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Int J STD AIDS OnlineFirst, published on March 31, 2015 as doi:10.1177/0956462415580503
Original research article
SAS doctors career progression survey 2013
International Journal of STD & AIDS 0(0) 1–4 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462415580503 std.sagepub.com
Carlos Oroz1, Lorna R Sands2 and John Lee3
Summary We conducted a national survey of Staff, Associate Specialists and Specialty (SAS) doctors working in sexual health clinics in the UK in 2013 in order to explore their career progression. The aim of the survey was to assess SAS doctors’ experience in passing through the thresholds and to gather information about the adherence by SAS doctors and employers to the terms and conditions of service laid out by the new 2008 contract. Out of 185 responders, whom the authors estimate comprise 34% of the total workforce, 159 were on the new contract. Of those, most SAS doctors were women (84%), the majority (67%) worked less than nine programmed activities per week; only a few had intentions to join the consultant grade (15%), and a considerable minority (26%) were older than 54 years of age and likely to retire in the next 10 years. The survey showed that most participating SAS doctors had had an appraisal in the previous 15 months (90%), most had a job planning discussion (83%) with their employer and most had some allocated time for supporting professional activities (86%). However, a significant minority had no appraisal (10%), no job planning discussion (17%) and had no allocated supporting professional activities (14%), which allows time for career development in the specialty. Most SAS doctors, who had the opportunity, had progressed through the thresholds automatically (88%); some experienced difficulties in passing (8%) and only a few did not pass (4%). SAS doctors must ensure that they work together with their employer in order to improve adherence to the TCS of the contract, which allows for career progression and benefits both the individual doctors and ultimately service provision.
Keywords SAS doctors, SAS contract, career progression, appraisal, job planning, SPA, personal development plans Date received: 22 October 2014; accepted: 11 March 2015
Introduction In 2008, after negotiations between National Health Service (NHS) Employers and the British Medical Association, a new contract was introduced and offered on an optional basis from 1 April 2008 to doctors and dentists in the following grades: . . . . .
staff grades; associate specialists; senior clinical medical officers; clinical medical officers; clinical assistants and hospital practitioners (but not GPs who are providing a primary care service in the secondary care setting or community hospitals).
The criteria for career progression are clearly laid out in the terms and conditions (T&C) of the contract.1 There are two specific thresholds within an 11-point incremental pay scale. This process is aimed at
recognising degrees of seniority and is based on demonstrating evidence of satisfactory participation in appraisal, job planning (JP), 360-degree feedback and an overall recognition of the doctor’s contribution to a wider role (an increased ability in taking decisions, carrying responsibilities without direct supervision and being able to lead a team, regular completion of audit, an ability to innovate within the area of specialisation, evidence of involvement in the wider management role, a leading involvement in research and/or a leading role in teaching). The contract states that this 1
Chalmers Centre, Edinburgh, UK Oxford Sexual Health Service, Churchill Hospital, Oxford, UK 3 Mid Yorkshire Hospitals NHS Trust–Sexual Health, Josephine Butler Centre for Sexual Health, Clayton Hospital, Wakefield, UK 2
Corresponding author: Carlos Oroz, Chalmers Centre, Chalmers Street, Edinburgh, EH3 9ES, UK. Email: [email protected]
Downloaded from std.sagepub.com at Northeastern University on November 14, 2015
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2
International Journal of STD & AIDS 0(0)
process should be facilitated by the employer, should not be onerous and an overall view should be considered, rather than an exhaustive list of activities. The aim of the survey was to explore doctors’ experience in passing through thresholds as laid out by the new Staff, Associate Specialist and Specialty (SAS) doctors contract and to gather information about SAS doctors’ and employers’ adherence to the terms and conditions of service of a contract that allows the career progression of a group of doctors that were once referred to as the backbone of the Genitourinary Medicine (GUM) services.2
Methods We conducted a national survey of SAS doctors working in GUM and/or sexual health services during the period September to December 2013. Doctors were invited to complete an online survey designed by the authors. The survey was publicised both on the British Association for Sexual Health and HIV website and at the national annual BASHH conference for SAS doctors (Warwick, September 2013).
