We first approached the health secretary in 2019 to ask him to reopen the closed AS (associate specialist) grade on a national basis.

We did this because we knew employers in England were already struggling to find ways to recruit and retain the best staff, associate specialist and specialty doctors in the country.

Many employers recognise the need for experienced SAS doctors delivering expert care, with senior levels of autonomy and responsibility, to the highest clinical standards.

Sadly, however, that is not the case among all employers. Ever since the AS grade closed in 2008, there has been a blurring of boundaries between the work expected of specialty doctors and the work expected of AS doctors.

Even with a senior grade closed, that high level of care and responsibility is needed.

We represent incredibly dedicated clinicians who, time and again, demonstrate their willingness to go above and beyond for their patients and for the service they deliver.

It comes as no surprise that, when asked by their employers to take on greater responsibilities, SAS doctors stepped into the breach and shouldered the burden.

Specialty doctors, who have so often been the workhorses of the health service, were once again being asked to deliver some of the most senior levels of care without it being properly recognised. And employers have been getting that work on the cheap.

Regrettably, we were not able to secure any form of regrading through negotiations around the new contracts. This was an absolute red line for the Government and NHS Employers.

However, we have been clear with NHS Employers we cannot allow the situation to continue. We see hardworking specialty doctors working at a senior level of responsibility and competence, and there is little incentive for their employer to offer them the opportunity to progress to a higher grade.

That is why we have produced new guidance on the specialist grade. 

We want to support our members to ensure they are being remunerated at a level appropriate to their work.

To do this, we need to find ways of removing the financial incentive for employers not to make a specialist post available because they already have a specialty doctor delivering that work at a lower cost.

The first step is to make clear the distinction in roles and responsibilities between a specialty doctor and a specialist. We hope this will empower doctors to recognise when they are being asked to work beyond the level that should be expected of their contract.

We also want to help doctors make the case that their employer has a need to create a specialist post to ensure this work is being done.

The process will not be easy but we hope this is a first step towards addressing the issue.

We need to work towards a future in which all SAS doctors can progress in their careers and ensure the expertise and skills they bring are recognised and rewarded.