In this blog, Dr Julie Anne Forbes, RCOG Associate, Co Vice-Chair of the RCOG SAS and LED Committee, and Associate Dean for SAS Doctor Career Development in Northern Ireland — shares her reflections on the importance of the specialist grade and why its wider adoption in O&G is key to supporting patient care, retention, and senior workforce sustainability.
The SAS and LED Committee represent SAS and LEDs across RCOG Boards and Committees, ensuring the views of this workforce are represented in College activity and products. I am proud to be an Associate member of the College and to strengthen the voice of the SAS and LE doctor community as the SAS and LED Committee Co Vice-Chair and Northern Ireland representative.
Alongside my RCOG and NHS roles, I am also Associate Dean for SAS Doctor Career Development at the Northern Ireland Medical and Dental Training Agency (NIMDTA). I have been working to advocate for the creation of specialist posts in Northern Ireland and have seen first-hand the benefits that supporting senior specialty doctors to progress can have on both an individual, as well as what they can bring to the service to improve patient care.
Across the UK, medical specialties are taking advantage of the specialist grade, introduced in 2021 to provide career progression for specialty doctors (SAS doctors). Yet in obstetrics and gynaecology (O&G), uptake has been slower than in many other specialties. This raises an important question: are we in danger of lagging behind and missing a vital opportunity to enhance our senior medical workforce?
I believe the answer is yes – and the RCOG is actively advocating for the creation of specialist posts to address workforce gaps, improve retention, and strengthen service delivery.
The SAS workforce is growing and this offers an exciting opportunity that I believe will be positive for the whole O&G workforce. The specialist post has a major role to play in addressing the long waiting lists in gynaecology, the workforce shortages at senior medical level in O&G, addressing the need for expansion in teaching and leadership capacity and providing career progression for specialty doctors, locally employed doctors and resident doctors who choose to follow an alternative career pathway.
Alongside the NIMDTA SAS career development team, I facilitated a focus group with departments that have embraced the specialist role. They have seen a number of benefits from creating specialist posts. As one consultant and Clinical Director put it:
It’s a small jump in pay scale for a huge jump in what a person can do.
The benefits in practice
Departments reported to the focus group
- Greater workforce stability
- Stronger autonomous service delivery across multiple sites
- Career role models for locally employed doctors (LEDs) and specialty doctors
- Better retention of experienced clinicians
- Expanded leadership, teaching, and service development capacity
Reflecting on the addition of a specialist doctor to their department, one consultant colleague expressed:
I wanted to develop our department on a solid basis, with a home for everyone – including those not on the specialty training pathway.
What makes a specialist?
A specialist is:
- Senior and experienced – an expert decision-maker
- Capable of managing the full range of presentations in their area of practice
- Supported with development opportunities (leadership, management, teaching, research)
- Expected to have a minimum of 1 core SPA (with Colleges recommending 1.5)
- Progressing through pay thresholds by evidencing extended roles
Why should we advocate for the creation of specialist posts?
The specialist grade was introduced in 2021 as the new senior SAS role. Its aims are clear:
- Attract, recruit, and motivate senior doctors
- Retain talent within the NHS
- Promote SAS career pathways
- Improve service delivery and tackle waiting lists
- Enhance the senior medical workforce without requiring consultant-level recruitment for every senior role
NHS England’s national guidance encourages internal advertising in the first instance, allowing local specialty doctors to progress their careers without leaving the organisation. The role offers a way to formally recognise, reward and enable senior specialty doctors who are already delivering at an advanced level to progress in their career without requiring consultant registration.
Why now? The case for O&G
Local service needs should drive specialist post creation. Key triggers include:
- Vacant or partially vacant Associate Specialist posts
- Hard-to-fill consultant or specialty doctor vacancies
- New service developments
- Organisational change or restructuring
- Tackling long waiting lists
- Tackling reduction in locum spend
- Moving towards a more stable workforce who can deliver long-term service improvement
- Recognising specialty doctors already “over-delivering”
After recently appointing a specialist grade doctor, an O&G Clinical Director in England shared with me:
I hope to have this as a significant contribution to our unit, especially for fetal medicine, high risk obstetrics and teaching. The intention was not to save money. It was to acknowledge the individual’s skills for the post needed and also to support services.
Next steps for doctors, managers and workforce planners.
- Review local service needs, workforce gaps, and current workforce composition.
- Consider whether incorporating Specialists into your workforce will stabilise your workforce, reduce reliance on short term temporary staff and boost service delivery by senior medical staff
- Discuss with HR and Medical workforce colleagues re advertising internally first
- Engage SAS tutors in England and Wales ( SAS Leads in N.I., SAS Educational Advisers in Scotland) & SAS Advocates
- Use RCOG resources to design the role and job plan
- Submit job plan for RCOG approval
Specialist eligibility:
- Minimum: 12 years post-graduation (10 in Scotland)
- Minimum: 6 years in the relevant specialty
- Must meet the Generic Capabilities Framework
- Must work autonomously to defined competencies within local governance frameworks
- Evidence clinical skills via work-based assessments, logbooks, audits, reflections, appraisals, CPD records, qualifications, and colleague references
- College exams and specialist registration are not essential – otherwise the role should be a consultant post