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Who are SAS doctors?

Though traditional paediatric training is often referred to as the ‘standard’ career route, there are many doctors who choose to take a different career path and undertake a SAS career. Doctors who are not working as consultants or postgraduate doctors in training for several reasons, can be employed on one of several different SAS contracts.

The term ‘SAS’ first emerged around twenty years ago and was used to refer to Staff-Grade and Associate Specialist doctors as well as some other nationally recognised roles at the time. Contracts and job titles have since evolved, with most roles being replaced with the Specialty Doctor title. During the 2021/22 contract reforms, the Specialist role was brought in to offer more opportunities and development for senior, experienced clinicians working independently and autonomously.

As such, the acronym SAS now refers to Specialist, Associate Specialist and Specialty doctors.ÌýIn addition to the nationally recognised roles above, trusts can appoint doctors onto local contracts with ID badges that read ‘Trust doctor,’ ‘Trust grade,’ ‘Clinical fellow,’ ‘Senior clinical fellow,’ ‘Locum registrar’ and many others. These titles may not demonstrate the level of experience of a doctor and therefore caution must be taken when grouping all locally employed doctors (LED) and SAS doctors into the same group.Ìý

Workforce data

The GMC describes LED and SAS doctors as the fastest growing group of UK doctors with vastly different workplace experiences and needs. Data reveals that the number of SAS doctors in the UK increased by 40% between 2017 and 2021, mainly, but not exclusively, driven by doctors from overseas coming to work in the UK. LED and SAS doctors now form almost one quarter of the total medical workforce (24%)1 . The experiences and needs of LED and SAS doctors are described in the .

Further information about how many SAS doctors work across the UK can be found along with more workforce data in our workforce information evidence library.Ìý

Inclusive language

There remains a lot of work to be done to demystify the SAS role and raise awareness around the appropriate terminology.

While the term ‘non-training grade, has been used in the past, it is not recommended for use in referring to LED and SAS doctors, as they also undergo training through the work they do, and it is not the correct terminology. We also advise against the use of ‘middle grade.’  The experience and needs of an early career Specialty doctor are vastly different from those of a Specialist and therefore referring to this group as a collective of ‘middle grades’ can be unhelpful. Instead, we encourage the workforce to refer to the tier of the rota that doctors are working on, as in ‘doctors working on a tier 2 rota’ when describing levels of experience, or simply ‘paediatric clinicians.

Eligibility and roles

Two SAS contracts currently exist, Specialty Doctor and Specialist. Speciality Doctor incorporates a whole variety of levels of experience, and Specialist represents a more senior, autonomous role.

The BMA resource comparing Specialty and Specialist Doctors is particularly helpful here in defining the roles (anchor to resources)

Speciality Doctor

In order to undertake a Specialty doctor role, clinicians will need:

• Full GMC registration and licence to practice
• At least 4 years of medical work since obtaining a primary medical qualification (continuous or aggregate) 
• At least 2 years of which are in paediatrics, within a specialty training programme or other role.

Specialist

In order to undertake a Specialist role, clinicians will need:

• Full GMC registration and licence to practice
• At least 12 years medical work since obtaining a primary medical qualification (continuous or in aggregate)
• At least 6 years of which are in Paediatrics, this experience can be in the UK or overseas and does not need to be within a training programme.
• Meet the criteria set out in the

SAS careers

There is a long-running myth that taking an alternative career path is somehow ‘lesser than’ the formal training route and lacks opportunities to progress and develop further skills. This assumption fails to acknowledge or appreciate the multitude of skills, decades of experience and expertise that SAS doctors can offer in the care of children and young people, and the opportunities offered within these roles when properly supported.

Benefits of a SAS career

There are many reasons why a paediatrician might become a SAS doctor. Many of these doctors make a choice to do so as it can be a rewarding and fulfilling career that can offer many advantages:

• Opportunity to focus on direct patient care
• More flexibility without having to meet the requirements of the formal training pathway
• Remaining in one geographical location without the need to rotate
• Working in a subspecialty that you have chosen and suits your professional interests
• Optimised work-life balance, with options for more predictability in hours
• Achieving a portfolio career

Career journeys

A new Specialty Doctor can choose to pursue a career in paediatrics in several different ways:

• They may elect to remain a Specialty Doctor, broaden their areas of interest and participate in non-clinical activities like:
  • Educational supervision
  • Teaching
  • Department leadership roles
• Some may progress on to becoming a Specialist.Ìý
• Others may choose to become a Consultant, either through the portfolio pathway or by returning to or entering the formal paediatric training pathway.

Wider non-clinical work

SAS doctors should be encouraged and supported to take on wider roles in education such as clinical and educational supervision, Director of Medical Education, Training Programme Director and more. They should also have access to leadership and management opportunities on a par with other doctors of senior experience and expertise. Ensuring that these opportunities are being made available to SAS doctors is essential.

SAS doctors working on tier 1 and 2 rotas with equivalent experience to postgraduate doctors in training should be afforded access to department training.

The is designed to help SAS doctors elevate their work towards further professional development and improve working opportunities. https://www.bma.org.uk/advice-and-support/career-progression/best-practice/the-sas-charter. It covers minimum conditions of employment, revalidation, appraisal and job planning, support and supervision, opportunities for development and involvement in management structures.

There are also lots of opportunities to get involved with RCPCH work as a SAS doctor.

Becoming a consultant via the SAS route

The to entering the GMC Specialist register to become a consultant was introduced in November 2023 and replaces what was formerly referred to as the CESR (Certificate of Eligibility of Specialist Registration) process. The portfolio pathway, as CESR did before, offers a route to become a consultant without following a traditional training route, it is equivalent to a CCT and certifies that the recipient has the same knowledge, skills and experience as a doctor who has completed training in the CCT curriculum.

There should not be any assumption or expectation that a SAS doctor will want to do this, and those wishing to grow their careers as SAS doctors and not become a consultant are not any less deserving of equal opportunities for supervision, leadership, management, education and professional development.

Member stories 

The following paediatricians share insights into careers as paediatric SAS doctors, and the extended roles available for SAS doctors.

Eslam Idris and Peter Rose, SAS committee members, reflect on their SAS career journeys so far

Alice Nichols and Liz Baker share their perspectives on working in their team to create positive SAS roles, and the benefits of these roles

Further resources

There are a whole range of resources available for SAS doctors and colleagues to draw on to support career development, a few of which are below: 

RCPCH resources

We have a variety of resources to support SAS doctors and colleagues:

RCPCH Consultants and SAS doctors job planning toolkit

Workforce information deep dive on consultant and SAS doctors

RCPCH SAS Committee 

BMA resources for SAS doctors

The BMA has several resources for SAS doctors and employers:

NHS resources for SAS doctors development 

NHS sites contain a selection of sources for SAS doctors development as well as employment information:

GMC and portfolio pathway (CESR)

The Portfolio Pathway to become a Consultant, formally known as the Certificate of Eligibility of Registration (CESR) is delivered by the GMC:

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