I recently discussed locally employed LE (locally used) and SAS (specialty and specialist) doctors. Many of the people who attended admitted that they expected a presentation about medics from the military, which highlighted how little information is available about these doctors.
Specialist doctors have been trained for at least four years, with a minimum of two years of specialty experience. Specialist doctors are certified at 12 years old and have at least six years of expertise in their field.
SAS and LE doctors comprise at least 25 percent of General Medical Council (GMC)-registered doctors within the NHS. SAS doctors are skilled doctors who work in the NHS under an agreement that is a nationally approved contract. LE doctors come with a wide range of skills. They could, for instance, be doctors from the UK who have completed the initial two years of foundational education or newly recruited international medical students, in addition to several other possibilities. LE physicians are employed by trusts with individual beliefs and locally stipulated contract terms and conditions.
Despite these differences, SAS and LE doctors are considered an individual group within GMC information, and the GMC anticipates that by 2030, they will constitute the most significant cohort of GMC-registered doctors within the NHS and outnumber consultants registered on the register of specialists. Although the number of doctors on their record is growing, they face obstacles and limitations that must be sorted out urgently.
A majority of SAS and LE doctors are trained internationally. However, more and more UK graduates are also opting for this route of career because it comes with many benefits, such as the possibility of having fewer work hours than full-time and possibly better options for life balance and avoiding annual transfer between hospitals that could mean the transfer of patients to different regions.
In 2022, the Medical Workforce Race Equality Standard (MWRES) found that doctors who come from Black or ethnic minorities are nearly twice as likely to have faced discrimination at work due to an employer team leader, manager, or colleagues
Sixty-five percent of LE or SAS doctors come from Black or minority ethnic backgrounds, which is especially pertinent considering the current state of the gap in equality and inclusion in the NHS workforce and the unique challenges and challenges that staff who are ethnic minorities face. In 2022, the Medical Workforce Race Equality Standard (MWRES) found that doctors with Black or ethnic minorities have a twice higher chance than physicians of white backgrounds to have experienced personal discrimination at work by the team leader, manager, or other colleagues. They also have less experience in exams at medical school and post-graduation. They are also nearly twice as likely to be the subject of an inquiry or complaint to the GMC compared to their white colleagues.
SAS doctors and LE doctors, particularly those who are from ethnic minorities, are faced with a variety of issues. A survey in 2020 found that 30 percent of SAS doctors and 23 percent of LE doctors had experienced being harassed, abused, or hounded at work over the past year by patients co, leagues, and their family members. “Rudeness and incivility” was the most frequent type of behavior, and those who took part reported that it was the most frequently associated with race.
SAS, as well as LE doctors, have spoken to me about the subtle prejudice and discrimination they face from their colleagues and patients. For example, doctors for whom English is a second language are treated as less valued and must strive more to receive respect. There is a lot of awareness of the terrible effects of openly violent racism. However, little has been done to deal with the more nefarious experiences of microaggressions, the lack of support, progression in careers, or harsher disciplining actions. It will require serious reflection and uncomfortable discussions for those in leadership positions in all facets of the NHS to tackle these issues. Why has this discrimination continued for this long? Who gets the benefit? What can we do to change the power imbalances at the table?
SAS and LE doctors also need better inductions, a lack of recognition in training, and access to career advancement. According to a local doctor, after being recruited internationally, the doctor was promised a well-organized orientation to NHS but was told to “sink or swim” instead.
The NHS Medical workforce is believed to mainly depend on SAS and LE doctors, as more than 9000 SAS and LE doctors have been recruited into the NHS over the last two years. The latest NHS workforce plan sets out an approach to improve the quality of education, training, and recruitment by increasing the number of medical schools. While this could significantly boost the workforce over the long term, the doctors won’t be certified and independent for 10-15 years. SAS, as well as LE doctors, can be the solution to the workforce shortage right now.
