to a more senior manager with overall responsibility for the service you deliver.

As part of the 2024 pay deal, we have worked with NHS Employers to develop a Specialist Hub that contains a range of resources and guidance that help to promote the Specialist role within your trust and have also have published joint guidance to encourage NHS organisations to create specialist roles and embed them into their workforce.

These resources alongside the guidance for specialist grade appointment for specialist grade appointment may be useful to anyone looking to make the case that they meet the essential requirements of the grade, or that their existing role requires work that should ordinarily be expected of a specialist role.

It will assist you in reviewing the generic capabilities framework and making suggestions for how each can be demonstrated using evidence that may already available elsewhere.

Webinar

Watch the webinar on the specialist grade hosted in collaboration with NHS Employers in England and Wales, and members from England and Scotland.