1、September 2020 SAS doctor development Summary of resources and further work Contents Introduction 3 Background 4 SAS Charters 5 Job planning 5 Continuing professional development 6 Autonomy 8 Certificate of eligibility for specialist registration (CESR) 9 Routes to CESR Extended roles 10 Educational

2、 and clinical supervision Management roles Appraisal roles Induction roles Guardians of safe working hours roles Coding / tariffs for clinical activity 14 Contract / progression 16 Credentialing 16 Defining the SAS grade 17 Commitment 18 Actions for NHS boards 20 Actions for medical directors 21 Act

3、ions for SAS doctors 23 Actions for medical staffing and human resources 25 2 SAS doctor development Introduction Sustaining good quality services to patients requires doctors to be up to date and fit to practise. The personal development needs of doctors are a vital part of that. The British Medica

4、l Association (BMA), British Dental Association (BDA), Health Education England (HEE), the Academy of Medical Royal Colleges (the Academy) and NHS Employers have worked together to produce this guidance on the development of specialty and associate specialist (SAS) doctors and dentists in the NHS in

5、 England to help ensure that this important group of doctors are helped to remain fit to practise and develop in their careers. This guidance was originally published in 2017 and updated in 2020. This guide describes actions that can be taken to ensure that best practice is applied in the developmen

6、t of all SAS doctors and how different groups can work together to ensure best practice is consistently applied. It is useful and appropriate to anyone involved in the development of SAS doctors, such as employers, medical royal colleges, HEE, the General Medical Council, consultants, and SAS doctor

7、s themselves. Specific sections are targeted at: NHS boards medical directors SAS clinicians medical staffing and human resources teams. The principles set out can also be applied to dentists working in the SAS grades and other doctors who are not in training, for example locally employed (LE) docto

8、rs. We have used the term SAS doctors in this document although it also applies to this wider group which includes dentists. In applying the principles to a broader group of doctors, appropriate funding arrangements will need to be made in addition to the existing ring-fenced fund for SAS doctors. 3

9、 SAS doctor development Background SAS doctors are a diverse group with a wide range of skills, experience, and specialties. They work as staff grade doctors, associate specialists, specialty doctors, hospital practitioners, clinical assistants, senior clinical medical officers, and clinical medical

10、 officers. Ensuring that SAS doctors receive effective development will benefit patients, employers, and doctors. Good patient experience is strongly associated with a motivated and engaged workforce where every individual has the opportunity to work at their full potential. Investing in development

11、 is a step to achieving this, and will mean that doctors are better equipped to meet the needs of the service and improve patient care. For SAS doctor development to succeed, it is important that they receive effective annual appraisal, revalidation every five years, study leave, and mutually agreed

12、 job plans which include appropriate supporting professional activity (SPA) time. NHS Employers has produced guidance for employers on improving SAS appraisal. This includes practical advice based on feedback, ideas and experience from SAS doctors themselves. It also sets out the steps that employer

13、s can take to acknowledge and develop SAS doctors skills. The HEE and NHS Improvement guidance Maximising the Potential: essential measures to support SAS doctors sets out how the NHS can better recognise and support SAS doctors to continue to deliver high quality patient care. It includes 11 recomm

14、endations for national partners on issues such as developing an improved SAS doctor data set, supporting implementation of the SAS Charter, and raising awareness of induction and revalidation guidance. Maximising the Potential also tasks HEE and NHS provider organisations with ensuring that SAS doct

15、ors are offered development opportunities linked to service need, their experience and career aspirations. This updated SAS development guide aims to set out in more detail the ways in which employers can help to meet this commitment. HEE, with partners, will ensure that the SAS role is supported, d

16、eveloped and promoted as a viable alternative to training and consultant grade roles. 4 SAS doctor development SAS Charters To demonstrate a shared commitment to supporting and developing the role of the SAS doctor as a valued and vital part of the medical workforce, each nation has developed a char

