SAS Doctors working in primary care

The RCGP has been carrying out some scoping work into the potential role of doctors who are not GPs working in general practice. This comes following the publication of the GMC report which recommended SAS Doctors to work in general practice. 

We have been having discussions internally and engaging with NHS England and other stakeholders. In February 2023, we sent a letter to NHS England expressing some questions and concerns we had regarding the role, as well as setting out some redlines which we believe must be in place if this role were to be introduced. Following this, in April 2023, we wrote a public letter to NHS England (PDF file, 160 KB) to further reiterate the unanswered questions and concerns we have.

The College has identified some principles for this role, which have been agreed by our Council:

• The GP role, as the expert medical generalist, should remain protected, with this role having its own separate, limited scope of practice.
• Efforts to expand the GP workforce should not be undermined as a result of the introduction of the role.
• This role should contribute to maintaining and improving the standards of patient care.
• This role should be fully integrated within the primary care team.
• This role should be seen as a career in its own right, with opportunities for progression. 

Furthermore, the redlines that we have set out for this role are that:

• These doctors must be supervised by a qualified GP and must be given a thorough induction to general practice.
• These doctors cannot be seen as an alternative to addressing the urgent shortage of GPs and we cannot support counting them as contributing towards the Conservative Manifesto target of 6000 more doctors in general practice. There must be a clear distinction between this role and the role of the GP.

The first letter we sent set out some of the questions we had around: 

• funding for this role
• current capacity issues in general practice estates
• concerns over the capacity of supervisors and educators to take on additional workload
• the changes that need to be made to legislation
• entry requirements and induction support needed for this role.

NHS England responded to our letter in April to reassure us that they are not proposing pilots at this time and that the introduction of SAS doctors in primary care are not intended to fill gaps in GP recruitment. They are working on putting a framework in place to allow doctors with secondary care expertise to work closer to the community and to become part of the multidisciplinary team in general practice. However, many of the above questions remain unanswered and NHS England recognise that there are still issues to be resolved. There are also questions around the extent to which these doctors would be working in specialist or generalist capacities.

The College is not currently in a position to support the introduction of this role until we have greater clarity. We will continue to engage with NHS England and carry out additional scoping work over the coming months to explore some of the outstanding questions, including the difference between a specialist and generalist role.