UK Shape of Training steering group: report annexes

Annex 9: SAS doctor questionnaire in Scotland

SAS Doctors in Scotland - Questionnaire

Report from the Shape of Training Implementation Group in Scotland describing the results of a questionnaire that has been undertaken of SAS doctors for recognition of skills acquired through funded workplace based training.

Background

1. The Shape of Medical Training Review ( SoTR) was established by UK Ministers for Health to consider how medical training could better need the present and future needs of patients. The review group reported their findings in October 2013 making 19 recommendations.
( http://www.shapeoftraining.co.uk/reviewsofar/1788.asp)

2. The report recognised that the needs of patients in the UK are changing. In particular an ageing population will lead to more patients with multiple co-morbidities. This in turn will require more doctors to have and maintain generic skills to enable them to work within integrated models of care.

3. The Review considered all aspects of medical training including the needs of doctors who are not in formal training programs. In this context recommendation 17 specifically applies to SAS doctors. It states:

• "Appropriate organisations should review barriers faced by doctors outside training who want to enter a formal training program or access credentialed programs"

The SoTR further stated in relation to SAS doctors that:

• Para 129 they should also be offered opportunities to enter or return to training throughout their careers. They should also be given access to credentialed training.
• Para 130 Credentialing will give opportunities to SAS doctors to further develop in their specialty or move into other practice areas.
• Para 131 there will continue to be a need for an equivalence route onto the appropriate registers.

4. In response to the report UK Ministers convened a steering group ( UK Shape of Training Steering Group UKSTSG) tasked to consider the implications of implementing the recommendations and to provide appropriate policy advice. The key function of the UKSTSG is to maintain a UK consensus where that is necessary in areas such as curricula development.

5. In the first instance, the UKSTSG initiated a number of workshops of which one was devoted to exploring the training requirements of SAS doctors. It concluded that measures were required to better develop and utilise the skills of SAS doctors. The UKSTSG asked the Welsh and Scottish Implementation groups to take this work forward as follows:

• "measures to be scoped out, based on evidence collected through pilots, how to further develop the careers of doctors who are outside formal post graduate training and who are not consultants such as SAS doctors".

SAS Doctors

6. Approximately 20% of doctors are not in training or on the GP or specialist Register. These doctors make an important contribution to health care across the UK.

7. The scope and complexity of care delivered by these doctors varies. Some with specific competencies currently deliver care equivalent to that of Consultants.

8. It is of note that current and future trainees are seeking flexible, part time working with the opportunity to take career breaks. In this context, non-Consultant career posts may become increasingly attractive especially if they are developed.

9. The NHS requires to ensure that all staff can contribute "to the top of their competence". In relation to SAS doctors this means ensuring that they can fully use the skills that they already have and to support them developing new skills. The SoTR specifically recommended that SAS doctors should be able to access credentialed training.

Purpose of this paper

10. The purpose of this paper is to describe the work to date and to outline the results of a survey that has been undertaken of SAS doctors in Scotland about how best to recognise skills and enhance career development opportunities.

11. In the first instance officials from the Welsh and Scottish Governments met with a representative from the GMC to discuss the specific recommendation that SAS doctors should have access to credentialing training. It was concluded that given the anticipated length of time that it will take to implement credentialing it would be reasonable for the Medical Education & Training bodies in each country to develop an interim recognition/accreditation process.

12. There is a willingness by both Governments to consider measures that would enhance the training and careers of SAS doctors. In the context of the Shape of Training Review, two specific measures have been proposed. The first would involve the development of a process to recognise specific skills that SAS doctors already process. Such recognition should be "portable" and allow the doctor to deploy the expertise/skill in independent practice.

13. The second proposal involves the development of training modules for SAS doctors based upon local and National Service needs. As in the first initiative, a method should be developed to recognise any additional skill.

14. In order to test whether there would be an appetite among SAS doctors for these proposals, a questionnaire-based survey was undertaken of the approximately 1000 SAS doctors in Scotland ( SAS Dentists were excluded). Participants were identified from the databases held by NHS Education for Scotland ( NES) SAS Educational Advisers. The response rate was approximately 25% (246 respondents). The results are presented in embedded document at the end of this document.

15. In brief, the survey shows that approximately 60% of the 246 respondents believe that they currently process a specific skill that could be formally recognised. Overall, 83% of respondents would be interested in undertaking a workplace-based training programme, and 87% would value an accreditation process in Scotland that formally recognises enhanced skills. Approximately three quarters of respondents remained interested if the process involved an end of training assessment.

16. These results suggest that, as a minimum, over 200 SAS doctors in Scotland would be interested in a process that recognised their current skills/competencies or allowed them to develop skills that would be formally recognised. On this basis, it is concluded that the development of these measures could make a substantial additional contribution to patient care in Scotland.

