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RCGP ‘can’t support’ SAS doctors working in general practice as it stands

RCGP ‘can’t support’ SAS doctors working in general practice as it stands

The RCGP is ‘not in a position’ to support the introduction of SAS doctors to general practice due to ‘unresolved’ concerns around funding and patient safety, it has told NHS England.

Earlier this month, Pulse reported that NHS England is set to run pilots of SAS doctors in general practice, in a move that the BMA’s GPC England said was an ‘abuse’ of the legislation.

In a letter to the national commissioner, RCGP chair Kamila Hawthorne set out the college’s ‘redlines’ regarding a potential rollout.

These include SAS doctors needing to be supervised by a qualified GP, the college said. SAS doctors must also not be seen as ‘an alternative to addressing the urgent shortage of GPs’. 

The letter, sent yesterday to NHSE’s director of primary care Dr Amanda Doyle, said the RCGP is ‘still unclear’ whether there will be funding to back any pilots or full introduction of the role. 

Professor Hawthorne also said it is ‘highly concerning’ that more flexible regulations to the Performers List that were introduced during the pandemic are being used to facilitate the piloting of the SAS doctor role. 

In March, GMC chief executive 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 RCGP said its recent letter to NHSE was based on scoping work into the potential role of SAS doctors in general practice, which followed the GMC’s report recommending it last year. 

The college sent a letter in February citing similar concerns and Professor Hawthorne said she has been ‘disappointed by the lack of meaningful information’ or engagement since then. 

She said: ‘These changes will not only significantly impact the daily lives of GPs and their teams, but it could also impact patient experience, and not necessarily for the better. 

‘GPs and their teams should not be blindsided by these changes.’

Ahead of any pilot scheme, the RCGP called for a ‘robust and external evaluation’ and for a formal stakeholder group to be set up which includes the college, the BMA, the GMC and SAS doctor representatives.

Professor Hawthorne added: ‘As many important details have not been fully considered, I worry about the impact any piloting of this role could have on patient safety.’ 

Details of a pilot scheme have not yet been published by NHS England, however in her letter Professor Hawthorne said the organisation has been ‘pursuing informal enquiries with ICBs’ regarding the pilot. 

The principles the RCGP has agreed for the SAS doctor in general practice role include:

  • The GP role, as the expert medical generalist, should remain protected, with this role having its own separate, limited scope of practice.
  • Efforts to expand the GP workforce should not be undermined as a result of the introduction of the role.
  • This role should contribute to maintaining and improving the standards of patient care.
  • This role should be fully integrated within the primary care team.
  • This role should be seen as a career in its own right, with opportunities for progression. 

RCGP’s SAS doctor ‘redlines’

  • These doctors must be supervised by a qualified GP and must be given a thorough induction to general practice.
  • These doctors cannot be seen as an alternative to addressing the urgent shortage of GPs and we cannot support counting them as contributing towards the Conservative Manifesto target of 6000 more doctors in general practice. There must be a clear distinction between this role and the role of the GP.



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

Darren Tymens 14 April, 2023 12:28 pm

Also, what about funding the time of the GP who is going to have to supervise the work of the SAS doctor?
And funding the extra capacity to make up for pulling that GP away from the frontline?
And funding the triage mechanisms that will be necessary to make sure that the SAS doctor only sees patients within their scope of practise?
These are not general practice roles, they are secondary care roles performing a secondary care function – but that they expect general practice to fund and supervise.

RAMAN PRABU 14 April, 2023 12:44 pm

We should welcome this move rather than oppose it.
We supervise many health care professionals like Nurse Practitioners and this would be much easier.
It will stop GP locums holding practices to ransom and won’t be any different from having a GP registrar or a newly qualified GP.
The RCGP should leave it to the practices to decide.
The RCGP does nothing to improve GP’s contract so why intervene now?!

Turn out The Lights 14 April, 2023 2:26 pm

Wondering id the RCGP have seen there demise approaching on the horizon with the demise of GPs.What do you call the RCGP when there’s no GPs.

