1. What prevents SAS Doctors from fully engaging in CPD opportunities U Dashora R Govindan S Raheman

2. NCCG (Non Consultant Career Grade doctors) The doctors who cannot automatically progress to become Consultants. Medical assistant grade was created in 1967, to offer suitable post to registrars' who could not get consultant grade (Platt R, 1961) The name was then changed to Associate Specialist grade in 1981. The Staff Grade was created in 1988 to address staffing shortages.

3. SAS SAS grade doctors generally includes Associate Specialists, speciality doctors, general dental practitioners and hospital practitioners. These doctors serve dual roles of training junior doctors but at the same time supporting consultants in delivery of services.

4. Understanding SAS doctors The number in this grade has increased substantially from 490 in 1991 to 12800 in 2009 but their professional development has lagged behind. These doctors have been referred to as the lost tribe (Claxton N and Griffin L, 2006) Two thirds were found to have come from overseas (Oikelome & Healey 2007), largest number being from Indian subcontinent

5. BMA survey 2013 Senior surgeon present for most day time operations was a Consultant, SAS doctors were the senior clinicians for over 7,500 day time operations, accounting for around 12% total SAS doctors was the senior anaesthetist present for 13% of daytime operations.

6. Departmental work force SAS doctors form (excluding training doctors) 80% general medicine 49% A & E 33% general psychiatry 42% oral surgery The data confirms that SAS doctors made significant proportion of staffing in almost all departments in the NHS and they perform highly skilled jobs.

7. CPD funding IN 2008, DOH has allocated £12 m funding every year to improve the professional development of SAS doctors. Number of programmes to support CPD, were developed all over the country. However, SAS doctors engagement with these programmes has frequently been lower than anticipated.

8. Courses for SAS doctors Leadership, management, education and other courses were organised in the Trust They were appreciated and taken by some but participation rates suggest SAS doctors are not fully engaging with the CPD opportunities.

9. Our Study The aim of our study was to explore in depth the factors which may be impacting SAS doctors to engage in CPD activities.

10. Material and Methods It involved a case study of one District General Hospital (DGH) with 60 SAS doctors One focus group discussion with a representative group of seven SAS doctors Six individual semi-structured interviews were conducted

11. All interviews were transcribed and analysed The interviewees were anonymised The doctors experience ranged from 4-20 years post graduation They were between 1.5 to 14 years in post One doctor was a Phd and others had done research

12. SAS doctors 7 from Indian subcontinent 2 from far east 2 from EU 2 British 11 males 2 females

13. Results The identity factor: there is a perceived lack of fairness, identity and recognition The awareness factor: unawareness of personal development needs, the opportunities available to satisfy them and the support necessary to access those opportunities The relevance factor: SAS doctors are likely to engage more heavily with the programmes that are aligned to their professional needs and personal circumstances.

14. The identity factor published BMJ careers 25 th Jan 2014 Lack of recognition Non recognition of previous overseas service as non equivalent, that is reflected in the salary, which is the lowest. Trainees work at the same level towards becoming a consultant, but I cannot....... Which is disheartening. Feeling of SAS doctors as second class

15. Cog in the machine It is de-motivation. You feel you are just a little cog in the machine and you are just seen as a worker bee and you are not supported, then that creates apathy in applying for available funding and so on because you do not believe that the organisation really has the intention of furthering your career.

16. Difficulty in obtaining Consultant post SAS doctors who are on specialist register after gaining CESR are struggling to get Consultant posts. They are perceived lesser doctors compared to their colleagues who come through structured training.

17. Awareness factor SAS doctors are unaware of Personal development needs Opportunities available to them Support necessary to access those opportunities

18. Reasons of not engaging in CPD No Induction No clear path as trainees Unaware of courses in the Trust Unaware of their study leave allowance Lack of guidance Lack of communication

19. Reasons of not engaging in CPD No Job plans Lack of professional learning support Lack of support from the department Inability to get study leave Anxiety Lack of IT support

20. Unaware of funding Some SAS doctors were unaware of the available funding and courses offered for SAS doctors in the Trust. He said he did not know about the funding. I was not aware of the courses. Other doctors did not understand the departmental study leave funds. The doctor said, I don’t even know how much personal allowance I have.

21. Work-home-work pattern One SAS doctor recalled, There was no guidance and the mindset was a fixed work-home-work pattern. He was mainly involved in service provision and progression was not considered an option. Very often unawareness was due to lack of adequate communication as the doctor was unable to access work email. I should, may be think about changing to my personal email.

22. Work, work, work There has been no induction for us. I started as a staff grade in A & E in 2005 and I had no induction, no idea about SAS things until... 6 or 7 years ago..that was the first I even knew that there was any provision that we were even recognised as human beings in the hospital, you know you are just kind of there to work, work, work.

23. Anxiety A new specialty doctor described feeling like an ant, as a result of inadequate supervision and forced him to concentrate on building the clinical base before contemplating CPD.

24. No IT support There is a lot more that we could do web based that we cannot do at the moment due to limitation of hardware and software. It is very bad. Atrocious.

25. Discussion The SAS doctors continue to lack a positive identity and recognition in the hierarchical structure of NHS. They feel marginalised and subordinate as compared to the doctors in training or doctors in consultant grade. They feel their experience is not recognised and there is no structured career progression. They do not feel valued and believe they are exploited

26. Discussion Many SAS doctors are unaware of available CPD opportunities. Lack awareness of their own professional needs. Lack of support Poor IT access SAS doctors are a diverse group with varying but highly specific individual needs.

27. Conclusion It is crucial to build a role and identity for the SAS doctors in the hierarchical culture of NHS. Development of an effective educational programme for SAS doctors. A structured system of CPD linking with appraisal and job planning would increase the awareness and relevance of CPD programmes. A national programme is needed to support the training and development needs of SAS doctors.

28. Recommendation To build a role and identity for the SAS doctors. This has been advocated before as treating them as equal in previous research (French F et al., 2007).French F et al., 2007 One way of building such an identity is by supporting suitable SAS doctors to take-up enhanced roles like educational supervisor and clinical supervisors, which is accepted now by GMC.

29. Recommendations Individual personal professional development plan for every individual SAS doctor Structured programme of one-to-one support for every individual SAS doctor Better utilization of IT based training SAS leads in each specialty, trust SAS leads, SAS tutors, Local Faculty Groups, SAS group meetings and easy access to regular mentoring and support.

30. Recommendation Induction is of paramount importance A structured system of CPD linking with appraisal Access to royal college e-portfolios A national programme to support the training needs of SAS doctors which will be different to the trainees.

31. SOS Unless these crucial issues are addressed, the plight of SAS doctors is likely to continue and they are likely to remain frustrated and undervalued. Their considerable contribution to NHS can be substantially enhanced by some relatively easy steps mentioned above and at a small investment. The benefits will thus be very cost effective and very gratifying.

32. Thank you