Intended for healthcare professionals

  1. Vaishali Parulekar, associate specialist in radiology1,
  2. Vinita Shekar, specialty doctor in oral and maxillofacial surgery2
  1. 1Oxford University Hospitals, NHS Foundation Trust
  2. 2Ninewells Hospital, Dundee, Scotland

We must recognise that the SAS workforce will be one of the strongest pillars of the future NHS, write Vaishali Parulekar and Vinita Shekar

We welcome the long awaited Medical Workforce Race Equality Standard (MWRES) First Five report.1 Race inequality and discrimination within the NHS have been acknowledged in many national surveys and reports. As stated in the MWRES report, time has come for commitment and action from all stakeholders in senior management positions within the NHS to influence change in the workplace. The communication and collaboration between senior NHS Leaders and SAS leaders within the Academy of Medical Royal Colleges (AoMRC) will play a crucial role in future planning and implementation of any proposed changes.

The MWRES report is concise and collaborative, with five main relevant and topical domains. As our roles are an integral part of the Specialty and specialist (SAS) community—and we both come from International Medical Graduate (IMG) backgrounds—domains 4 and 5 are especially close to our hearts.

Historically, IMGs have dominated the size of SAS workforce and have grown by 40% in the past five years. The General Medical Council (GMC) estimates the SAS will be the largest cohort of doctors in the NHS by 2030 compared to consultants and GPs.2 They offer high standards of patient care, valuable experience, expertise, and stability. Yet they remain among the most overworked and undervalued members of the workforce in the NHS and continue to experience insurmountable challenges and burnout. A large proportion of SAS doctors face challenges of bullying, undermining, and a lack of pastoral support. We also know from a GMC survey that 22% SAS doctors feel they are not supported with personal and professional development opportunities to advance their careers.3 Over a third of SAS doctors feel that they are treated unfairly. Well over a quarter of all SAS doctors have experienced bullying. This cannot go on any longer. As one of the largest growing workforces in the NHS, we must recognise that the SAS workforce will be one of the strongest pillars of the future NHS.

The MWRES report is a first positive step towards that. It acknowledges the strength and value of the workforce and supports their development and progression towards leadership roles. Validation from NHS England and the MWRES team is valuable, and this partnership will be a key factor for us to work at ground level and make a difference.

We have SAS leaders in national positions, but it does not necessarily translate to local level leadership. The Academy of Medical Royal Colleges SAS committee has done valuable work on the SAS workforce in the past three years with relevant publications, which include several recommendations at all levels. It is now of utmost importance to start national networks and collaborations towards implementing these. We begin with small steps, relevant conversations, and engagement with not just SAS groups, but also leaders in the NHS and regulators. We need to identify best practices and role models and learn from them to tackle challenges and gaps, and monitor progress and outcomes.

An engaged and empowered SAS workforce will improve patient safety and care, provide vital capacity in the current workforce crisis, and will be pivotal to the future shaping of the NHS.


  • Competing interests: Vaishali Parulekar is associate specialist in Radiology, Oxford University Hospitals, NHS Foundation Trust; Co-Chair Academy of Medical Royal Colleges SAS Committee; and SAS Lead, The Royal College of Radiologists (Clinical Radiology). Vinita Shekar is specialty doctor in Oral and Maxillofacial surgery, Ninewells Hospital, Dundee, Scotland; Co-Chair Academy of Medical Royal Colleges SAS Committee; SAS Lead, The Royal College of Surgeons of England. No further competing interests declared.

  • Provenance and peer review: not commissioned, not peer reviewed.