Working on-call guidance for SAS doctors

Our guidance explains how the terms and conditions of service contributes to the on-call working arrangements for SAS doctors.

Location: UK
Audience: SAS doctors
Updated: Wednesday 22 February 2023
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If you are working on-call it’s important to calculate the hours you work, understand how you will be supplemented and be aware how the terms and conditions of service contributes to the on-call working arrangement. 


Calculating the hours you work

You should treat unpredictable emergency work arising from on-call duties as counting towards the number of programmed activities (PAs; known as ‘sessions’ in Wales) which you are contracted for.

You and your employer will need to assess, on a prospective basis, the number of PAs that represent the average weekly volume of unpredictable emergency work. This will normally be a maximum of two PAs per week.

To calculate the average weekly amount of on-call work you should agree a reference period with your employer and keep a diary of how much work you do in an on-call period. You may find our job planning app, Dr Diary helpful.

Some things to remember:

  • include travel time if you need to return to your workplace, time on the phone to colleagues, time making notes at the end of a call, etc
  • doctors should be adequately rested in order to effectively care for their patients. If this isn’t happening you should also agree a suitable compensatory rest period after your on-call shift in the interest of patient safety
  • if you are on two different rotas with different frequencies you will need to blend those together and reach an average for a longer period
  • associate specialists on the 2008 contract have the right to refuse non-emergency work after 7pm and before 7am during weekdays or at weekends (under schedule four, paragraph six of the terms and conditions of service). Such work should only be scheduled by mutual agreement between you and your clinical manager.


On-call supplement

If you are required to be on an on-call rota, you will be paid an availability supplement which is calculated as a percentage of basic pay (excluding any additional PAs, London weighting allowance and any other fees, allowances or supplements).

The amount of the supplement will depend on the frequency of the on-call duties which will be set out in your job plan.

There is some variation among employers as to how total frequency is calculated but our Dr Diary app and employment advisors can help ensure your on-call commitment is being appropriately recognised and paid.

2008 contracts supplements

More frequent than or equal to 1 in 4 - 6%

Less frequent than 1 in 4 or equal to 1 in 8 - 4% 

Less frequent than 1 in 8 - 2% 

2021 contracts supplements

More frequent than or equal to 1 in 4:

  • category A - 8%
  • category B - 3%

Less frequent than 1 in 4 or equal to 1 in 8:

  • category A - 5%
  • category B - 2%

Less frequent than 1 in 8:

  • category A - 3%
  • category B - 1%

Category A, which we believe will apply to the vast majority of SAS doctors, requires you to return to work immediately or conduct complex remote consultations. 

Category B applies to phone consultations only.


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Prospective cover

According to the TCS (terms and conditions of service), SAS doctors have a duty to provide cover on a short-term basis where reasonable. However, if the employer believes that cover is required for a longer period, it should be agreed with you and reflected in your job plan.

Prospective cover is not an obligation but all doctors have a responsibility not to leave the rota unfilled due to an unexpected absence. If you agree to provide prospective cover, there should be a suitable addition to your PA allocation to recognise that.

Step one Step two Step three
Number of programmed activities (PAs) to be covered per year divided by number of doctors on the rota.

This will provide the number of PAs each doctor has to do per year.
Number of PAs each doctor has to do per year divide by weeks in the year (usually 42 weeks, though there may be local variation). The number of PAs to be added to the weekly job plan.

In practice:

A doctor works one night a week resident on-call from 10pm to 7am. That accounts for nine hours of work in premium time, which equates to three programmed activities (PAs) per week. As such, this would be paid as three PAs every week (including when on leave), or 156 PAs (3x52) per year.

Due to leave arrangements ’a working year’ is actually less than 52 weeks. There should be local agreement with the LNC as to what 'a standard year’ should include but it is often agreed as 42 weeks to allow for study leave, public holidays and annual leave.

In practice:

However, if they are to factor in prospective cover, the employer will need to calculate how much additional time an individual will be working in order to provide cover for their colleagues. If there are seven doctors on the rota, each of them will be absent for approximately 10 weeks – each of the seven will be providing 52 shifts per year, over a 42 week year.

In practice:

As such, each of them will actually be doing a longer working week than first appears when calculated over the course of a year. They will actually be working approximately 11 hours, not nine hours, per week, and should get approximately 3.6 PAs, not three.

Shift arrangements

Doctors working full shifts out of hours will not be paid an on-call supplement but will be paid at time and a third for the entire duration of the shift.

​Doctors who are working the majority of the on-call period may be working a shift. This is particularly the case for those required to be at their place of work for the on-call period. If this is confirmed as a shift in a job planning review then it would no longer attract the on-call supplement if your contract no longer states that it is ‘on-call work'. 


Resident on-call

The terms and conditions of service do not specifically reference resident on-call work.

The BMA staff and associate specialists committee believes that as it is technically classed as 'on-call work’ it should attract the availability supplement. Also, all time spent as resident on-call would attract the enhanced pay rate of time and a third.