Results In total, 185 doctors responded and 159 (86%) explicitly stated that they were on the new contract. The following analysis will focus only on the 159 SAS doctors who were on the new contract, 54 (34%) of which were associate specialists and 105 (66%) specialty doctors. There were 134 (84%) female responders; only 5 (3%) were under the age of 35 and 42 (26%) were above 54. Only 52, out of 156 responders (33%), worked more than eight programmed activities (PA) per week and 33 (21%) less than five. Of 158 responders, 40 (25%) obtained their primary qualification outside the UK. The Diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) and the Diploma in Genitourinary Medicine (Dip GUM) were the main additional qualifications in 108 (68%) and 61 (38%), respectively. The Diploma of the Royal College of Obstetric and Gynaecologists (DRCOG) was held by 48 responders (30%), and 29 (18%) held the Membership of the Faculty of Sexual and Reproductive Healthcare (MFSRH). The Membership of the Royal College of General Practitioners (MRCGP) was held by 42 (27%) of responders. When exploring SAS doctors’ participation in appraisal and JP (see Figure 1), which form the basis for progressing through the pay scale of the contract, out of 159 responders, 143 (90%) had had an appraisal within the last 15 months and a JP discussion was had by 124 (83%) out of 149 responders. However, 16
(10%) SAS doctors had had no appraisal, and a significant minority of 25 (17%) had no JP discussion. Of 144 responders, 124 (86%) had one or more supporting professional activities (SPA) built within their JP, and 20 (14%) had none at all. The experience of doctors passing through thresholds is shown in Figure 2. Out of 138 responders, 86 (62%) had the opportunity to pass through the thresholds; 76 (88%) of them had passed automatically, 7 (8%) reported passing through the threshold with considerable effort and 3 (4%) reported being rejected because the service had not supported them. In assessing the SAS involvement in a wider senior role, out of 159 responders, 145 (91%) of SAS doctors reported performing clinical work without formal supervision in the last year; 119 (75%) supervised other doctors, 133 (84%) other health care professionals and 115 (72%) were involved in audit. With regard to active involvement in education, 124 (78%) reported teaching in clinic or on the wards; 69 (43%) reported having a formal role in teaching postgraduate doctors and 58 (36%) undergraduate students. A significant minority of 27 (17%) said that they acted as mentors, 18 (11%) as appraisers, 14 (9%) were actively involved in research, 25 (16%) had a management role and 33 (21%) were involved in external NHS duties. When asked about plans for re-grading to consultant grade at some point in their career, out of 147 responders, 22 (15%) were planning at some time to apply for Certificate of Eligibility for Specialist Registration or go back to a formal training post, 91 (62%) had no
Figure 1. SAS doctor’s participation in appraisal, job planning and time allocated for SPA. SPA: supporting professional activities.
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Oroz et al.
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Figure 2. Experience of SAS doctor’s passing through thresholds (n ¼ 86).
plans of doing so and a significant amount of 34 (23%) did not know.
