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NHS England planning pilots of SAS doctors in general practice in ‘abuse’ of rules

NHS England planning pilots of SAS doctors in general practice in ‘abuse’ of rules

Exclusive NHS England are set to run pilots of staff and associate specialist doctors in general practice, in a move that the BMA’s GP Committee England has ‘significant concerns’ around.

In a letter to NHS England, GPCE acting chair Dr Kieran Sharrock referenced plans to pilot the use of SAS doctors in primary care, but said the committee ‘vociferously oppose’ this plan unless certain requirements are implemented to make it safe and feasible. 

The letter also revealed that NHS England were planning to use Covid-19 regulations – which relaxed the rules around doctors joining the GP register – which Dr Sharrock said was an ‘abuse’ of the legislation.

Last month, GMC chief Charlie Massey gave a speech at the Pulse Live conference calling for regulatory hurdles to be lifted to admit a ‘sizeable’ pool of SAS doctors who are ‘itching’ to work in general practice. 

The letter, sent to NHSE’s interim national medical director for primary care Dr Kiren Collison on Friday, referenced the GPC UK’s meeting on 16 March where the possibility of SAS doctors working in primary care was discussed. 

Dr Sharrock wrote: ‘We believe that the use of regulations brought in due to the COVID pandemic to pilot SAS doctors working in general practice is an abuse of these regulations. We are not currently in a national emergency and have had our requests to suspend and protect QOF and IIF refused on this basis.

‘To use regulations amended specifically to assist during a national emergency in this deliberate way is highly inappropriate and ethically questionable.’

He highlighted concerns around capacity in general practice to support and house these doctors, as well as the clinical risk involved if they do not have proper supervision.

 In order for the GPCE to accept the pilot, Dr Sharrock called for the following minimum requirements:

  • Recognition that general practice is a distinct specialty and that doctors working in general practice require CCT or CEGPR to work without supervision if performing undifferentiated care
  • Planning and development of supervision and education for more doctors in England’s general practices
  • Expansion of the education and supervisory workforce
  • Expansion and resourcing of the infrastructure to house more doctors in general practice
  • Development of contracting mechanisms which enable more doctors to undertake supervised clinical experience whilst working toward CEGPR without risk of exploitation.

In his letter, Dr Sharrock also said there should be other actions taken to support general practice ahead of this pilot, and highlighted the lack of support given in the recent contract imposition. 

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

NHS England imposed a new GP contract for 2023/24 last month which included more stipulations around access but no extra funding. 

The BMA and NHS England have been contacted for comment.



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

Centreground Centreground 3 April, 2023 11:39 am

If NHSE staff had the same regulatory restrictions as GPs , the majority from experience would be struck off for incompetence, lack of knowledge , dangerous practice and general lack of awareness of their own organisation.

Darren Tymens 3 April, 2023 12:19 pm

SAS doctors would be mad to try to work in general practice as GPs. They won’t know what they are doing, they will be working outside of their competency, and it will be frankly dangerous. Also, the terms and conditions of general practice are far worse than working in a hospital setting.
If they stick to their competency, they won’t be working as GPs, but as specialists running cut-rate secondary care clinics in general practice – but with general practice funding and GPs taking responsibilty for their errors.
This idea would never have got passed the initial stages if Charley Massey wasn’t a card-carrying Conservative (GMC – so we – pay his expenses to attend Conference each year, I believe), and the GMC a heavily-politicised government-supporting organisation.

Lucy Henshall 3 April, 2023 12:32 pm

This is the same NHSE organisation that failed to enable the return to work of a hugely experienced GP/GP Trainer in 2021 when Covid rules DID apply. (Barely 2 years out of clinical work following accidental injury, and still training other GPs).
Rather than fast track/support their resumption of clinical work, NHSE instead actively blocked their return – by imposing Conditions preventing ANY work and forcing them to do I&R route delaying return by 8months. All during a time of very real national crisis.
Go figure… I can’t.

C P 3 April, 2023 12:53 pm

If I understand this correctly the COVID regulatory framework for Primary Care is being used to permit a form of registration for SAS doctors in General Practice. As a GP of 40 years I am about to relinquish my license but I am not permitted continue to practice in any form under those same regulations. Seems rather curious…..

