Supporting SAS Doctors: Why implementing the ‘SAS Six’ is key to delivering the NHS 10-Year Plan

By Dr Karen Ellison, former SAS doctor and Medicolegal Consultant at Medical Protection

When the NHS 10-year plan was published earlier this year it came with an ambitious commitment to ensure that every member of the NHS workforce is empowered, supported, and given the opportunities they need to develop their careers.

A particular welcome all be it, brief, sentence within the plan was the commitment in relation to Specialist, Associate Specialist and Specialty (SAS) doctors. Described in the NHS 10-year plan as an “invaluable part of the NHS team”, the government said it would work to introduce a more streamlined pathway for SAS doctors to progress their career development and be given increased opportunities to operate at a specialist level.

There are more than 45,000 SAS doctors working in the NHS. They carry a significant share of frontline care, often providing stability and continuity in clinical services.

Yet, historically, they have not always enjoyed the same opportunities for recognition, development, and structured support as other colleagues.

I know because I experienced these issues firsthand while working as a SAS doctor in urogynaecology for many years. It was a personal choice for me, as it is for many, but it is not for the faint hearted because to be resilient enough to overcome the injustices of the grade described above is not easy.

Therefore, the NHS 10-year plan’s promise to invest in and support this workforce in their career development is both necessary and long overdue.

But as we celebrate SAS Week, how do we turn this aspiration into meaningful change for SAS doctors?

A large part of the answer lies in adopting and embedding the ‘SAS Six’ – a framework designed to translate high-level commitments into practical, measurable improvements in the working lives of SAS doctors.

Understanding the SAS Six

The SAS Six is six core principles of good practice, designed by the SAS Collective, to guide trusts and health boards to support SAS doctors consistently and effectively.

The SAS Six policy calls are:

1. Every early career SAS doctor should have access to an educational supervisor.
2. All SAS doctors should have equity of access to professional development opportunities relevant to their stage of career.
3. All specialty doctors who meet the required capabilities should have the opportunity to become specialists.
4. Senior SAS doctors should be offered the opportunity to be educators at every level on a par with consultants e.g. educational supervisors, clinical supervisors, directors of medical education.
5. All extended roles in leadership and management should be open to all substantive medical staff that is, consultants and appropriately experienced SAS doctors.
6. All locally employed doctors that are employed for more than two years within one NHS employer should be offered the opportunity to transfer to the appropriate SAS contract.

These are not abstract ideals, but pragmatic standards developed by SAS doctors for SAS doctors, and backed by employers and professional bodies. Each of these principles are targeted at areas where SAS doctors have historically faced barriers. They form a ready-made package that can help the NHS deliver on its promises.

It is exactly for this reason that Medical Protection was one of the first organisations to endorse the SAS Six and why we made its adoption a key component of our proposed ‘Priorities for the Government’ that we published just before the election.

Why the SAS Six

Implementing the SAS Six is not just about fairness; it is about maximising the contribution of a workforce already critical to service delivery and would allow the NHS to get the most value out of its SAS workforce at a time when every resource counts.

The SAS Six can achieve improvements in:

• Retention: If SAS doctors feel valued and supported, they would be less likely to leave the NHS early or reduce their hours. By addressing the structural issues that drive dissatisfaction, the SAS Six can reduce attrition and protect vital experience.
• Recruitment: The SAS grade is an increasingly attractive career route for doctors who prefer this pathway. But this potential can only be realised if the grade is seen as respected, rewarding, and well supported.
• Service continuity: SAS doctors often provide the stability within teams where rotation of trainees is frequently disruptive. By supporting them to develop specialist expertise, services can benefit from not only enhanced quality but importantly continuity of care.

From commitment to action

The government cannot achieve the ambitions of the NHS 10-year plan without supporting its SAS doctors. They are a backbone of service delivery, providing care across every specialty and setting. But for too long, their needs and aspirations have been overlooked.

The SAS Six offers a way to move beyond warm words to deliver the meaningful change that SAS doctors deserve at the same time improving patient safety and benefitting patients.

The SAS Six aspiration should be formally endorsed and championed within the forthcoming NHS England workforce strategy, with accountability for implementation, and appropriate resources to ensure the framework is not just rhetoric.

Thinking back to my time as a SAS doctor before joining Medical Protection, I know that steps in this direction would have made a meaningful difference. Supporting SAS doctors isn’t a side issue, it must be central to workforce planning, and I believe the SAS Six offers the clearest path forward.