This is the speech as drafted and it may differ from the delivered version.

Unlocking the potential of the SAS workforce

Charlie Massey's speech to the Health Education England North East SAS conference, 17 March 2023.


It’s great to be here with you today, though I only wish I could have been with you in person.

The title of my speech today is Unlocking the potential of the SAS workforce. But I want to start by recognising that many SAS doctors don’t feel their potential needs to be 'unlocked' and already enjoy highly rewarding and satisfying careers.

As everyone in this room knows, there is massive diversity in the SAS population, both in terms of specialties and also in background. Much of the growth of this cohort has been driven by the increasing numbers of IMGs joining the workforce. So the SAS group counts many overseas medics amongst its ranks.

What SAS doctors have in common is their high level of experience and skill. In our 2019 survey, 83% of SAS doctors reported 10 or more years in clinical practice . The group as a whole is also growing faster than any other – six times the rate of GPs in fact. If current trends continue, by 2030 they will be the largest group in the medical workforce .

In the North East alone, there are around 2,000 SAS and locally employed doctors with a licence to practice .

So this is a dynamic and growing group of highly experienced doctors, one that is already making a massive contribution in the health service.

Bureaucratic barriers 

There are many positive reasons why a doctor might choose the SAS path. The opportunity to focus on providing direct patient care is a draw for many. Not to mention the flexibility and work/life balance gained by not having to adhere to a formal training programme .

But while many make an active decision to pursue a SAS career, some find that bureaucratic barriers make that choice for them.

For those SAS doctors who want to work at consultant level, the CESR route – which is set out in great detail in the underlying legislation – represents a real hurdle.

This antiquated process, which takes close to a year, can require doctors to supply 2,000 pages of evidence or more. Around 50% of applicants are unsuccessful the first time around. 

Then there’s the red tape that restricts where SAS doctors can practise. That includes being prevented from working in primary care, where the skills and experience that many SAS doctors have could make a real difference in meeting patient demand.

The point is that SAS doctors should be supported to reach their full potential. Their contribution should be dictated by their ability and their ambition, not red tape.

The fact that the current model acts as a break on those ambitions for so many SAS doctors also undermines the desire of many to remain in UK practice.

Because while we see large numbers of SAS doctors joining the workforce, we also see large numbers leaving. In fact, SAS doctors are more likely to leave than the average across all specialty groups. Of the SAS and LE doctors who took up a licence to practise in 2013, more than half had left the workforce by 2021 .In the North East, 113 SAS doctors left in 2021 alone . 

Embracing the changing workforce

The mismatch between supply and demand in the health system is at a critical level. Clearly, more doctors are needed. 

But recruitment without retention is like watching sand slip through your fingers. There’s no point hiring new doctors if we end up losing just as many who we fail to retain. 

Furthermore, even if we had the money and the will to do it, there is no cavalry of doctors coming over the hill who we could recruit at scale to alleviate pressure. So for the foreseeable future, we need to make more of the workforce we already have. 

That requires all of us across the health system to think differently.

Despite their growing presence and influence in the service, SAS doctors too often suffer from others’ outdated notions about what their careers should look like. Rather than valuing their skills, the focus and the narrative remains skewed towards consultants. Those dated ideas are holding SAS doctors back and patients are being denied their skills in the process. 

We also know from our own research that many SAS doctors aren’t always able to access the learning and development opportunities they need to build their skills. The absence of proper recognition and support is leading some to vote with their feet and leave the service entirely.

There are now around 64,000 SAS and locally employed doctors in the workforce . Imagine the impact on patient care if even a few thousand stayed in UK practice just six months longer, let alone if they were deployed to maximum effect. 

And what about making it easier to convert to a SAS career for those who might otherwise leave the service. Linear career pathways are no longer the norm. A SAS role could be a positive choice for a GP or consultant looking to improve their work/life balance . Promoting that prospect could be a powerful way of retaining talent in the system.

What needs to be done

It is therefore clear that there is both a moral and a business case for improving the workplace experiences of SAS doctors. So how do we go about it?

I’d call out three areas in particular – recognition, representation and deployment.

First, recognition.

There is a growing body of data that detail the demography of SAS doctors and the challenges they face. Our 2019 survey, for example, gave us new detail into their day-to-day experiences, which can help inform areas for action amongst employers and others.

Here are a few highlights of what that data told us.

Many SAS doctors reported that their working environments were not as supportive as they should be and that they didn’t feel able to raise concerns. Almost a third said they didn’t always feel they were treated fairly at work. And one in four said they’d been bullied, undermined or harassed in the previous year .

Given the diversity of SAS doctors, there an obvious link here to questions of inclusion and the need for more compassionate workplace cultures. No doctor can thrive and provide the care they want to for patients in an environment where they feel excluded and undermined. And given the additional challenges SAS doctors face around career progression and learning and development, it’s clear more concerted support and action is needed.

So identifying and tackling the particular issues facing this cohort is crucial. But we also need to look outwards and do more to promote the benefits of being a SAS doctor. Medical schools have a vital role here in raising awareness of SAS careers as potential positive choices to their undergraduate students . And conversations in the wider system need to acknowledge the crucial role that SAS doctors play, and reinforce how much they are valued as a critical part of the medical workforce.

Secondly, SAS doctors need better representation at senior levels.

We need to see SAS tutors, appraisers and champions in every trust, as well as representation in royal colleges and medical schools. 

There are already stellar examples of SAS doctors breaking new ground, such as Dr Jamie Read, the first SAS doctor in the UK to be appointed Dean of Medical Education, and Dr Laura Hipple, the first SAS Vice President of a medical royal college, who I know is at the conference today. But to ensure a voice at both a local and national level, we need to see SAS doctors occupying senior posts at every level of the health service, in every location.

Lastly, we need to think differently about how SAS doctors are deployed in the workforce.

I’ve already mentioned the red tape that restricts where SAS doctors can practise. Working with NHS England and the Department for Health and Social Care, we’ve been pushing for reform to the Performers List, which details which practitioners can work in primary care. As part of that we’re making the case for the creation of a SAS grade in primary care. This would increase the pool of talent available to support GPs, and provide more opportunities for SAS doctors with relevant experience.

We also need to improve routes to specialist registration. We’ve been lobbying for reform to the CESR process to allow us to assess doctors’ skills in a more proportionate way. We’ve been advocating for these changes for over a decade, so are delighted that they will come into effect later this year.

But there’s also a job to do in improving the access to and availability of training and development for SAS doctors. Anecdotally, we hear of SAS doctors being under-prioritised in favour of trainees  – another example of outdated thinking holding this group back.


So, to conclude.

SAS doctors are already playing an indispensable role in patient care – and as numbers grow, this contribution is only set to increase. 

But this is a workforce that needs to be nurtured if we’re to make the most of its talents.

The stark reality is that while the composition of the medical workforce is changing, the rules and attitudes that govern it aren’t keeping pace. SAS doctors need more support, and more opportunities. And within the wider system, we need more creative thinking that will enable SAS doctors both to develop their skills and encourage them to pursue long careers in UK practice.

All of us have a role to play to maximise the abilities and experience of this vital and growing group. There’s much to be done. But the prize – well supported doctors using their skills to meet modern healthcare needs – justifies the effort.

Thank you.