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SAS doctors ‘itching’ to work in general practice, says GMC chief

SAS doctors ‘itching’ to work in general practice, says GMC chief

Regulatory hurdles must be lifted to admit a ‘sizeable’ pool of SAS doctors who are ‘itching’ to work in general practice and fully utilise their skills, the GMC chief has said.

In a keynote speech to the Pulse LIVE conference in London today, Charlie Massey argued that regulation is not ‘keeping pace’ with the changing nature of the medical workforce.

And he warned that waiting for more GPs to come and plug the workforce gap ‘risks killing the primary care model’.

In response, he said that it was ‘vital’ that NHS England makes this possibility a reality by updating Performers List rules.

He told the conference: ‘The medical workforce is changing but the rules that govern it aren’t keeping pace. Dated ideas are holding SAS doctors back and patients are being denied their skills in the process.

‘I believe the key to tackling the challenges confronting the service is to make the most of what we already have, both in terms of GPs and the wider medical workforce.’

He added: So it’s vital NHS England and others enable these changes, so we can realise the benefits to both the public and profession.’

He said the ‘first’ thing that needs to happen is to ‘reform to the Performers List, which determines which doctors can work in primary care’.

‘Changing the criteria could allow SAS doctors to work alongside GPs in complementary roles. Exactly what that mix looks like would be down to primary care leaders, and would vary according to the needs of different locations.’

According to Mr Massey this could include ‘having a SAS doctor with a particular specialism, such as in paediatrics or elderly care, to work within that area of practice in a primary care setting’.

Another model could see SAS doctors who are ‘skilled in emergency care being used to triage patients’.

‘This would allow GP time to be freed up, so they could focus their time where their skills and expertise are most in demand,’ he said.

But, addressing the GP audience, he stressed that he wanted to ’emphasise that this isn’t about SAS doctors substituting for GPs’.

‘And I’m certainly not suggesting that GPs don’t have a particular and expert set of skills and knowledge. Instead, what I am arguing for is that the rules should be changed to allow other doctors with relevant expertise to work alongside GPs and the primary care team.

‘If we get this right, we can open up primary care to a new part of the medical workforce, using the skills of SAS doctors in combination with the wider team to the good of patients.’

Highlighting current pressures on GPs, he said: ‘The state of play today is intolerable – both for patients, who feel that their needs aren’t being met, and for GPs themselves, who are unable to provide the quality of care they want to provide for their communities.

‘All of this tells us that just expecting more GPs to plug the gap will not give us the sustainable and long term answers we need. Instead it risks killing our primary care model altogether.’

Pulse exclusively revealed in October last year that the GMC is hoping for 10,000 or more SAS doctors to be able to join the general practice workforce, both from the UK and overseas.

The controversial proposal has been met by a mixed response from GP leaders, who have said they will need to see more detailed plans drawn up.

But Mr Massey’s Pulse LIVE speech acknowledged that ‘altering the composition of the primary care workforce in this way is, of course, not without its challenges’.

‘The devil is in the detail, and the mechanics of how these changes play out on the ground will require careful thought and attention. That includes how SAS doctors will be supported and supervised by experienced GPs, without increasing their workload.

‘It is not for the GMC to work out the answers to all of these questions. But there is reason to believe that primary care is well placed for this sort of reform.’

He concluded: ‘Doing things as we’ve always done will not create the sustainable workforce we need. It threatens the very survival of our primary care model.

‘To sustain general practice fresh thinking is needed. We at the GMC, working with partners across the system, are committed to playing our part.’

Pulse 365 LIVE is two-day conference (21 and 22 March) with a comprehensive programme covering the latest clinical updates, career development workshops, and policy updates. The event is run by Cogora and is taking place in Hammersmith, London.


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Please note, only GPs are permitted to add comments to articles

Born Jovial 22 March, 2023 3:04 pm

If GP’s are working to scale we maybe be helped by SAS doctors with expertise in particular speciality but they are NOT itching to work in general practice as due to lack of facilities, equipment and career satisfaction or progression.

Eg Respiratory SAS doctor will see all COPD exacerbation, LRTI and common cold
ENT SAS doctor will see otitis medica, externa , blocked nose , tinnitus – they cant even see ear wax as there is no microsuction facilities in general practice

The only SAS doctors who maybe helpful to general practice would be geriatric specialist doctors as they can sort out the multimorbidity patients but even then they will not have direct access to scans, urgent bloods etc. and will be hobbled.

Does GMC really think they will get professional satisfaction in general practice.

Also what happens to hospitals which will collapse as they are short staffed as well although not as bad a s general practice

Also where do we put all these SAS doctors as there is no real estate left in GP land after ARRS staff?

Simon Ruffle 22 March, 2023 3:30 pm

I wish they’d stop leaving dead skin cells everywhere!

Massive disrespect to their specialism and to ours.
Do we expect SAS doctors to turn up in GP land and see undifferentiated patient lists?
Who supervises?
Where will they work (in corridors? Plus ca change, I suppose.)
Who pays?
Money for primary care is now funding secondary care activity?

