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NACT SAS Doctors Development Day 18th Sept 2009
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Tutors for SASG doctors- why do we need them?
Dr Meng Aw-Yong Staff Grade (AS) in Emergency
Medicine National Medical Advisor St John
Ambulance Forensic Medical Examiner Met
Police FASSGEM President NWT SAS BMA Vice Chair
SAS Advisor to London Deanery Frontier
Project
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Objectives

• History of SAS grade
• Issues with SAS grade
• Results from surveys
• Frontier project Developments in the SAS grade
• SAS tutor do we need them?
• Qualities of a SAS tutor
• A success story FASSGEM A success story of
  empowerment
• ABCDE

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SAS doctors The lost tribe
SAS The Lost Tribe
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Evolution SAS doctors

• Senior Clinical MO
• Medical assistants - SG, AS 19811
• NCCG, SAS - craft
• Clinical fellows/Trust grades
• Specialty Grade
• Effects of MMC and EWTD
• Main service providers
• Workforce shortage at middle grade level
• ? Increases in SAS doctors/subconsultants
• Medical staffing structure in the hospital
  service Platt Report 1961

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Attitudes

• Grades such as the staff grade, have been
  perceived as a threat to standards and a possible
  means of obtaining medical care on the cheap
• Thinking of taking a staff grade post? Buckley
  ,G.BMJ 7120 Volume 315 Saturday 29 November 1997

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Attitudes

• Many of them do clinical work that is comparable
  to that of consultants and have an operational
  responsibility for their work but the majority
  of them feel frustrated about their lack of
  career progression and feel that their
  contribution to the NHS is not recognised
• (PWC, 2001).Franklin Oikelome and Geraldine
  Healy. HUMAN RESOURCE MANAGEMENT JOURNAL, VOL 17
  NO 2, 2007

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Attitudes

• At the root of all this is ..a historical lack
  of adequate workforce planning, with the
  resulting two tier system we have today
• The rise of trust doctors. Stop exploiting them
  and start rewarding their input. Cooper,N.
  Burr,W. Editorial. BMJ 20033279434

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• Leadership  clinical and managerial  must be rei
  nforced and developed to  create wellmanaged orga
  nisations where all staff feel  supported,
   valued, listened to, empowered and involved
• Education, learning and development for all
  staff must be a priority to  ensure they have the 
  appropriate skills, behaviours and knowledge to me
  et  the professional standards expected of them
• Improving leadership, both clinical and managerial
  , so that organisation  structure, culture and sty
  le match new models of care. 
• Supporting performance improvement. 
• Developing the workforce.
• Paramedics . Taking healthcare to the patient. P
  Bradley. DoH 2005 

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Role play Imagine you are a dr and you have just
come from abroad

• How would you feel?

• These are your working conditions

• 1.Your pay is (30) less than the junior drs you
  supervise
• 2. No DDRB pay rise for 3 years
• 3.You have no teaching/training at all
• 4. STs/Spr have 1 day a week teaching
• 5. Juniors have 1 day a week teaching
• 6.You see 40-60 of the patients
• 7. You have no appraisal
• 8. You are not included in any meetings
• 9. There are no funds for your needs

• 1. Is it fair?
• 2. Can this exist today?
• 3. Should it exist today?
• 4. How could you catch up on training?
• 5. Who is going to help you?
• 6. How are you going to get the time?
• 7. Who is going to service the department?

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• Why take up a SAS post?

• Problems

• Exam failure
• No jobs
• Family life
• Portfolio career
• 9-5 hours no on-calls
• Clinical no management
• Did not fit

• Isolated
• Not respected by ST
• Excluded from management
• Regarded as failed consultant
• No training/funding
• Demoralised
• Bitter

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Trainees

• ST doctors are supported by Deanery, Schools,
  Tutors
• Training days educational support
• Supernumerary
• Regional programs
• RITA, MEDNET, MSF, SYNAPSE, Mentoring
• E-learning
• SAS doctors ?

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So what is new ? The SAS contract

• Appraisal
• Responsibility of trust
• Spa
• Funding

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What are SAS career aims

• Total years in grade 368 years average 5.9 1
• Career aims
• EM 1 AS 2 SG 2
• CESR 38.6 34.7 28.5
• Remain 50.9 57.3 16.1
• Regrade 19.3 81.3 35.5
• Frontier Survey 32 qualified abroad 63 UK
• Mean age 45 years SAS 7 years
• TNA FRONTIER Tony Rao
• 1 EM survey 62 doctors Meng Aw-Yong
• 2 BMA survey of SAS training and professional
  development needs I England Sep 2008 HPERU 969
  doctors

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CPD for SAS drs or not.?

