SAS and locally employed anaesthetists need better support and career progression

A new report from the Royal College of Anaesthetists (RCoA) reveals significant and persistent challenges faced by specialty, associate specialist, and specialist (SAS) and Locally Employed Doctors (LEDs) working in anaesthesia across the UK.

These doctors are an integral part of the anaesthetic workforce but often lack job security and are not provided with sufficient access to training or career progression opportunities.

The report, SAS and Locally Employed Doctors, draws on data from our Anaesthetic Workforce Census. It shows there are 2,215 SAS doctors and 2,278 LEDs working in anaesthesia in the UK.

Key findings for SAS doctors

• More than half (55%) said the lack of opportunities for career progression were their single biggest source of dissatisfaction. This includes the ability of ‘specialty’ doctors to access the more senior ‘specialist’ contract.
• Nearly half of specialty doctors (49%) said that although they were eligible to move to the specialist contract, they had been unable to access it.
• A lack of fair treatment is a concern for more than a quarter (28%).

Key findings for Locally Employed Doctors

• Desire for progression is very high – only 5% want to remain in their current posts indefinitely.
• There is a clear desire to enter formal training – 39% had already applied for a training post at the time of the Census, with a further 29% planning to apply in the next two years.
• Most LEDs (81%) are employed on fixed term contracts, giving them significantly less job security than other groups.

Why this matters for retention 

The data builds on our recent Wellbeing, Burnout and Retention report, which found that almost one in five anaesthetic staff plan to leave the NHS within  the next five years. Improving access to training, secure contracts and progression is vital if experienced doctors are to be retained and patient services protected. 

Our calls for action

• NHS employers to provide greater access to the specialist contract, ensure meaningful representation through SAS advocates.
• Include SAS doctors fully in clinical governance meetings.
• Expansion of specialty training posts.
• NHS employers to better support LEDs to learn and progress.
• LEDs to be able to access the SAS specialty contract after two years of service.

Dr Claire Shannon, President of the Royal College of Anaesthetists, said: 

“SAS and locally employed doctors are central to the delivery of anaesthetic care across the NHS. Yet there remains a significant gap between their ambition and the opportunities available to them, particularly in access to training, supervision and senior contracts. 

“If we want to retain skilled anaesthetists and protect patient services, we must do better. That means secure contracts, equitable access to training, and clear, supported routes for progression.”

Dr Ashwini Keshkamat, Chair of the RCoA's SAS Committee, added: 

“As a specialist anaesthetist and Council member of the RCoA, advocating for SAS doctors and LEDs is a top priority. 

“We are an integral part of the anaesthetic workforce in the delivery of care across the NHS, which needs strengthening with opportunities for career progression, autonomous practice, leadership and educational roles.”