The specialist contract was perhaps the most important aspect of the 2021 SAS contract reform, providing an additional destination role for senior and experienced doctors. To be appointed as a specialist, a doctor must evidence considerable experience and corresponding professional development.

As is the case for consultants and GPs, becoming a specialist empowers doctors to work independently, with overall responsibility for the patients under their care. As described in the national rhetoric, the clinical niche in which specialists practise this autonomy will vary from doctor to doctor and may potentially be narrower than that of a consultant colleague. This will depend on their experience, and the service need.

Daily work

In my own career, having been appointed as a specialist anaesthetist with an interest in obstetrics, I have my own job-planned day as the senior responsible anaesthetist in the busy maternity unit of a large district general hospital. I work independently on this labour suite, as well as in my other regular anaesthetic lists, taking ownership of the decisions I make in the same manner as consultant colleagues.

Alongside this clinical autonomy, becoming a specialist carries an expectation of a broad portfolio of work beyond the clinical. Specialists should be educators, leaders and scholars. These things are written into the ‘generic capabilities framework’ for the specialist role, and this document provides the template for what doctors must achieve to earn this progression. It also sets the expectation for what the role of a specialist should look like after appointment.

Career development

I have become the lead trainer for obstetric anaesthesia in my department, supporting the next generation of anaesthetists taking their first steps in my favourite subspecialty area and beyond. I take a great deal of pleasure from supporting colleagues to realise their potential, and to that end I am also an educational supervisor to two resident doctors at different stages of formal anaesthetic training, and to foundation doctors.

While another specialist colleague is away, I am the interim subspecialty lead for obstetric anaesthesia and obstetric anaesthetic governance. In these leadership roles, I help to maintain and improve the standards of the whole obstetric anaesthetic service. I have also recently been involved in interviewing our next intake of specialists, helping to sculpt the future of my department.

I would like every specialty doctor to have the opportunity and expectation that their career should involve progression to autonomy and roles beyond the clinical, as mine has. The specialist contract provides incentive to make that progression normal, both for doctors and for employers.

If you are a medical leader and you don’t believe you have a service need to support the professional development of your specialty doctors, and empower them to be all they can be by creating specialists, I suggest you check again. Quoting other national rhetoric, a career as a SAS doctor should be a ‘viable career choice’ and provide an ‘attractive additional pathway’ for a career in medicine, and we need these things to be true more than ever.

Robert James Fleming MBChB FRCA is a specialist anaesthetist and BMA SAS committee member

Further reading

• The 2021 specialist grade explained (bma.org.uk)
• Generic capabilities framework for the Specialist grade
• SAS contract 2021 implementation guidance | NHS Employers
• Becoming a specialist - a SAS perspective | NHS Employers
• SAS doctor development guide | NHS Employers
• SAS - A viable career choice - Academy of Medical Royal Colleges (aomrc.org.uk)
• The SAS charter (bma.org.uk)