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In September 2018, the Secretary of State committed to working with the BMA SAS Committee to reform the SAS contract and agreed to reopen a reformed Associate Specialist (AS) grade to extend career development for those doctors.

The preparatory work on these reforms identified a strong feeling that the newly reformed grade must be aligned with a strategy for reform to the whole SAS grade; the aim being to improve morale, provide support for career development and define a structured career pathway.

The landmark NHS Workforce Race Equality Standard: 2021 data analysis report for NHS trusts was published in March 2022 and is available for download by clicking here.

The links below should help you navigate through the newly-introduced processes which underpin these reforms.

The portfolio pathway (May 2024)

In the United Kingdom, the pursuit of a surgical career traditionally follows a conventional pathway, primarily through the completion of specialty programmes accredited by the Royal College of Surgeons or the Intercollegiate Surgical Curriculum Programme (ISCP).

However, for doctors with overseas training or those who have followed unconventional routes into the field, the Certificate of Eligibility for Specialist Registration (CESR) route offers an alternative means to attain the General Medical Council specialist registration and practice as a substantive consultant in the UK. It has an evidence-based application route that is meticulously assessed against the standards of the UK Certificate of Completion of Training (CCT) curriculum.

Last year, the CESR route underwent significant changes, reflecting broader shifts in medical education and regulatory frameworks. This led to the development of the portfolio pathway which was announced at the end of 2023. This article dives into the details of the new portfolio pathway and the evidence required to apply for GMC specialist registration through this route.

Click here to read the article by Adham Ahmed & Mehwash Nadeem in Urology News.


Information about embarking on CESR & professional development (updated Feb 2022)

The SAS Charter ** - In collaboration with NHS Employers, HEE and the AoMRC, the BMA published the SAS charter for England in 2014 ... download

** For further information about the SAS Charter, click on the dropdown tab ("The SAS Charter") below

The SAS Doctor Development Guide - The BMA, HEE, AoMRC and NHS Employers published the New SAS Doctor Development Guide England in February 2017. This was then superseded by the SAS doctor development guide in September 2020 to help SAS doctors remain fit to practice and develop in their careers ... download

Maximising the Potential: Essential measures to support SAS doctors - Published in February 2019 by Health Education England and NHS Improvement ... download

Terms and Conditions of Service - As published in Specialty Doctor (England) April 2008 ... download

Terms and Conditions of Service- SAS contract reform published in 2021 ... download the specialty doctors' version or download the specialists' version

Job Planning for SAS Doctors ... download

Further guidance

Doctors seeking employment, top-up training, educational or observational opportunities should consider secondment, sabbaticals, career breaks, SPA, study/annual leave or unpaid leave.  You are advised to seek out Honorary or Fixed-term contracts because this activity has to be official.

In addition, you should seek guidance from one or more of the following: your nominated mentor, SAS Tutor, Clinical Lead/Clinical Director, Director of Medical Education, Local Medical Committee Chair, Medical Director, Chief Executive, Regional Postgraduate Dean, the British Medical Associatin (BMA), your Royal College, the General Medical Council and professional colleagues.


CESR Rotations Within Integrated Care Systems (ICS) – November 2023:

This statement has been developed through discussions between GIRFT (Getting It Right First Time) Urology, the SAC (Specialist Advisory Committee) in Urology and the SAS@BAUS Group.  It is being published on the BAUS and JCST (Joint Committee on Surgical Training) websites. 

For further information – please contact Mr Khaled Hosny (Consultant Urological Surgeon).

Units in relevant ICS groups are encouraged to support their senior SAS (Specialty & Associate Specialist Doctors)/LED (Locally Employed Doctors) /NCHD (Non-Consultant Hospital Doctors) and locum consultants to attain CESR requirements by working in three different units by facilitating a 4–6-month honorary contract.  The SAC/JCST are looking for externality rather than fixed time; they are looking at assessments from different consultants in each one of the three units.  Therefore, 1-2 days per week should be accepted provided that candidates submit 15-20 WBAs (Work Based Assessments) from each unit within their CESR application.

The bare minimum for the six index procedures 9 WBAs each are needed (total 54), 4 WBAs for special interest and, for the 14 critical conditions, at least one WBA each required (total 14).  Therefore, a bare minimum of 72 WBAs are needed from three different units. The WBAs are to be considered hand in hand with other data such as MCR (Multiple Consultant Report), CIPs (Capability in Practice), logbooks etc. i.e. all other requirement for the standard application to be completed as requested.  Candidates are advised to refer to the curriculum guidelines for more information.