17. In considering options it has been assumed that the current process that allows SAS doctors to gain access to the specialist register via CCT/ CESR will remain.

18. The UKSTSG are invited to note the results of the questionnaire and to consider the implications.

Scottish Government Health Workforce Directorate
June 2016

Scottish Government SAS Survey Report - March 2016

The purpose of the questionnaire was to determine whether there was appetite from amongst Scotland's SAS Doctors for recognition of skills acquired through funded workplace based training.

The questionnaire was sent out to approx 1000 SAS Doctors (1300 SAS grades minus SAS Dentists) through the databases held by our SAS Educational Advisers. The response rate was 246, which is approx 25% of SAS Doctors in NHS Scotland.

Responses were received proportionately from all grades of SAS Doctors, in all specialties (except laboratory specialties) and all Health Boards areas (except NHS Orkney, Shetland and Western Isles, which may reflect that currently there is no SAS Educational Adviser in post covering these areas).

Survey Question Responses

While Scotland has already recognised that more needs to be done to recognise and improve the training and development opportunities for SAS doctors, as evidenced through sustained Scottish Government funding of the SAS Doctors Training and Development Fund, the Shape of Training review has provided further impetus on how best to address barriers to medical training.

As you will be aware, the Shape of Training Review made the following recommendation.

Recommendation 17: "Appropriate organisations should review barriers faced by doctors outside of training who want to enter a formal training programme or access credentialed programmes"

In taking forward consideration of the review's 19 recommendations, this recommendation has been widened to include a consideration of measures to enhance the careers of SAS doctors in general.

It has been proposed that workplace-based training programmes could be developed for SAS doctors allowing them to develop specific enhanced skills that they do not currently have and which would improve delivery of patient-centred NHS Board services. A process for the recognition of these skills would be developed that would allow the doctor to work independently within that skill set.

Q1) In principle, would you be interested in undertaking such a workplace-based training programme?

Q2. Would you be interested in undertaking such a programme if it involved training out with your current workplace assuming reasonable financial support?

Q3. Would you be interested in undertaking such a programme if it involved an assessment by log book review or other continuous assessment?

Q4. Would you be interested in undertaking such a programme if it involved a formal end of training assessment?

Q5. Can you identify an area of training that you would wish to undertake? If so what?

There were a large variety of suggestions here some of which we have quoted below.

"Enhanced surgical skills"

"Leadership and management training"

"Teaching training, rather than specialty/sub-specialty training"

"Ultrasound and laparoscopy"

"Oncology and oncoplastic procedures"

"Regional anaesthesia"

Q6. A number of SAS doctors already have specific enhanced skills that at present are not formally recognised or are transferable to another employer. It may be that these skills at present are not being fully utilised. It has been proposed that a process should be developed to formally recognise such skills i.e. via an accreditation-type process.

a) Do you have skills or an area of practice that could be formally recognised?

b) In principle, would you value an accreditation-type process in Scotland that formally recognises enhanced skills?

c) If not an accreditation-type process in Scotland, what alternative model(s) would you find acceptable? Please briefly describe.

"It would be good if there was a provision for SAS Doctors to be recognised based on the experience, rather than their qualifications/exams".

"The Associate Specialist grade should be re-opened with the same criteria as before, to allow career development, improve recruitment and retention and make NHS Scotland an attractive place for SAS Doctors to work".

"Recognition of experience and use of Appraisal in assessment".

"Any potential accreditation process in Scotland, should be the same as the one in the rest of the UK".

The results of this survey show that this group of SAS Doctors are keen to develop their skills and competencies and interested in any Scottish Level Accreditation of skills that might be developed.

It is clear on discussion within the board areas that many SAS Doctors are unfamiliar with "Shape of Training" and were unaware about proposals within that document. They felt that it did not relate to them as SAS grades and have not attempted to find out more information.

We added the opportunity to provide some free-text comments to the answers which are summarised as above, under the relevant headings.

Of those not interested in a Scottish level accreditation system the themes that emerge are

• Some SAS chose the grade due to other commitments or have developed within the grade without the need for formal accreditation; some of these are already practicing independently within their service or have gained a place on the specialist register through CCT /CESR.
• Those who had concerns about how such accreditation might be viewed in the rest of the UK.
• Some who felt that we should develop Specialty Doctors using a career progression model such as that from Staff Grade to Associate Specialist, with career development relating to the experiential accrual of skills and competencies.
• Concerns around cost and complexity of any such system.
• No mention of any Royal College involvement- would such be recognised by the colleges?
• Might this be a parallel but less creditable route to career development than CESR?

This survey has shown evidence of support for development opportunities within Scotland for SAS doctors. Both those who expressed an interest in these proposals and those with misgivings were keen to find out more about the detail of them.

The SAS project, with the existing network of SAS peer advisers placed within all the boards, would be keen to be involved in any further development or consultation work in this area.