Another idea that has not had primary care and obviously no working GP input.

Darren Tymens 22 March, 2023 3:44 pm

Great news – now please stick them all into three year training schemes so they can do the job of a GP.
Charlie Massey has politicised the GMC to the point it has no credibility.

Douglas Callow 22 March, 2023 3:50 pm

GMC are doing whatever HMG tells them to do
They will of course peddle the line that SAS docs reducing time in training/increasing skill mix PAs other AHPs will solve the ‘GP problem’

Perhaps they may do a Dyson university and fund the training/living costs and pay a wage in these new medical apprenticeship training schemes

What’s becoming clear to anyone who has any dealings with NHS care is that its tipping over and as the battle lines are finally drawn up by GPC with regards general practice

Nicholas Sharvill 22 March, 2023 4:21 pm

In reply to Simon Ruffle there is no reason why GP cant provide micro suction .I realise there are those who will say not a core service and want extra funding but it is simple quick and of great patient benefit- in contrast perhaps many other activities we do

A more general question is why there is no career progression open to them anyway (ie Consultant or GP) and why we still have many nhs posts not recognised as training even though exactly the same as those working in parallel are -is this the GMC or Royal colleges that are to blame

Has anybody asked the GMC today why they have such high cash reserve?

Is the GMC boss a political appointment?

Douglas Callow 22 March, 2023 4:33 pm

Nicholas Sharvill

to all intents and purposes YES!

Janine O'Kane 22 March, 2023 4:44 pm

I am “itching” to work as. Neurosurgeon but guess what am not trained to do so
Many he means dermatology

Janine O'Kane 22 March, 2023 4:44 pm

Maybe …..
Sorry but the idiocy causes typos

Elizabeth Toberty 22 March, 2023 6:39 pm

I’d much rather SAS doctors than ARRS staff. But our skill is dealing with undifferentiated problems, so surely better to just get them doing GP training? Maybe make it 2/2.5 years in light of previous experience.

Michelle Hatch 22 March, 2023 10:07 pm

I’m a SAS doctor working in ICU. Where would you like to use my expertise in General Practice? ‘Itching to work in Primary Care’… Ha ha ha ha… what planet is the GMC on?
Most SAS doctors are in a specialism and have no expertise in General Practice.

Adam Crowther 23 March, 2023 9:10 am

Specialists itching to get into general practice and general practitioners itching to get out. Surely those Specialists that what to train as specialist generalists can do so and become GPs or do we need specialists in communities as opposed to big hospital boxes. All solved by placing GPs on the specialist register I would have thought 🤦🏼‍♂️

Some" Bloke 23 March, 2023 1:40 pm

I am itching to deal with complaints resulting from orthopods handling of a mental health crisis, or gastroenterologists dealing with HRT query or contraception.
If they are itching- it’s not to join us, it’s to get out of dead end jobs in secondary care. If SAS Drs itched to become GPs- they would have applied for vocational training.

Jamal Hussain 25 March, 2023 2:29 am

With specialists itching to get into primary care and GPs itching to get out. The solution is clear to me. We need more dermatologists working both in primary and secondary care.

David Mummery 25 March, 2023 7:53 am

If secondary care doctors want to work in primary care they should re-train as GPs ( likely a shortened bespoke training according to needs and experience)
What is not helpful is a multi-tiered , confused Primary Care workforce (many of whom not working independently) with unspecified roles needing endless , and ongoing supervision.

Malcolm Kendrick 28 March, 2023 1:15 pm

Is there a survey of some sort to back up Massey’s great itch. Or, is he just making it up? Personally, I have long believed that being a GP would be much more enjoyable if we could do more ‘specialised’ work e.g. dermatology, minor ops, a bit of work in hospitals for time to time, some occy health stuff – whatever floats your boat. Variety being the spice of life, and all that. Equally, having some specialists/SAS do work in GP surgeries would be good fun for them. But SAS docs working as some weird hybrid, not quite knowing what they can do, GPs. Worst of all possible worlds. So, no doubt this is what will happen. Because for some unfathomable reasons, the stupidest ideas always seem to float to the top of the pile.

Jolyon Miles 28 March, 2023 8:48 pm

Our PCN includes many practices that offer OP type services including Opthalmology, ENT/microsuction, surgery, dermatology, MSK/orthopaedics by using GPERs, SAS and consultant grades. Works very well once service specification and finance agreed. Could easily expand to use SAS doctors for QOF CD areas. The big question is would these roles be properly funded as the treasury view would probably be “were already paying GP to do this work”.
As an aside my daughter in law has just given birth to twins in Germany. State hospital and state of the art facilities with copious staff, empty rooms/beds, great food, family room so son could stay and help with care, nursing staff always on hand to take/feed/change babies if too knahckered. Sharp contrast to first time round when induced in corridor in Tommy’s and nursed whilst very unwell by overworked staff in 6 bedder.