As one of the negotiators of the new staff, associate specialist and specialty doctor (SAS) contract, I know that part of this process involved a lot of discussion about SAS doctors’ health and wellbeing. This was high in the minds of negotiators due to recent surveys carried out by the BMA and the GMC in which SAS doctors spoke of experiences of bullying and harassment in the workplace.
In Northern Ireland there have also been reports of SAS doctors being undermined, of not feeling valued, and the use of what many feel is a belittling term, ‘middle grade’, when referring to thise branch of practice in the workplace.
In order to address this, it was agreed through the contract negotiations that there should be a new strategic role to promote and improve wellbeing support for SAS doctors in England, Wales and Northern Ireland – an ‘SAS advocate’ role.
Many organisations have in place roles which already support SAS doctors – for example, in Northern Ireland, SAS leads take forward the training and career development of the grade within each health trust; this new role of SAS advocate will be supplementary to that of the leads.
A vision for the role
The SAS advocate will be a visible point of contact for SAS doctors in the workplace and will provide signposting help and support for workplace issues. The advocate will work with both the health trust board and local negotiating committees to ensure a consistent approach to SAS doctors’ health and wellbeing across trusts. Update reports from the SAS advocate will be a regular agenda item on meetings of senior trust management.
The advocate should engage with, and share, best practice with fellow advocates across other health trusts, and facilitate signposting to external organisations if workplace concerns cannot be addressed locally. It would be useful for the advocate to collate information from informal and formal complaints to help identify patterns of poor behaviour and enable early intervention to ensure SAS doctors are treated fairly.
Employer buy-in
Health service employers have the discretion to create an advocate role; giving SAS doctors access to an advocate shows the employer’s commitment to improving the experience of SAS doctors.
Health and wellbeing of all staff is important as it benefits the organisation and, ultimately, results in better care for patients. The advocate role will also be additional for an employee, so they must be provided with adequate time and resources to carry out the job effectively; the amount of time allocated to the advocate should be dependent on the number of SAS doctors they are responsible for.
There has been much debate on whether the advocate must be a SAS doctor. I personally think that they should be, as a SAS doctor will be sensitive to the particular challenges of the branch of practice in their workplace. Whoever is appointed to the role must have a broad understanding of issues affecting SAS doctors; they must have the ability to challenge, to push for change with senior management, and they must feel confident in liaising with key stakeholders on health and wellbeing issues.
I regularly meet with representatives from the Northern Ireland health trusts and the Department of Health at our SAS contract implementation working group meetings. The advocate role is a topic I consistently bring up as I believe it is an essential part of the agreed safeguards for SAS doctors, one which supports the ambitions set out in the NI Workforce Strategy 2026, Delivering for our People.
We have seen the appointment of SAS advocates within health trusts in Wales and England, so I look forward to the first trust in Northern Ireland appointing an advocate here. It is long overdue.
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