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Invisible Army of 'Underpaid' Middle-Grade NHS Doctors That Keeps the Heart of the Nation's Hospitals Beating

Posted on: Tuesday, 27 September 2005, 09:00 CDT

By MADELEINE BRINDLEY Western Mail

Collectively known as SAS doctors this growing band of middle- grade doctors are the wallflowers of the medical world. Often overlooked by patients because they are neither consultants nor junior doctors, the grade plays an integral role in the delivery of hospital-based services. As a new contract is being negotiated to finally put SAS doctors in the limelight, Health Editor Madeleine Brindley met some of them working in Welsh wards

THERE are more than 12,000 staff and associate specialist (SAS) doctors working in the UK's hospitals - 800 in Wales, or 25% of the workforce.

Yet despite their size, this group has some of the lowest morale, some of the worst access to training, some of the poorest job prospects and some of the worst pay among doctors.

They are also overlooked and forgotten by a public which is only trained to recognise a consultant and has only just grasped the concept of a junior doctor.

But without this small army of doctors, many of whom have duties and responsibilities on a par with consultants, it is arguable whether our hospitals would be able to run as smoothly as they do today.

And without these middle grades we would be faced with a huge on- call crisis as it is typically staff and associate specialists who do the anti-social shifts and emergency work.

Rajnesh Nirula, is the newly-elected chairman of the British Medical Association's Welsh Staff and Associate Specialist Committee, and works as an associate specialist in urology at Bridgend's Princess of Wales Hospital.

He said, 'These doctors do a fantastic job, they are all senior doctors doing the work of consultants.

'I think the reason the public does not know much about them is that previously the numbers were very low in Wales but they have grown over the years as responsibilities have increased with time.

'Everyone's pay is based on different rates and sessions but there is a lot of difference and that's why we're negotiating a new contract which will also help to raise the profile of this group of doctors and the fact that they make up a considerable part of the workforce.'

Formerly called non-consultant career grade doctors, doctors in the staff and associate specialist group work at the senior career- grade level in hospital and community specialties.

SAS doctors work in key service roles within the NHS in posts which do not require them to be on the specialist register. Their numbers expand with every year.

Associate specialists are senior hospital doctors, technically responsible to named consultants.

Such posts are often personal appointments, although employers may advertise for and recruit associate specialists directly in certain circumstances in England and Wales.

Research carried out by PricewaterhouseCoopers in 2001 found that 15% of associate specialists work at a similar level to that attributed to consultants.

The staff doctor grade was introduced in 1988 to meet service requirements where necessary.

Originally a national ceiling of 10% of the consultant workforce was imposed on staff doctor numbers but this was removed in 1997.

The PricewaterhouseCoopers research also found that 3% of staff doctors work at a similar level to that attributable to consultants.

Clinical assistants - part-time medical officers - are hospital posts that were initially intended for GPs who wished to work in a hospital.

There are limits on the number of notional half-days (NHDs) for which clinical assistants can be appointed - no more than 5 for non- GP clinical assistants, and no more than 9 for others.

However, in practice, these restrictions are now very rarely enforced.

Full-time clinical assistants are in effect employed in a non- standard grade with no clearly defined national terms and conditions of service.

Partly to circumvent manpower planning mechanisms involving overall targets for the proportion of staff and associate specialist doctors within trusts, and also due to resource pressures, many trusts have created new grades of doctors with non-standard terms and conditions of service.

Doctors employed in such irregular posts are not protected by national terms and conditions of service and may well be employed on poorer terms.

The BMA said that at present, the SAS group of doctors is seriously underpaid for the hours and work they undertake.

A spokesman said, 'SAS doctors are senior doctors, who play a vitally important role in the NHS.

'It is appalling that their salaries do not recognise their skills and experience, their clinical responsibility, the long and unsocial hours that they work nor their demanding roles often with onerous on-call rotas.'

Source: Western Mail

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