SAS and LE doctors need targeted and specific support, GMC report shows

Published 9 October 2023

The fastest growing groups of UK doctors have vastly different workplace experiences and need targeted and specific support to make the most of their expertise, the General Medical Council (GMC) said in a report published today.

Taken together, specialty and specialist (SAS) doctors and locally employed (LE) doctors are a rapidly expanding and important part of the medical workforce. This rapid growth – up 40% between 2017 and 2021 – is mainly, but not exclusively, driven by doctors from overseas coming to work at UK hospitals.

A new GMC research paper, Spotlight on SAS doctors and LE doctors: analysis of barometer survey 2022 results, sets out how the two groups differ from each other. It also provides, for the first time, data on the types of roles the two groups of doctors do, and underlines the diversity within both in terms of characteristics and experience.

It shows how they are likely to face different challenges and require different kinds of support from employers and healthcare leaders. In particular, their experiences can vary widely depending on whether they graduated in the UK or overseas, and how long they have been working here.

SAS and LE doctors are skilled practitioners who do hands on work but are not in formal training posts to become a consultant or a GP. For many this can be a positive career choice for reasons such as flexibility or work life balance, or due to other factors such as difficulties having specialist experience gained overseas formally recognised.

SAS doctors are experienced seniors with a wide range of skills and expertise. They include specialty doctors and specialist grade doctors with at least four years of postgraduate training, including two in a specialty relevant to their area of work.

The GMC research paper shows that:

  • More SAS doctors are generally satisfied than other types of doctors. Those who qualified outside the UK are doing well and work flexibly, but more of them often carry out work more normally done by more junior doctors.
  • Overseas SAS doctors who are less established in UK practice need better access to development and learning opportunities. Those who have worked here for longer say they want better recognition and support from teams and senior medical staff.
  • Many SAS doctors who qualified in the UK report routinely coping with heavy workloads. Despite this, data suggests they’re less likely to leave the UK to work elsewhere.

LE doctors work in a wide variety of specialties and settings, and are employed by an individual trust on a locally defined contract, usually in a non-permanent post. They reported some similarities with SAS counterparts in their experiences, but also some differences. The GMC data shows:

  • LE doctors who qualified overseas and who were newer to UK practice take frequent stress-related leave, but this may be a protective factor as they don’t otherwise appear to have had particularly negative experiences.
  • Their more established peers need more development and learning opportunities, and better support from colleagues.
  • LE doctors who qualified in the UK report a range of negative experiences, even compared with similar groups of doctors. Those who are less established in UK practice have had particularly poor experiences that need to be addressed, including workload, difficulty providing patient care, and feeling less supported. As a result they’re more likely to take steps to leave UK practice.

There may be benefit in engaging with their more established UK-qualified LE colleagues to understand the reasons why they aren’t on a formal training pathway.

Charlie Massey, Chief Executive of the GMC, said:

‘SAS and LE doctors have often been treated as a homogenous group defined by what they aren’t, rather than what they are – a diverse, vital and rapidly expanding part of the UK medical workforce.

‘Our new data allows us, for the first time, to really dig down into the detail, and to highlight the specific differences between them, and other groups within the workforce, in terms of their experiences at work.

‘We hope this paper will help healthcare systems consider how to address the diverse challenges these talented doctors face. This will not only improve doctor wellbeing, recruitment and retention, but will ultimately help patients to get the best care possible.’

Read Spotlight on SAS doctors and LE doctors: analysis of barometer survey 2022 results, which was published to mark the start of SAS Week 2023.