17、ter for SAS doctor development. The charters, according to nation, set out what SAS doctors can expect from their employer and what the employer can expect from them. NHS Employers has also jointly published with the BMA, SAS Charter resources to help employers and SAS doctors work together to asses

18、s their organisations progress and develop an action plan to support implementation of the charter and incorporation of its principles into local procedures and policies. NHS Employers and the BMA jointly held a webinar to support NHS organisations in the implementation of the SAS charter through sh

19、aring available support and resources and providing an overview of two examples of best practice. The Secretary of State for Health and Social Care, Matt Hancock has written to BMA council chair, Chaand Nagpaul to say that he expects trusts to implement the SAS Charter. Job planning SAS doctors are

20、contractually entitled to job plans which are mutually agreed and relevant to their roles. Job plans should be completed in good time with at least annual review. They should allow time for SPA that will allow them to undertake development activities which can include audit, clinical governance, tra

21、ining, and research. Job planning should be undertaken in a spirit of partnership and balance the needs of patients, the employer, and the wider NHS with those of the individual doctors. Within this context, it is expected that all parties will participate openly in the process and actively consider

22、 alternative ways of working, to enable service improvements to be introduced. See the SAS job planning guide for more information about job planning. 5 SAS doctor development Continuing professional development Continuing professional development is vital for SAS doctors to keep up to date with the

23、ir skills and competencies. There are many ways SAS doctors can develop, through their own personal learning or via facilitated development sessions or awaydays. The General Medical Council (GMC) Continuing professional development guidance sets out: 54 Employers and contractors of doctors services

24、are responsible for making sure their workforce is competent, up to date and able to meet the needs of the service. They should maintain and develop the skills of all of their medical staff whether they are consultants, staff grade, specialty or associate specialist (SAS) doctors, sessional general

25、practitioners (GPs), locum doctors or trainees. They should also facilitate access to the resources (including the time to learn) that will support this. SAS doctors should also have adequate time and support to allow them to fully participate in the annual appraisal process. This includes having su

26、fficient breadth and depth of clinical work and relevant professional activities that will enable SAS doctors to achieve and maintain relevant competencies and develop as clinicians. Continuing professional development opportunities should be a mix of formal and informal learning, for example: refle

27、ction on data from audits, assessments, and feedback training courses peer reviews or peer tutoring specialty networks or programmes run by medical royal colleges shadowing of consultants and other more senior clinicians secondments or opportunities to act up into more senior roles for periods of ti

28、me. Appointing a SAS tutor will ensure that these doctors have someone who acts as a voice for them and can promote SAS doctor development. A fund for SAS doctor development is available from HEE. Employers can work with SAS Deans and SAS tutors to access this fund. The Academy of Medical Royal Coll

29、eges has published a paper detailing the support and encouragement for personal and professional development for SAS doctors/ dentists provided by their relevant royal college/faculty. 6 SAS doctor development Case study A SAS development programme in the North East Tees, Esk alongside attending mor

30、e developmental sessions such as autonomous working, coroners reporting, consent and capability, development coaching for medics, and managing self for success. These more specialist topics are led by the internal consultant body with support from relevant external services. Both elements are extrem

31、ely helpful because they ensure colleagues feel connected to organisational support and are able to consider topics in the context of their roles and responsibilities. There are opportunities for SAS colleagues to join the agenda also and present “hot topics” that are of importance to them, which us

32、ually relate to specialist areas of clinical or personal interest and expertise. Sessions are evaluated, to continuously ensure that the programme is fit for purpose and reflective of SAS doctors needs. SAS business meetings are also planned, bi-monthly and are attended by SAS colleagues and led by

33、the lead SAS tutor. The trust uses them as a means of ensuring that all SAS colleagues are updated on work to develop the SAS programme. This provides a valued platform for consultation and ensuring the group has the opportunity to share views and concerns on proposals before implementation. In rece