We would ask employers / ICS to facilitate an honorary contract with full access to clinics and theatres in order to allow candidates to fulfil the requirements in terms of exposure to clinical activities that would allow them to fill in WBAs and attain competencies as per the standard urology curriculum. Those placements should be complementary to each other and help cover the breadth of the curriculum.

Benefits for ICS:

  1. Retain senior candidates to continue working as consultants.
  2. Short- and long-term solutions for workforce issues across any ICS group.
  3. Provide an attractive environment for the recruitment of middle grades and locum consultants.
  4. Weekly assistance with workload, with an extra candidate working as a supernumerary in the unit.

Benefits for candidates:

  1. CESR.
  2. Reduce travel time.
  3. Reduce financial implications from changing Tier 2 visas to join a different unit on full time basis.
  4. Reduce financial implications from moving across the country, especially for those with young families.
  5. Experience in working in different trusts and different work environment.
  6. Networking and building up regional reputation.

Click here for a pdf version of this statement


The SAS Charter (updated Sep 2020)

The SAS charter was created by the BMA and NHS employers to help SAS doctors with their development, and to provide opportunities in their workplace. In collaboration with NHS Employers, Health Education England and the Academy of Medical Royal Colleges, the BMA published the SAS charter for England in 2014. The BMA has since adapted the SAS charter for all other UK nations. The information provided includes:

  • How to implement the charter (with links specific to individual nations)
  • SAS charter resources  (including checklists & toolkits for England & Wales)
  • Further resources from NHS Employers (linked to the SAS Doctor Development Guide)
  • SAS progression guidance (including thresholds, gathering evidence & mediation/appeals)

Click here to view the SAS Charter information


The SAS Contract (updated Jan 2021)

This guidance covers the terms and conditions of the Staff, Associate Specialists and Specialty Doctors contract 2008, for all nations and gives example of model contracts. It also offers the terms and conditions of contracts pre-2008.

From April 2008, a new "Specialty Doctor" grade was introduced, followed by a contract for Specialty and Associate Specialist (SAS) doctors. The information provided includes the terms and conditions of service for both Associate Specialists and Specialty Doctors in all the home nations.

The information provided includes:

  • Terms & conditions of service specific to individual nations
  • Model contracts specific to individual nation
  • Additional online resources

Click here to view the SAS Contract information


GMC Speciality-Specific Guidance

This guidance is to help doctors who are applying for entry on to the Specialist Register with a CESR in Urology against the 2021 CCT curriculum.

You should also see the information below about the 2021 Urology Curriculum.

Click here to read the GMC guidance


JCST Certified Guidelines & Checklists *

Each of the Specialist Advisory Committees has produced a set of certification guidelines to identify what a trainee will normally be expected to have achieved during their training programme.

These cover all aspects of training - clinical and operative experience; operative competency; research; quality improvement; and management & leadership.

Click here to view the JCST guidelines/checklists

* From August 2021, there will be a new curriculum (see below). Further information is available on the ISCP website.

The 2021 Urology Curriculum (updated 22 Feb 2022)

From 4 August 2021, surgical training will become outcomes-based. Trainees will be assessed against the fundamental capabilities required of Consultants.

The SAC in Urology requires that all evidence submitted for consideration needs to be recent (within the last 6 years) and verified by a Consultant (who will also require verifiication by the GMC). In practice, anyone applying for CESR probably needs to pass the FRCS Urol examination, otherwise it can prove difficult to sign off a full knowledge assessment of knowledge.

The end of training will be reached when supervisors agree that a trainee is performing at the level of a day-one Consultant i.e. successfully managing unselected emergency takes, clinics and wards, operating lists and multi-disciplinary working, while demonstrating the generic professional behaviours required of all doctors.

Click here to download a PDF version of the 2021 Urology Curriculum

The January 2022 edition of the Journal of Clinical Urology 2022; 15(1): 70-76 contains an article about the 2021 Urology Curriculum (authored by Neil Harvey, Georgia Savvides & Philip Cornford, SAC in Urology Chair) ... click the journal reference above to read the article


CESR Guidance (updated Nov 2023)

Applications are now referred to as Certificates of Eligibility for Specialist Registration (CESRs). Previously, the legislation governing equivalence was Article 14 of the PMETB Order, hence these applications were known as Article 14 applications.

PMETB was subsumed by the GMC, and its legislation was formally incorporated into the 1983 Medical Act in 2010.

Click here to download the guidance for CESR applicants (published in 2021)


Frequently Asked Questions (FAQs)

Questions which have arisen, either by direct submission to the SAS Doctors Section or following SAS webinars, podcasts & newsletters, will be posted and answered here.

There are no FAQs at the moment ... but keep checking back.


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