Discussion Although there is no clear data on the number of SAS doctors working in sexual health in the UK, the authors estimate that the 185 participants in their survey represent 34% of the total SAS workforce. This survey focuses on the majority of responders who were working under the new 2008 contract (86%). Of those, most were women (84%), a significant proportion (26%) was older than 54 years of age and expected to retire in the next 10 years; two-thirds (67%) were working less than nine PA, and only a few responders (15%) had intentions to join the consultant grade through CESR application or go back to formal training posts. This, together with the demands on service provision, will inevitably have implications for the future of workforce planning in the specialty. The survey also revealed a group of doctors that have significant expertise to provide integrated sexual health services with 18% having the MFSRH qualification, 68% the DFSRH, 30% the DRCOG and 38% the Dip GUM. In addition, 27% of responders have the MRCGP. The vast majority (91%) were working independently without formal supervision and had a wider senior role in supervising and teaching others; 21% were involved in external NHS duties, such as involvement in other professional groups as a representative, and 16% had a formal management role. In assessing the responders’ and employers’ adherence to the T&C of their contract, the survey showed
that most SAS doctors (90%) had had an appraisal in the previous 15 months which forms the basis for career progression under the new contract’s T&C1 and as set by the General Medical Council on the core guidance for revalidation.3 However, a significant number had had no appraisal (10%), no JP discussion (17%) and no allocated time for SPA (14%), which is important both for the individual doctor’s development in the specialty and patient safety. Although 83 (96%) doctors who had the opportunity had passed through the thresholds, seven of them reported difficulties doing so and three (4%) reported not passing because the service did not support them. This survey reveals a small but considerable amount of SAS doctors who had had no appraisal, no JP meeting and no SPA time allocated which may inevitably lead to less personal development plans, less job satisfaction and may hinder career progression to a more senior role. The authors acknowledge that this survey did not specifically explore whether the amount of PA undertaken by SAS doctors correlates with their experience in adhering to the T&C of the contract. This could be a subject further explored in future surveys. In the meantime, SAS doctors and employers must work together to make sure that they adhere to the T&C of the contract, which facilitates career development and progression to a more senior role and can only benefit individual doctors and ultimately service provision. Acknowledgements The authors would like to thank Andrew Massie, Senior Information Analyst from NHS Lothian Analytical
Downloaded from std.sagepub.com at Northeastern University on November 14, 2015
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(STD)
[1–4] [PREPRINTER stage]
4
International Journal of STD & AIDS 0(0)
Services, for his valuable help with the cleaning and interpretation of data.
Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
References 1. SAS contract BMA, http://bma.org.uk/practical-supportat-work/contracts/sas-contracts (2008, accessed 17 March 2015). 2. Lee JD, Carlin EM and Robinson A. Specialty and Associate Specialist doctors: still the dependable backbone of genitourinary medicine. Int J STD AIDS 2013; 24: 383–385. 3. GMC guidance on revalidation, http://www.gmc-uk.org/ doctors/revalidation/12386.asp (2013, accessed 17 March 2015).
Downloaded from std.sagepub.com at Northeastern University on November 14, 2015
(STD)
[1–4] [PREPRINTER stage]
Int J STD AIDS OnlineFirst, published on March 31, 2015 as doi:10.1177/0956462415580503
Original research article
SAS doctors career progression survey 2013
International Journal of STD & AIDS 0(0) 1–4 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462415580503 std.sagepub.com
Carlos Oroz1, Lorna R Sands2 and John Lee3
Summary We conducted a national survey of Staff, Associate Specialists and Specialty (SAS) doctors working in sexual health clinics in the UK in 2013 in order to explore their career progression. The aim of the survey was to assess SAS doctors’ experience in passing through the thresholds and to gather information about the adherence by SAS doctors and employers to the terms and conditions of service laid out by the new 2008 contract. Out of 185 responders, whom the authors estimate comprise 34% of the total workforce, 159 were on the new contract. Of those, most SAS doctors were women (84%), the majority (67%) worked less than nine programmed activities per week; only a few had intentions to join the consultant grade (15%), and a considerable minority (26%) were older than 54 years of age and likely to retire in the next 10 years. The survey showed that most participating SAS doctors had had an appraisal in the previous 15 months (90%), most had a job planning discussion (83%) with their employer and most had some allocated time for supporting professional activities (86%). However, a significant minority had no appraisal (10%), no job planning discussion (17%) and had no allocated supporting professional activities (14%), which allows time for career development in the specialty. Most SAS doctors, who had the opportunity, had progressed through the thresholds automatically (88%); some experienced difficulties in passing (8%) and only a few did not pass (4%). SAS doctors must ensure that they work together with their employer in order to improve adherence to the TCS of the contract, which allows for career progression and benefits both the individual doctors and ultimately service provision.
Keywords SAS doctors, SAS contract, career progression, appraisal, job planning, SPA, personal development plans Date received: 22 October 2014; accepted: 11 March 2015
Introduction In 2008, after negotiations between National Health Service (NHS) Employers and the British Medical Association, a new contract was introduced and offered on an optional basis from 1 April 2008 to doctors and dentists in the following grades: . . . . .
staff grades; associate specialists; senior clinical medical officers; clinical medical officers; clinical assistants and hospital practitioners (but not GPs who are providing a primary care service in the secondary care setting or community hospitals).
