Dr Radhakrishna Shanbhag, chair of the BMA’s SAS doctors committee, addressed its annual conference this week. Here’s a summary of his speech:

The new government seems to have made some good suggestions in their first few weeks but I have been in politics long enough to know that the proof is in what is delivered rather than what is said. We know that the financial situation and inexperience of the new administration will bring us some additional challenges to meet. I and my colleagues on SASC will continue to stand up for you, to face the wide ranging issues that arise and to work to turn challenges in to opportunities that lead on to progress.

Unfortunately, every SAS doctor is likely to face some difficulty in their working lives in the coming years, SPAs will be squeezed, study leave and funding will be more difficult to obtain and there could be redundancies. I know that I would rather have the might of the BMA behind me to face these challenges and if you are not members you may want to join the BMA.

The present economic situation will also increase our strength to act as a stepping stone for improvements to the working lives and careers of SAS doctors across the UK and in turn to deliver the essential role in caring for our patients that we are renowned for. Let us work together to achieve this and stand up to be counted.

Since we last met a year ago, we have continued our efforts to raise the profile of SAS doctors and one of the first steps to this was through the new contract.

Our biggest challenge has been implementation of the new contract. This has not only been patchy, but frankly poor in some regions. We have taken this up with NHS Employers on many occasions.

We have been working to assist those that have expressed an interest to assimilate to the new contract. There has been good progress in Wales and more patchy progress elsewhere. It has been frustrating but we have worked hard to do all we can to speed the process up. It’s not yet good enough. I’m amazed and disappointed to hear that two years on many are still awaiting their new contracts. We will continue this battle.

Despite the deficiencies in the contract, the focus on job planning will give many SAS doctors and dentists a voice that they did not previously have. Job planning is an opportunity to have a say in how patient care should be delivered, how your job should be done and what resources and development you need to be an effective doctor.

It appears to be on the way to resolution with some successes. By highlighting the benefits of ‘regrading’ for employers through repeated communications with LNC’s , support from the BMA and local initiatives such as the NW Regrading Peer Group, we have made inroads into making employers acknowledge the value and commitment that SAS doctors bring to the service.

We have carefully monitored the GMC/PMETB merger and have continued our regular dialogue with those involved in the assessment of CESR applications. Despite the name change our influence has remained constant - we meet the same people although their name badges and phone numbers have changed. I am pleased we have this liaison and we will continue to use this route to support our members through what is often a traumatic process.

An issue of concern at the present time appears to be the inappropriateness of having and promoting a system that justifies two classes of specialists - those through CCT and others through CESR. We will engage and work with the GMC to try and address these inconsistencies.

Revalidation is the other big issue on the horizon and I was very pleased to hear of the new health secretary’s decision to extend the pilots by a further year. Revalidation has the potential to give patients greater confidence and be a useful tool in monitoring our skills. However, several issues need to be worked out before it is introduced. Who will take up the responsible officer roles? Who will assess responsible officers? How will the additional workload be funded? How will we ensure that it is not an inappropriate and bureaucratic burden on doctors and employers? How do we ensure that it is not used by employers to make you conform to their agenda?

In announcing his decision to extend pilots for an additional year until 2012, Andrew Lansley noted the need for “a clearer understanding of the costs, benefits and practicalities of implementation”. Our key functions in the development of revalidation are to represent your views and to provide guidance on developments.

In 2008, we warmly welcomed the £12 million development funding in England. There have been many good uses of this funding in some areas and we have sought to raise these as examples of good practice to be followed elsewhere whilst castigating those deaneries who are inappropriately using this valuable funding. At the beginning of this month I met Patricia Hamilton who is the director of Medical Education in England. She reiterated her support for the continuing development of SAS doctors and offered her support to ensure the appropriate use of funding. Raj Nirula’s appointment as the Welsh Associate Dean has shown what can be done without funding. Two weeks ago I attended an excellent conference in North Wales where we heard more about the e-learning Tool already available to Welsh SAS doctors. The conference was organised by the Welsh Deanery and all this without funding!

Scotland have made some progress, they have an Associate Dean and I believe are several steps towards providing some similar funding. Northern Ireland SASC is lobbying hard for some support for SAS doctors in Northern Ireland but this is a tough battle given the acute funding issues they face.

Listen to a podcast on the conference issues.

I got into medico-politics to improve the lives of staff grade and associate specialist grade doctors. What I didn’t fully appreciate was the how painfully slow the process would be.

The BMA first sat down to negotiate a new contract with NHS employers over four years ago and this was after many years of calling for a new deal for non-consultant career grade doctors - as we were described then. When SAS doctors voted to accept the new contract the suggested timetable for implementation was for the majority to have transferred to the new contract by June 2009.

It was even written into the terms and conditions that it was anticipated that the job planning process would be completed within three months of a doctor expressing an interest. I am disappointed but not altogether surprised to learn that this has not happened.

Since the implementation of the new SAS contracts in April 2008, we have monitored progress closely. The whole process has felt a little like wading through treacle. The first step for trusts was to send out letters inviting doctors to express an interest in switching to the new contract. Now sending a letter to the staff grade doctors in a trust does not seem like a huge undertaking, yet according to our recent reports five trusts have not even managed to do this. We have followed this up directly and I believe that they have now finally done so.
 
Critical to the implementation of the new contract is the process of job planning. There is a wide range of online resources available on the BMA website to help doctors with the job planning process. However, this is contingent on employers getting the ball rolling. Our monitoring shows that only 13% of employers have concluded the job planning process and offered the new contract.

Now that we have the full picture of the sluggish nature of implementation, we have challenged NHS employers to put pressure on NHS trusts to properly implement the contract. It is not acceptable for trusts to drag their feet on this process. We are particularly keen to ensure that SAS doctors who move to the new contract get the back pay owed to them. It seems that only 7% of employers have reached this stage of implementation.

I am confident that back pay will be paid but the delays are still an unnecessary imposition and further evidence of the lack of value many employers seem to put on those in our grade.  

The proliferation of non-standard grades has been a bugbear of mine. Our research has shown that 7 out of 10 employers are offering the new contract to doctors in non-standard grades. I would like to see all non-standard posts offered the new contract. Non-standard posts create confusion for other healthcare workers and patients and should be consigned to the dustbin.

After intense pressure at our last negotiating meeting, NHS Employers has put a message out to all employers in England asking for their progress and for detail of any challenges they are facing. Perhaps a case of ‘too little, too late’ but at least a sign that they acknowledge the problem.

I have also just written to the chairs of local negotiating committees to urge them to support us in ensuring the speedy completion of implementation. We will continue the pressure both locally and nationally. The DoH has consistently said how important SAS doctors are to the NHS. This is their chance to prove their commitment to us. Contract implementation needs to be a priority, not an afterthought.