The NHS workforce strategy has confirmed Government plans for Specialty and Associate Specialist (SAS) doctors to join the primary care workforce.
The Government and NHS England will work together to ‘ensure that doctors other than GPs are more easily able to work in primary care’, the long-awaited document said.
According to the plan, the medical workforce ‘is expected to change over the next 15 years’, with more SAS doctors and doctors in training choosing different career paths including general practice.
Ensuring that doctors other than GPs can work easily in primary care will give general practice additional capacity, improving patient access and creating opportunities for these doctors to develop and progress in their careers, the plan said.
The Department of Health and Social Care is consulting on reforms to the Medical Performers List to ‘retain the flexibilities introduced during the pandemic’ to allow doctors other than GPs to work as part of a general practice team.
NHS England said that SAS doctors ‘form an increasing proportion of the medical workforce’, including at a senior level and the commissioner is committed to working with DHSC, legislators and employers to support SAS doctors to have ‘a better professional experience’, by improving equitable promotion and ensuring options for career diversification.
The document said that locally employed doctors (LEDs) are ‘another rapidly growing group’ who generally undertake more junior roles, requiring direct or indirect supervision, and provide ‘considerable input’ to the medical workforce.
It said: ‘The number of SAS doctors and LEDs on the GMC’s medical register has increased at six times the rate of GPs. LEDs are a huge asset to the NHS.
‘We are committed to working with partners to review medical career pathways and identify ways to better support postgraduate career progression for LEDs, including routes to progress their careers into high demand specialties such as cancer.’
NHS England pledged to continue building on the Out of Programme Pause pilot, working with the GMC and devolved nations so that taking out of programme opportunities ‘becomes a more accepted part of the training pathway’.
The commissioner said that this would retain more doctors in training by facilitating the return of those who want or need to take a break, and on their return accelerate their training when they have gained competencies working as an SAS doctor or LED.
The plan also considered ‘the future need for more generalist doctors’ and the modelled increases are ‘particularly targeted towards general practice’.
The document added: ‘This is reflective of a growing progressive professional consensus over the past decade that training should change, supporting a better balance of generalist and specialist skills so that doctors are equipped to provide the joined-up care required for people with multiple morbidities.
‘This is an important strategic objective, and we will work closely with medical schools, royal colleges, the GMC and employers to support the profession in making this agenda a reality.’
In March, speaking at the Pulse Live conference, GMC chief executive Charlie Massey said regulatory hurdles must be lifted to admit ‘sizeable’ pool of SAS doctors who are ‘itching’ to work in general practice.
But the idea has proved controversial, with the BMA saying that the proposal could cause doctors to be open to exploitation under a ‘two-tier system’. And last month, LMC leaders called on the BMA to reject proposals which would allow SAS doctors to work in general practice as primary care doctors.
READERS' COMMENTS [5]
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1. the reason that there are 6 hospital doctors for every single GP – despite every GP seeing roughly 7 times the number of patients as their hospital colleages – is that hospital terms and conditions are far better than those in general practice at the moment. modern general practice is a car crash. i doubt any sensible SAS doctor would want to work at much higher intensity for longer hours and less pay whilst also taking the abuse we receive from patients, the government and NHSE.
2. if any SAS doctor wants to function as a GP they should retrain as a GP. simple. but no short cuts.
3. the GMC should stay out of politics. Charley Massey has made it a Tory Party organ, and has worked with NHSE to the detriment of patients and the profession. most doctors consider it an enemy of the profession now, and not a regulator.
Darren, on your first point- abuse from NHSE and gov only affects partners, or mostly. An SAS Dr would have limited role- unless they retrain to become fully qualified GP of cause. But I see myself employing, say, a gynaecologist or dermatologist, or another partialist for 0.5-1 session to cover what they are good at or even train staff. At very least they could do a couple of tutorials for trainees. Obviously I am not going to offer them same pay as I do to fully trained GP, that is not discrimination, just reflection of qualifications and suitability for role of generalist. They will need more admin support and possibly triage of their appointments, but I see this working, in right team.
other 2- agree unreservedly
All of this is too little, too late. GPs are leaving now & we are already very short & it worsens daily.
General practice is a specialty of its own & should be recognised as such. There is a skill set & it should be valued. We do something that none of the rest of the NHS doctors do. Seeking to constantly “plug the increasing gaps” by introducing all these other solutions devalues what we do & totally misses the point. Does anybody see a parallel with district nursing of old & current community nursing – we still have great nurses but the specialist skill set has just about gone?
SAS colleagues are very valuable but in the correct setting – by taking them away from where they are we create a different shortage; additionally they will need supervision to practice in a GP setting which we again cannot support on top of more GP trainees & a growing ARRS team.
The government must put up its hand & say that there is a severe shortage of GPs, that patients must expect to wait to see us like they have to wait to see a consultant. How is it ok to have waits of a year or more in secondary care & to say “they are trying to fix it” yet to have pressure issues of the same or greater degree on the primary sector yet we must be able to somehow magically deliver quicker access? Be honest for once & stop the spin!
The rhetoric from our leaders must be clear, that politicians are playing fast & free with the NHS, creating unhappiness and abuse that does not need to be there if they were honest with the population, and that they must stop playing games with a service that their voters rely on & expect them to protect & support. Indeed it is time for the NHS to be cut free of political interference & to be allowed to create plans that can deliver the needs of the population now & into the future.
This fits exactly with government goals which would be to have primary care as little more than a triaging service, funnelling people to expensive specialists to manage each problem. Much money will be made by conglomerates who own the private hospital and the clinics renting out the rooms to private specialists. SAS doctors will not be able to manage complex multimorbilidty making up the majority of primary care work. Healthcare especially for the elderly and those from poorer backgrounds will be unthinkably bad in a few years times. The private model is closer than we think, the foundations are nearly in place.
Perhaps more and more simple consultation s dealt with by less qualified doctors and clinicians leaving chronic follow up and complex consultations for GP partners making their day more mind numbing and with complex and administrative work such as referrals
Nurses and allied HCPs often see mainly chronic monitoring and often simple consultations meaning partners must have more time per consultation or they will burn out
Basic mathematics indicates fewer GPs, more time needed for consultations as more medical notes and comorbidities, aging population so more frequent attendances and doctors will no longer work 80+ hours a week in general practice – nor should they
We need more doctors to enter general practice but clearly it is not attractive so work conditions must change and be improved