The criteria for career progression are clearly laid out in the terms and conditions (T&C) of the contract.1 There are two specific thresholds within an 11-point incremental pay scale. This process is aimed at
recognising degrees of seniority and is based on demonstrating evidence of satisfactory participation in appraisal, job planning (JP), 360-degree feedback and an overall recognition of the doctor’s contribution to a wider role (an increased ability in taking decisions, carrying responsibilities without direct supervision and being able to lead a team, regular completion of audit, an ability to innovate within the area of specialisation, evidence of involvement in the wider management role, a leading involvement in research and/or a leading role in teaching). The contract states that this 1
Chalmers Centre, Edinburgh, UK Oxford Sexual Health Service, Churchill Hospital, Oxford, UK 3 Mid Yorkshire Hospitals NHS Trust–Sexual Health, Josephine Butler Centre for Sexual Health, Clayton Hospital, Wakefield, UK 2
Corresponding author: Carlos Oroz, Chalmers Centre, Chalmers Street, Edinburgh, EH3 9ES, UK. Email: [email protected]
Downloaded from std.sagepub.com at Northeastern University on November 14, 2015
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(STD)
[1–4] [PREPRINTER stage]
2
International Journal of STD & AIDS 0(0)
process should be facilitated by the employer, should not be onerous and an overall view should be considered, rather than an exhaustive list of activities. The aim of the survey was to explore doctors’ experience in passing through thresholds as laid out by the new Staff, Associate Specialist and Specialty (SAS) doctors contract and to gather information about SAS doctors’ and employers’ adherence to the terms and conditions of service of a contract that allows the career progression of a group of doctors that were once referred to as the backbone of the Genitourinary Medicine (GUM) services.2
Methods We conducted a national survey of SAS doctors working in GUM and/or sexual health services during the period September to December 2013. Doctors were invited to complete an online survey designed by the authors. The survey was publicised both on the British Association for Sexual Health and HIV website and at the national annual BASHH conference for SAS doctors (Warwick, September 2013).
Results In total, 185 doctors responded and 159 (86%) explicitly stated that they were on the new contract. The following analysis will focus only on the 159 SAS doctors who were on the new contract, 54 (34%) of which were associate specialists and 105 (66%) specialty doctors. There were 134 (84%) female responders; only 5 (3%) were under the age of 35 and 42 (26%) were above 54. Only 52, out of 156 responders (33%), worked more than eight programmed activities (PA) per week and 33 (21%) less than five. Of 158 responders, 40 (25%) obtained their primary qualification outside the UK. The Diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) and the Diploma in Genitourinary Medicine (Dip GUM) were the main additional qualifications in 108 (68%) and 61 (38%), respectively. The Diploma of the Royal College of Obstetric and Gynaecologists (DRCOG) was held by 48 responders (30%), and 29 (18%) held the Membership of the Faculty of Sexual and Reproductive Healthcare (MFSRH). The Membership of the Royal College of General Practitioners (MRCGP) was held by 42 (27%) of responders. When exploring SAS doctors’ participation in appraisal and JP (see Figure 1), which form the basis for progressing through the pay scale of the contract, out of 159 responders, 143 (90%) had had an appraisal within the last 15 months and a JP discussion was had by 124 (83%) out of 149 responders. However, 16
(10%) SAS doctors had had no appraisal, and a significant minority of 25 (17%) had no JP discussion. Of 144 responders, 124 (86%) had one or more supporting professional activities (SPA) built within their JP, and 20 (14%) had none at all. The experience of doctors passing through thresholds is shown in Figure 2. Out of 138 responders, 86 (62%) had the opportunity to pass through the thresholds; 76 (88%) of them had passed automatically, 7 (8%) reported passing through the threshold with considerable effort and 3 (4%) reported being rejected because the service had not supported them. In assessing the SAS involvement in a wider senior role, out of 159 responders, 145 (91%) of SAS doctors reported performing clinical work without formal supervision in the last year; 119 (75%) supervised other doctors, 133 (84%) other health care professionals and 115 (72%) were involved in audit. With regard to active involvement in education, 124 (78%) reported teaching in clinic or on the wards; 69 (43%) reported having a formal role in teaching postgraduate doctors and 58 (36%) undergraduate students. A significant minority of 27 (17%) said that they acted as mentors, 18 (11%) as appraisers, 14 (9%) were actively involved in research, 25 (16%) had a management role and 33 (21%) were involved in external NHS duties. When asked about plans for re-grading to consultant grade at some point in their career, out of 147 responders, 22 (15%) were planning at some time to apply for Certificate of Eligibility for Specialist Registration or go back to a formal training post, 91 (62%) had no
Figure 1. SAS doctor’s participation in appraisal, job planning and time allocated for SPA. SPA: supporting professional activities.
