In August 2021 MSG entered into negotiations with BMA Scotland’s SSASC committee on reform of the 2008 SAS contract. The other three UK countries had conducted and concluded negotiations for a new contract, with Scotland deciding to have specific discussions for NHSS.
Negotiations concluded in September 2022, and following agreement between all parties circulars were issued on 1st December 2022 setting out amended terms and conditions and pay for Specialty Doctors and introducing a new Specialist Doctor grade in NHS Scotland.
New Contract – High Level Summary
Based largely on the arrangements agreed in the negotiations conducted in the other three UK countries as well as the mandate provided by the Cabinet Secretary, the new Scottish contracts provide increased pay, as well as improved terms and conditions and health and well-being measures for SAS doctors.
On Specialty Doctor pay, in line with the stated intention of ensuring that the new contract should be attractive to doctors, there were significant increases, particularly at the lower end of the pay scale. Salaries for doctors in Scotland on both the new Specialty Doctor and Specialist contracts are the highest in the UK thus aiding recruitment to, and retention in, NHS Scotland.
There was also potential back pay of up to 6 months for those eligible doctors who transfer to the new Specialty Doctor contract in line with the new contract transfer provisions, as well as Associate Specialists transferring to the Specialist grade.
In addition to changes in pay, enhancements in terms and conditions have also been agreed, including:
- Improved recognition of previous relevant experience when determining starting salaries on appointment for doctors on the new grades.
- An increase in out of hours’ availability supplements for on-call work, aligning them with those for consultants.
- An agreed double time rate of pay for SAS doctors undertaking waiting list work
- New work-life balance safeguards, including (unless by mutual agreement between the doctor and their NHS Board) a limit of 40% of total work to be undertaken out-of-hours, and job plans that do not require a doctor to work more than 13 weekends a year. Transitional arrangements will apply to current SAS doctors transferring to the new Specialty Doctor contract.
- New limits on shift-working, including the maximum number of consecutive shifts and the minimum rest period after a run of night shifts to bring them into line with provisions that already apply to junior doctors in Scotland.
- All Job Plans under the new contracts to include a clearly identified and specific SPA (Supporting Professional Activities) allocation
New Specialist Doctor Role
One of the primary outcomes for both NHS Scotland and SAS doctors from the new contract is the creation of a new grade, the Specialist doctor.
The introduction of the Specialist Grade will give NHS Scotland the opportunity to appoint experienced doctors to a senior role, working with a degree of autonomy within local governance arrangements. These appointments will be made to meet a described service need, while providing career and development opportunity for a range of doctors, including the current cohort of Specialty Doctors. The role will be developed by local teams, to meet an area of clinical need, and appointed to through a competitive entry process.
The new Specialist grade will not be part of our current regulatory framework, in that it will not necessarily have a post graduate qualification or CCT, and therefore it is crucial that the governance and assurance arrangements for the new grade are firmly established before appointments are made. Work in that area is currently ongoing
The Specialist Grade doctor/dentist will provide expertise in a specialised area, whether delivering care in a specific or a generalist service, and be able to manage the full range of presentations in their specific area of practice, competence and job requirement.
Through development work undertaken by MSG, before formal negotiations began, with Boards, clinicians, SAMD, HRDs and other groups strong support was voiced for the new Specialist new role, with the general view being that there is a real need for a new enhanced medical grade in NHSS.
The roles will inevitably be different in rural and central Boards, but both types of Boards expressed the view that such a role would be useful and valuable in enhancing service provision to patients and providing a new career development path for our doctors. Some Boards are already looking to the role in NHS E&W. During negotiations we have been in dialogue with Boards about the Specialist role and the enthusiasm and need for such a role remains high. These are not replacement consultant posts, but there is no doubt that an experienced Specialist Doctor will be a valuable member of the senior clinical team, in the chosen specialist area.
There is currently no recognised grade of doctor in NHSS, other than Consultant, which can work in this senior role, and the introduction of the Specialist Grade will provide Boards with an alternative opportunity. Unlike the current Specialty Doctor grade, Specialist Doctors will be able to work autonomously to a level of defined competencies and scope of practice. The Specialist will differ from that of a Consultant in that they will have a more limited scope of practice, but still be able to work independently. The Specialist role will also differ from speciality to speciality, and within the same speciality, as well as Board to Board. In addition, the role will be broader than purely clinical in nature, incorporating other elements, such as leadership, which will ensure that doctors carrying out this new role will feel valued and recognised as a member of the wider team.
