Authors

Co-Chairs APM SAS and Hospice Doctors Committee

Katie Jerram, Specialist Grade Doctor Palliative Medicine; Hampshire and Isle of Wight  Healthcare NHS Foundation Trust; Medical Director, Rowans Hospice

Paul Selway, Macmillan Locum Consultant in Palliative Medicine; Wrightington, Wigan and Leigh NHS Foundation Trust

What are SAS doctors?

The term ‘SAS doctor’ encompasses Specialty Doctors, Specialist Doctors, and those on now closed contracts, such as Staff Grade doctors and Associate Specialists. Nationally, the SAS workforce currently accounts for 30% of all licensed doctors, and by 2030 the General Medical Council (GMC) predicts that SAS doctors will become the largest group on the medical register⁽¹⁾.

It is recognised that the SAS doctor workforce is diverse, with a range of experience prior to becoming a SAS doctor. Some enter the grade from General Practice, others join after completing Core Medical Training, often with the intention of gaining further experience before applying for specialty training. Others may move into a SAS doctor role from another specialty.

SAS doctors in Palliative Medicine

Within Specialist Palliative Care, SAS doctors are primarily employed within the Hospice sector. Entry into the Specialty Doctor grade requires a minimum of four years postgraduate experience, and many individuals remain in these roles for several years. As a result, SAS doctors bring a wealth of experience and represent a significant pool of talent, forming a vital component of the senior workforce in specialist palliative care.

Ensuring the educational and professional development of this group is essential to delivering the highest standards of care, yet historically their development needs have been under-recognised. It is also critical to ensure that these doctors feel valued, as retention within the specialty is closely linked to recognition and support. Evidence from across the UK indicates that access to education and development opportunities contributes significantly to both job satisfaction and staff retention. In recent years, several national initiatives and Charters (BMA, NHS Employers)  have been introduced to support the development of SAS doctors in all specialities.  However, no initiatives to date have been developed specifically for palliative medicine.

The Specialist Doctor Grade

The Specialist Doctor role was introduced in 2021 to recognise the experience of senior SAS doctors and to provide a clear opportunity for career progression⁽²⁾. Specialists are autonomous workers and expert clinical decision makers, holding responsibility for patient care within their area of practice.  The variation in career backgrounds and job plans mentioned above presents challenges when designing a standardised development framework that meets all needs.

Framework for Progression to Specialist

The APM SAS Committee have developed a Framework for Progression to Specialist which seeks to guide and advise SAS doctors and employers on the specialty specific capabilities that should be demonstrated when considering suitability for a Specialist Doctor post.   The career background, experience, job plan and learning opportunities available to an SAS doctor will depend on the setting(s) in which they work. An individual’s development should therefore be aligned with the objectives of their employing organisation.   As such, this Framework is not intended to be prescriptive, but should be used as guidance that can be adapted for individual needs.

Benefits for SAS doctors and employers

This Framework seeks to support both SAS doctors and their employers. For SAS doctors, it provides guidance on the development of relevant knowledge and skills, outlining the competencies they may wish to achieve, and the experience recommended to work towards a Specialist Doctor application. It aims to support SAS doctors to fulfil their potential and to maximise their contribution to the delivery of high quality palliative care.

For employers, this document seeks to build on the core generic (non-specialty specific) capability and skills framework⁽³⁾; providing more specific guidance for capabilities expected of a Specialist Doctor in Palliative Medicine. Doctors applying for Specialist Doctor posts in the specialty will need to demonstrate evidence that they meet the outlined criteria in order to be successfully appointed.

What’s included in the Framework?

• Core Capabilities with suggested evidence:
  • Professional values and behaviours, skills and knowledge
  • Leadership and teamworking
  • Patient safety and quality improvement
  • Safeguarding vulnerable groups
  • Education and training
  • Research and scholarship
• Development programme
  • Summary of suggested experience by year
• Sample Person Specification
• Links to courses, resources and sources of support.

Summary

• The Association for Palliative Medicine has produced a Framework for Progression to Specialist which can be accessed here, with additional APM resources for SAS doctors found here.
• This Framework aims to support both SAS doctors and employers in progressing a career in Palliative Medicine via the SAS pathway.
• It takes into account the varied experience and roles within this diverse group to produce a flexible but robust Framework that aims to recognise and develop SAS doctors for the benefit of individuals and the Specialty as a whole.

References:

1. Strengthening the SAS workforce, Academy of Medical Royal Colleges, Dec 23.
2. The 2021 specialist grade explained, BMA (includes link to guidance on the establishment and introduction of the Specialist role), Oct 24.
3. Generic capabilities framework, NHS Employers, Sep 22.

Declaration of interests

We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.