Darren Tymens 3 April, 2023 1:25 pm

Perhaps they could also try their hand at dentistry, or maybe try something that requires no brains/training/morals like being an MP, or being CEO of the GMC. Apparently the going rate for an MP is £1500 per hour (cf Matt Hancock).

Paul Burgess 3 April, 2023 1:54 pm

Hold on to your hats -this is the beginning of the end of general practice.

Douglas Callow 3 April, 2023 2:38 pm

Complete silence from RCGP
Back foot peddling by BMA outmanoeuvred again by DH NHSE and their apparatchik Charlie Massey
Work to rule Signed undated resignations the options to turn around this are still out there but are getting slimmer by the minute

Gerard Bulger 3 April, 2023 3:51 pm

In Australia there is a two tier system. FRACGP. ACRRM “vocational trained” doctors earn more than other non-vocational doctors “SAS” . And they have to be supervised. It works quite well. But easier to ensure the pay differential and the the NHS funded fees are fee for service. Non-vocational are seen as such, even by patients.

So providing pay is less, and nominated supervisors, I have no issue with it.

Gerard Bulger 3 April, 2023 3:55 pm

The other this is is thos MRCGP FRCGP should be registered as specialist on the GMC register, as we are in Australia, and scrap the performers list, so SAS doctors could not be called or registered as specialists as now.

David Church 3 April, 2023 4:07 pm

British Nationals, trained in Britain, GP VTS in Britain, but with a break of more than 12 months outside the EU, are not allowed to work as GPs in Britain without first paying a practice to supervise them for 12 months while they earn nothing; British Nationals with an overseas medical degree have to pass the PLAB or equivalent, whilst Commonwealth Nationals with no past hostory of haveing worked in GP in the EU, are not allowed even to train in General Practice in the UK.
Mind you we do not seem to be discussing allowing SAS doctors to train as GPs in the UK, only allowing them to work in GP without any training in GP, which seems daft, since they can get better work in hospitals, unless they do something really stupid and make themselves unemployable – in which case they can work in GP.
We also do not appear to be talking about supervised practice in GP in UK, but unsupervised practice, which I could not see many other gPs wanting to take responsibility for?

David Mummery 3 April, 2023 5:54 pm

Maybe GMC could get all those GPs who are sitting in meetings all week starting to see patients again ?

John Graham Munro 3 April, 2023 9:26 pm

And maybe the G.M.C. could also drag that succession of television doctors off our screens.

Cameron Wilson 3 April, 2023 9:46 pm

Surely even the most pro NHS disciples of the BMA must realise the game’s over. This hypocritical dumbing down of GP ( whilst leaving the remaining foot soldiers carrying the can,naturally!”) is the future.
Revalidation and annual appraisal is a complete joke when the “Powers that Be” are happy for any man and his dog to assume the mantle of doing the most complex, cost efficient and taxing role in Healthcare!
Will be interesting where we end up at the end of this charade, definitely it’s every man for himself as there’s certainly no cavalry. BMA you have been totally naive.
GMC,NHSE,RCGP, CQC you win, good luck sorting out the debris that you have contributed to!

win win 4 April, 2023 1:37 pm

What a waste of time on CCT and RCGP. . what has GMC got to do with workforce planning ?

Andrew Jackson 6 April, 2023 12:30 pm

I’ve been a GP for 25 years and still find it really really really hard to do well. Everyone else not doing my job says it’s really easy!
Maybe I need more appraisal, more performance management, more supervision and more menopause training to be as good as those seeing my patients via other training routes.
I also need to see more patients every day in shorter slots to gain more experience.
Good job that is coming my way. Maybe I’ll be as good as these others by the time I retire?

Anonymous 10 April, 2023 10:41 am

David Church – its not about what passport you hold and whether you are British or not (which by the way sounds very racist to me). It is where you have done your undergraduate degree (or postgraduate specialism) and whether GMC recognises it as equivalent to UK training.

Example – UK national goes abroad to study medicine in Peru – cannot work in UK without PLAB.

miles fletcher 13 April, 2023 9:27 pm

I am a GP of 14 years who was an SAS in ENT. I had to do 2 1/2 years of retraining as a junior to qualify for General Practice and have obviously learnt vastly more since requalifying. I wouldn’t have had a clue and that is despite a long term sideline in A&E so at least I had experience in a spectrum of conditions. This simply won’t fly and anyone trying would be putting themselves at huge risk.