• How many hours CPD are you allocated each week?
• AS 2.9 hrs SG 2.8 hrs
• 27/62 had no CPD time at al (MAY) New contract
  1SPa
• On what grounds have you been denied study leave?
  2
• Lack of cover 50.8
• Lack of funding 36.6
• Why are you not able to utilise all allocated
  CPD? 2
• Lack of time 32.4
• Not allocated time 34.1
• Workload/cover 65.9
• Lack of suitable courses 26

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Training Needs Analysis Results March 2009

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Access to CPD (n212)
The percentage of SASGs who reported having
greater access to CPD during the current year was
consistently higher across all domains.

• Particularly for
• mentoring,
• e-learning,
• personal development
• teaching/training

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Support for CPD (n212)
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Local contribution to CPD (n212)

• In 2007/08 Over 20 of SASGs contributed to
• management
• leadership
• clinical audit
• clinical skills development
• risk management
• teaching/training

2008/09 - further increase particularly for
research
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Benefit from CPD (n212)

• 07/08 to 08/09 shows over 50 increase in
• Clinical skills/knowledge
• assessment/teaching
• patient care

Divider slide
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Why do we need a SAS tutor?

• Heterogeneous group
• Widely varying CPD needs
• Coordination
• Not part of the managed trainee network
• Many out of mainstream medicine e.g audiology
• Middle grade workforce issue
• Revalidation and recertification looming
• Independent from clinical director
• Support in relation to development needs
• How and what to access?
• Obtain and protect CPD/Spa time

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Qualities required for SAS tutor

• Be aware responsive to unique/shared nature of
  SASG
• Be abreast of current issues eg MMC, Tooke
  report, credentialing
• Be able to effect change within specialty/trust
• Been there done it
• Be effective
• Be knowledgeable, understand support CESR
  process
• Pastoral support
• Close liaison with Schools and Colleges

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SAS tutor an easy guide The ABCDE approach

• A Accessible available. Time.
• Engagement is difficult
• B SAS tutor needs to belief in SAS drs and
  instill belief. Involve SAS in dept/local
  management
• Many are demoralised
• C Champion, communication strategy, College
  involvement, CESR
• Cash DoH limited how recurrent
• D Develop personal skills teaching skills,
  leadership, portfolio
• Obtaining cover
• E Education, enthusiasm promote CPD
• Study leave SAS v ST
• F Frontier one way is it better?

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FASSGEM a success story of self empowerment

• Forum for associate specialists and staff grades
  in EM
• Started in 1997 by 2 consultants
• Organise conference annually providing 15 CPD
• Represent 500-800 members
• Incorporated into CEM structure - inclusivity
• Chair - Voting Council member CEM
• Committees - Professional standards, BMA CCSC,
  Simulation, International, Clinical
  Effectiveness, Revalidation Regional Reps
• PMETB - 5 FASSGEM reps
• Shape our future

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The future is .SAS

• Frontier Maximising awareness of Frontier and
  CPD opportunities
• (20 taken up at least 1 opportunity by April 09)
• 98 SAS Leads for CPD
• Database 96 complete and
• Article 14, CESR
• Senior lecturers
• Portfolio careers
• New contract SPA
• Revalidation CPD
• SAS to be under remit of deaneries

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The NHS need SAS doctors 500 shortage middle
grades
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EVOLUTION OF SAS CHANGING WINDS

• There is a will to integrate SAS and other Trust
  grade doctors into a more coordinated structure
  and give them CPD, study leave and appraisal
  opportunities to provide excellent health
  services that benefit local people requires
  education to be in the middle and in the heart of
  everything that this Trust does

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Any Questions ?
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• Thank you

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Supported opportunities 08/09
Whilst sponsorship for specialty skills courses
remains popular, there has been a dramatic
increase in the number of specialty-related
Masters taken up by SASGs
SASG development has also been supported with the
funding of 15 more Postgraduate diplomas this
financial year
Supported opportunities 09/10
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• Sponsorship opportunities 2008- 2010

The following data reflects the courses,
conferences and secondments supported by Frontier.