The Lay view of the SAS role 


I have served for six years on the Lay Committee of the Royal College of Anaesthetists. During that time, I have been the Lay representative on Review Teams visiting over two dozen hospitals on accreditation and invited reviews. I have a number of reviews to complete as and when circumstances permit.

I have discussed with SAS and Trust Grade Doctors their roles and working relationships. On the basis of evidence gathered during such visits, I would comment as follows, although these views are my own and not those of the Royal College nor the Trusts involved.


Generally speaking, in the better managed hospitals, SAS anaesthetic doctors are content with their job plans; levels of responsibility; appraisals; and engagement with their colleagues. In locations where there are staffing issues; less team ethos; and weaker leadership, SAS doctors seem to fare less well, compared to trainees and consultants.

In all cases, SAS doctors have been seen to be committed and hard working. The main issue is whether they are fulfilling their own potential; and whether local management structures allow development. Much is made of the emerging role of Physician Associates, Anaesthesia Associates etc in reducing the burden on other clinicians, but it appears that less time is devoted to encouraging SAS doctors to take on more higher grade clinical, supervisory and management roles.

Communication skills are vital in all aspects of patient treatment and safety. Lay people have been strong advocates of improved communication between clinicians and with patients. This issue affects all hospital staff and is not peculiar to SAS doctors. Again, very generally, the better the leadership, the higher the quality of communication at all levels.

Bullying and undermining have been reported as issues facing SAS doctors, although I have never personally witnessed this. It is hoped that the massive contribution (and sacrifices) made by SAS doctors (see below) during the pandemic will have reduced bias and prejudice. We hope also that the achievements of SAS doctors during the pandemic will have eliminated the attitude by some patients and families who used to think that effective advice, treatment and care could only have come from a consultant to the exclusion of any other clinician.

Optimism for the Future

The report by Dr Lucy Williams on Leadership Development for SAS doctors makes positive suggestions for more engagement in their Trusts’ work; and to promote the SAS role more effectively. In particular, greater involvement in job planning; more effective appraisals which identify training needs and opportunities; and encouragement from Directors to involve SAS doctors in management and external work are recommended. All of these suggestions would raise the profile of SAS work and ultimately make for improved patient care and safety.

As clinical standards are reviewed throughout all specialties, the recommendations check list in the report should be considered to see how these positive ideas can be brought into everyday practice.


No opportunity should be allowed to pass without reference to the contribution made by SAS doctors during the pandemic. The Lay view strongly supports the gratitude expressed to SAS doctors, for instance, by the President of RCoA who has written to SAS doctors, including a reference to the particular personal vulnerabilities of many such clinicians. RCPsych have also written to SAS colleagues.  RCP London has awarded its first posthumous Fellowship in its 500 year plus history to a SAS physician. I hope that more medical Royal Colleges will grant further Fellowships for SAS doctors in recognition of their work.

The pandemic has demonstrated the great importance of SAS doctors. This raised profile provides a good opportunity, when circumstances permit, to push forward on the recommendations for the benefit of these doctors, the NHS and patients.


Bob Evans

Lay Member, Academy SAS Committee