34、nt months this has involved much discussion around implementing the Maximising the Potential guidance, alongside other specifics like changes to rotas and the introduction of e-job planning. 7 SAS doctor development Autonomy Autonomous practice may mean different things to different people. It could

35、 be defined as an individuals self-governance that with engagement, peer support and recognition, enables safe and effective doctors providing safe and effective patient care. In the interest of patient safety, all NHS staff are subject to some form of supervision, whether from peers or lead clinici

36、ans. The terms and conditions do not prevent SAS doctors from working independently and ensuring staff are used to their full potential is beneficial for the employer, individual doctor, and patient care. Many SAS doctors already work as autonomous practitioners. There are a number of benefits to en

37、couraging and enabling autonomous practice, where it is appropriate. These can include: recognition of the high level of clinical skills and professionalism in the SAS doctor grade provision of personal and professional development opportunities for SAS doctors within the trust/organisation the oppo

38、rtunity to have greater medical engagement of SAS grades support for the recruitment, retention, and motivation of highly skilled clinicians enabling doctors to work to their highest potential, benefiting the service and patients improved governance and accountability. In practice, the level of supe

39、rvision will depend on a number of factors, including personal competence and agreed accountability arrangements for all aspects of the role. The Academy of Medical Royal Colleges guidance Taking Responsibility: Accountable Clinicians educational supervisor; SAS tutor; clinical director; medical dir

40、ector; governance lead; guardian of safe working hours; and freedom to speak up guardian. Doctors will benefit from taking advantage of these opportunities and employers will benefit from a greater proportion of the workforce supporting wider organisational objectives. These roles also promote the r

41、ole and visibility of SAS doctors. Trainees who work alongside SAS doctors in these roles will have a positive image of SAS as a career choice. It is good practice to support eligible SAS doctors to apply for such roles. SAS doctors should be included in management meetings and on committees and pan

42、els, for example, clinical advisory, clinical governance, audit committees, morbidity and mortality reviews, serious untoward incident panels, interview panels, directorate meetings, and the local negotiating committee (LNC). SUPPORT Medical directors should encourage the appointment of a SAS tutor

43、who acts as a voice for SAS doctors and promotes their professional development. SAS doctors should be supported through appropriate clinical supervision where required. This is especially important for SAS doctors below threshold one of the specialty doctor pay scales to support their ongoing devel

44、opment needs. Examples would be case-based discussions and supervisor sessions. 22 SAS doctor development Actions for SAS clinicians CHARTER SAS doctors should pro-actively support implementation of the SAS charter and formally engage with any appropriate committee, for example the local negotiating

45、 committee (LNC) or clinical advisory committee. SAS doctors should ensure they are aware of the provisions of the charter and extent to which they have been implemented at their trust. SAS doctors should work in partnership their employer at LNC meetings, using the SAS charter resources, to assess

46、their organisations progress on implementation, identify areas requiring attention and create an action plan for improvement. APPRAISAL Doctors should take personal responsibility for their annual appraisal. This should be supported by a portfolio of evidence, including patient and colleague feedbac

47、k. The outcome should result in clear achievable objectives and a personal development plan (PDP). SAS doctors should also contribute to an effective appraisal process across their organisation and consider how they can be supported to become trained medical appraisers. They should also encourage th

48、eir SAS doctor colleagues to engage with the appraisal process. AUTONOMY SAS doctors should be confident in their ability to work autonomously where appropriate and to seek supervision where necessary. The Academy of Medical Royal Colleges guidance on taking responsibility and its guide to Autonomou

49、s Practice of SAS Doctors assert that senior SAS doctors have the expertise and ability to take responsibility for patients without consultant supervision. CHARACTERISTICS OF SAS DOCTORS SAS doctors should be assertive in taking advantage of the opportunities that are available and challenging colleagues when opportunities are not open to them. SAS doctors should show personal responsibility in attending their trust induction, finding out about new service developments and offering their services, being informed about their contracts and the