‘Specialty doctor’ is a relatively new term and is one of the grades under what is known as the Specialty and Associate Specialist (SAS) doctors. The specialty doctor post is not a training grade; it is a grade where a doctor has at least 4 years of postgraduate training, two of those being in a relevant specialty. As specialty doctors are not in training, their roles are usually much more focussed on meeting NHS service requirements, compared to consultant roles. For example, specialty doctors often have considerably less administrative functions compared to consultants. This may suit some doctors, in fact there are many reasons why doctors might decide to take on a specialty doctor role e.g. they may be overseas doctors that have difficulty getting a training post; or they may prefer the work/life balance in this role as the hours are usually more regular; or they may have a portfolio career i.e. they may have several distinct roles.

Doctors that do not get a specialty training post (due to high competition) may need to become specialty doctors for a period of time. This will also be the case if doctors do not pass their membership exams or assessments.

The Associate Specialist (AS) grade was kept for doctors who were already in this role, and a window of opportunity was given to Staff Grade doctors who wanted to apply to it, as there are small differences in the terms and conditions. This grade is now closed to newcomers, as the window of opportunity to re-grade to AS closed on 31^st March 2009.  Some doctors have kept the title of 'Staff Grade' as they have retained their old contract. The Staff Grade was closed to new entrants in April 2008.

There are many different types of other non-training posts: non-consultant career grades, clinical fellows, Trust doctors, Trust fellows, clinical assistants, hospital practitioners etc. The posts have differing work and pay conditions, which are dictated by the employing trusts. Many of these doctors are very experienced and as their job is mainly a service role, they undertake an absolutely essential role in the NHS. For an explanation of these roles have a look on the BMA website.

Since 2008 the Department of Health has promised £12 million in additional recurrent funding per annum (for England only); the Welsh Government has also identified funds which are managed via the Wales Deanery to support CPD.  Scotland has ensured some funding for elearning and Northern Ireland is still in discussion on this area. SAS doctors in Scotland and Northern Ireland can contact their local BMA office to learn more about the arrangements.

In 2008 the British Medical Association commissioned a survey of SAS doctors which was organised by the Staff and Associate Specialists Committee (SASC). The results of this survey are being taken into account in the negotiations of how the £12 million (for England) is being spent. The five most popular choices by respondents in the survey have said they would like the money to be spent on:

• Top-up training to meet requirement for an Article 14 or CESR application
• Time limited post/secondment for a specific training opportunity or requirement
• Management training
• Specialist clinic or theatre placement
• Postgraduate qualifications

Source: BMA Survey of SAS doctors’ training and professional development needs in England. September 2008

This extra funding and changes to the contracts are being implemented because this grade has been overlooked in the past. It has suffered from having an image that it was a job that had a lower status compared to a consultant role and had worse access to training. There have been problems where it has been very difficult for SAS doctors to transfer to specialty training or a consultant job.