Downloaded from std.sagepub.com at Northeastern University on November 14, 2015
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Figure 2. Experience of SAS doctor’s passing through thresholds (n ¼ 86).
plans of doing so and a significant amount of 34 (23%) did not know.
Discussion Although there is no clear data on the number of SAS doctors working in sexual health in the UK, the authors estimate that the 185 participants in their survey represent 34% of the total SAS workforce. This survey focuses on the majority of responders who were working under the new 2008 contract (86%). Of those, most were women (84%), a significant proportion (26%) was older than 54 years of age and expected to retire in the next 10 years; two-thirds (67%) were working less than nine PA, and only a few responders (15%) had intentions to join the consultant grade through CESR application or go back to formal training posts. This, together with the demands on service provision, will inevitably have implications for the future of workforce planning in the specialty. The survey also revealed a group of doctors that have significant expertise to provide integrated sexual health services with 18% having the MFSRH qualification, 68% the DFSRH, 30% the DRCOG and 38% the Dip GUM. In addition, 27% of responders have the MRCGP. The vast majority (91%) were working independently without formal supervision and had a wider senior role in supervising and teaching others; 21% were involved in external NHS duties, such as involvement in other professional groups as a representative, and 16% had a formal management role. In assessing the responders’ and employers’ adherence to the T&C of their contract, the survey showed
that most SAS doctors (90%) had had an appraisal in the previous 15 months which forms the basis for career progression under the new contract’s T&C1 and as set by the General Medical Council on the core guidance for revalidation.3 However, a significant number had had no appraisal (10%), no JP discussion (17%) and no allocated time for SPA (14%), which is important both for the individual doctor’s development in the specialty and patient safety. Although 83 (96%) doctors who had the opportunity had passed through the thresholds, seven of them reported difficulties doing so and three (4%) reported not passing because the service did not support them. This survey reveals a small but considerable amount of SAS doctors who had had no appraisal, no JP meeting and no SPA time allocated which may inevitably lead to less personal development plans, less job satisfaction and may hinder career progression to a more senior role. The authors acknowledge that this survey did not specifically explore whether the amount of PA undertaken by SAS doctors correlates with their experience in adhering to the T&C of the contract. This could be a subject further explored in future surveys. In the meantime, SAS doctors and employers must work together to make sure that they adhere to the T&C of the contract, which facilitates career development and progression to a more senior role and can only benefit individual doctors and ultimately service provision. Acknowledgements The authors would like to thank Andrew Massie, Senior Information Analyst from NHS Lothian Analytical
Downloaded from std.sagepub.com at Northeastern University on November 14, 2015
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(STD)
[1–4] [PREPRINTER stage]
4
International Journal of STD & AIDS 0(0)
Services, for his valuable help with the cleaning and interpretation of data.
Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
References 1. SAS contract BMA, http://bma.org.uk/practical-supportat-work/contracts/sas-contracts (2008, accessed 17 March 2015). 2. Lee JD, Carlin EM and Robinson A. Specialty and Associate Specialist doctors: still the dependable backbone of genitourinary medicine. Int J STD AIDS 2013; 24: 383–385. 3. GMC guidance on revalidation, http://www.gmc-uk.org/ doctors/revalidation/12386.asp (2013, accessed 17 March 2015).
Downloaded from std.sagepub.com at Northeastern University on November 14, 2015