Some" Bloke 14 April, 2023 6:03 pm

Interesting to see two diametrically opposite views in first two comments, shows how all GP families (partnerships, localities) are unhappy but all in our own unique ways.
On the flip side, if it’s recognised that employing SAS comes with requirements for GP time for supervision, triage and training, and there’s funding coming to support us doing that, then potential new headache could turn into an opportunity. Who knows…
The only thing which is clear is that without more doctors coming into GP, we will crumble.
From my own limited experience… when I started training, one trainee Dr was enough to keep me nearly stressed nearly all the time. That was a while ago. I now have three GP trainees and a small squad of students of all kinds, ANPs, PAs, CPs and ECPs to train. Probably few more but I can’t remember all .
I think that it is possible, we can supervise and develop SAS colleagues, if we are given right support. They do it for returners. At least with SAS we will be able to interview and decide whom we employ, which isn’t the case with trainees.

John Graham Munro 14 April, 2023 6:58 pm

I’ve got an idea —–how about ”The Royal College of Locums”’—-no training and no funding——. but reliable

David Mummery 14 April, 2023 7:42 pm

GPs will be supervising themselves out of existence the direction things are going..

Some" Bloke 14 April, 2023 11:33 pm

Sorry, John, can’t vouch for all Locums I have ever paid for as reliable, in every meaning. So, not sure. Think if you don’t want to be part of the team, then fair enough you wait till someone finds you attractive enough to employ again.
Personally, in current circumstances, would prefer to train up an SAS, than hire locums. You might want to join me in that hard work, but if you prefer not to- that’s your choice

Michael Green 16 April, 2023 7:12 am

Hooray, every headache has an MRI, every constipated child gets referred to paediatrics, and I just don’t care anymore.

neo 99 17 April, 2023 9:32 am

sorry some bloke but have to disagree with you. Locums are not employees and are there to do a specific time frame of work. They don’t want to be exploited underpaid salaried GPs and to be frank even at rates of £120 per hour are not exploiting GP practices. They are the only GPs asking for what they are worth. As an ex-partner I am well aware of what partners earn. And if you are not getting £18k to 22k per session as partner you are clearly doing something wrong. Even at the higher locum rate above for a 3 hour session, locums earn well below the partner rate above. For partners encouraging use of Sas drs, it is all about protecting earnings. Sas drs are not GPs and if you think they can be by “training up” in an unstructured way, you are devaluing your own profession to extinction. They should go though the same training as doctors on the GP register to qualify.

Not on your Nelly 17 April, 2023 1:59 pm

Everyone has come to save the day in GPland, but all have only increased GPs workload. We have noctors, phoctors, paraoctors and now the SASGPs. I still think I would prefere the SASGP who can at least safely see patients from their own specialty in primary care as long as suitablly triaged. so the paeds sas doctor only seein under 16s, the gyne sas doctor only seeing Women with gyne problems/hrt/contraception. It does show how much work a qualifed GP can do that no one else can. So lets not devalue our training and the amount of things only we can deal with in practice and just appreciate desperate times need desperate measures. At least they will safely be able to prescribe, refer and request investigations.

Anonymous 18 April, 2023 5:05 am

Cannot comprehend how you all want to let the fox into the henhouse.

Train up the SAS??? Have you not trained up the PAs already? They are with you for a year and move on somewhere else.

Why don’t you invest in retaining the staff you already have?

You let noctors run your business without any real scrutiny anyway. If SAS doctors were allowed to see ‘their own soecialties’ they should be on the specialist register. Problem is most of them aren’t, for various reasons.

James Cuthbertson 19 April, 2023 9:12 pm

In all aspects of medicine doctors delegating work to non doctor clinicians (or in this case other less qualified doctors) means that their clinical time is spent with all the difficult cases, which is soul destroying. It’s a bit like asking a premiership footballer to play competitive matches 3 times a day. Protocol led medicine is practiced by everyone else and the risky, complex or heartsink patients left for GP’s and consultants.