I recently presented a talk on locally employed LE (locally used) and SAS (specialty and specialist) doctors. Some of those who attended said they expected a presentation about medics from the military, which highlighted the fact that there isn’t much information about these doctors.
Specialist doctors have been trained for at least four years, with a minimum of two years of specialty experience. Specialist doctors have been certified for twelve years and have more than six years of specialization experience.
SAS and LE doctors constitute at least 25% of General Medical Council (GMC)-registered doctors within the NHS. SAS doctors are highly skilled specialized doctors who work in the NHS under the terms of a nationally approved contract. LE doctors can draw on a range of skills. They could, for instance, be British-trained doctors who completed their initial two years of foundational training, or they may be recently recruited as international medical students, in addition to several other options. LE medical doctors work for trusts of individuals with locally established contract terms and conditions.
Despite these distinctions, SAS or LE doctors are considered one group in GMC information and the GMC anticipates that by 2030, they will comprise the largest group of GMC-registered doctors within the NHS over the specialists in the register of specialist doctors. Although the number of these doctors are growing, they are also faced with obstacles and challenges that must be addressed urgently.
Around 65 percent of SAS and LE doctors are trained internationally. However, UK graduates are increasingly opting for this path of study because it offers numerous advantages, including flexibility in being less full-time and possibly better choices regarding time management and avoiding annual transfer between hospitals that could mean the transfer of patients to different regions.
It was found that the 2022 Medical Workforce Race Equality Standard (MWRES) was reported doctors who come from Black or ethnic minorities are nearly twice as likely to have been discriminated against at work by the manager or team leader, as well as other colleagues.
Sixty-five percent in LE or SAS doctors come doctors from Black or ethnic minorities which is particularly pertinent considering the current state of discrimination and inequity of the NHS workforce, as well as the difficulties and challenges that staff with ethnic minorities have. It is estimated that by 2022 Medical Workforce Race Equality Standard (MWRES) found that doctors with Black or ethnic minorities are twice as likely than physicians of white backgrounds to have experienced personally discrimination in the workplace from the team leader, manager or a colleague; they also have less experience in exams both in medical school and post-graduation. They are also nearly twice as likely to have complaints or be referred to the GMC compared to their white colleagues.
SAS doctors and LE doctors – especially doctors who are who are from ethnic minorities are faced with a variety of issues. A study in 2020 found that 30% of SAS doctors and 23 percent of LE doctors have been victimized, humiliated or otherwise harassed in the last year by their colleagues, patients and their family members. Incivility and disrespect was the most frequent kind of behaviour, and those who took part reported that it was the most frequently associated with race.
SAS or LE doctors have shared with me about the prejudice that – overt and subtle – they face from their colleagues and patients. For instance, doctors for who English is not their first language are getting treated as less valued and must fight more to receive respect. There is a lot of awareness of the terrible effects of blatantly abusive racism, but not enough can be done to tackle the more nefarious experiences microaggressions, the lack of support, the lack of progression in careers, or harsher disciplinary actions. It will require honest reflection and uncomfortable discussions for those in senior positions at all levels of NHS to confront these disparities. Why has this discrimination been allowed to persist for this long? Who gets the benefit? What can we do to change the power imbalances at the table?
SAS, and LE doctors, also suffer from inadequate introductions, a lack of recognition, and access to training and career advancement. A local doctor said that after being recruited internationally, the doctor was promised a formal intro to NHS and was told to “sink or swim.”
It is believed that the NHS Medical workforce is heavily dependent on SAS and LE doctors as more than 9000 SAS and LE doctors have been recruited into the NHS within the last two years. The latest NHS workforce plan sets out an approach to improve education, training, and recruitment by increasing the number of places in medical schools. While this is an excellent contribution to the workforce in the longer term, the doctors won’t be certified and will work independently for 10-15 years. SAS, as well as LE doctors, offer an answer to the workforce shortage right now.
SAS and LE doctors also suffer from poor inductions, inadequate recognition, and access to training and career advancement.
The NHS must acknowledge the importance of SAS or LE doctors and strive to improve their experience. The current crisis in retention within this NHS physician workforce is is especially affected by SAS and LE doctors. of the SAS or LE doctors who obtained the licence to practice during 2013, 53 percent were out of the profession in 2021. This is a massive loss of skills and knowledge, and is at the expense of public health.
The NHS is not able to be able to function without doctors, and the patient experience and outcomes are affected. There are three organizations that support these doctors. BMA, NHS England and GMC all have initiatives in place to assist the doctors, but it is apparent that these initiatives need to be implemented consistently across the country. Amid celebrations, as the NHS is celebrating its 75th anniversary, it’s shocking that doctors are given such low visibility and do not receive the attention they are entitled to. Are these practices in line with NHS England the business strategy to help the NHS to draw and keep more people and work with a caring and inclusive environment What do you think?
The NHS must consider – who holds their employers accountable. What are the consequences for employers for widespread discrimination and bullying, as well as insufficient support and lack of progression? What is being done to keep these doctors? Do you think it is morally acceptable to continue actively recruiting doctors from abroad while they’re in these difficult working conditions?
The King’s Fund The King’s Fund, we plan to continue our efforts to bring attention to the experiences of both LE and SAS doctors working in the NHS and highlight their voices. This NHS workforce plan highlights the necessity to improve the quality of life and enhance the professional careers of SAS and LE doctors. Trusts and royal colleges as well as national NHS institutions must concentrate on the retention and development of careers of these doctors as our health services are dependent on them.
