2022 in review: The GMC’s SAS proposals  

The latest plans to boost numbers of GPs are somewhat radical, as Pulse reported in October.

If passed, GMC proposals will pave the way for the general practice workforce to be propped up by thousands of secondary care staff and associate specialist doctors.

Enter the SAS.

The GMC’s rationale is clear: there is a pool of talented doctors working across the UK, from which primary care could cherry pick enough to solve the GP recruitment crisis in one fell swoop.

Some 64,000 of these SAS doctors work in secondary care, and figures suggest that total could exceed 110,000 in five years’ time.

They are below consultant level but are skilled clinicians, nonetheless.

Many are former GP trainees who didn’t pass the CSA or RCA aspects of the MRCGP exam, while others are doctors who trained overseas, and whose qualifications don’t apply in the UK.

And therein lies an argument against the plan. SAS doctors are not qualified GPs and signing them up in their droves could be tantamount to dumbing down general practice, reminiscent of bygone days where GP training wasn’t mandatory.

Furthermore, they would likely need to be supervised, at least for an initial period. As with the pharmacists, physios, paramedics and the like brought in under the additional roles reimbursement scheme, it’s GPs who would be tasked with supervising them.

So, this idea to reduce GP workload could in fact create more work for GPs, not to mention the red tape involved, with the UK governments needing to amend secondary legislation to enable the move.

However, that process of ratification would be a relatively short one, if there is support for the proposals.

There are positives, too. For starters, SAS doctors are more qualified that some of the new ARRS roles, so they could take on greater responsibility for patient care than, say, physician associates and GP assistants.

The plan would also enable the UK to keep hold of highly trained doctors who might otherwise up sticks, as many already have. Of the total number of registered SAS doctors in 2013, 53% were no longer working in the NHS by 2021.

Their exodus is partly because of the short, fixed-term contracts they’re employed under in secondary care – a barrier that would be removed if they worked in general practice instead. That in itself would afford patients more continuity of care.

Right now, we’re at almost 1,900 fewer FTE GPs than there were seven years ago. This is a far cry from the 5,000 extra the government had ambitiously (read: unrealistically) hoped for. Any moves aimed at bolstering the workforce thus far have fallen short of their target.

Granted, the minutiae of this SAS operation needs ironing out with military precision, but all we can do is hope that it’ll be a mission accomplished.