According to the GMC’s The state of medical education and practice in the UK: workforce report 2022, published today, the number of doctors in those roles is growing at six times the rate of GPs. By 2030 they could be the largest group in the medical workforce.

But existing rules, such as the Performers List* – which details practitioners approved to work in primary care – restrict the roles those doctors, known as specialty and associate specialist (SAS) and locally employed (LE) doctors, can fulfil.


GMC Chief Executive Charlie Massey said many wanted better and more flexible career opportunities:

‘Lots of these doctors tell us they want better career development and progression, and to have more flexibility in the positions open to them. But there are barriers that hinder their development, and rules that prevent them fulfilling some important roles.

‘They are a fantastic resource of experienced and skilled doctors. If, for example, they could use those skills to complement the existing GP workforce it would begin to address some of the difficulties patients have accessing primary care, without lowering standards.’

Between 2017 and 2021 the number of licensed doctors in SAS and LE roles rose by around 40%, from 45,578 to 63,740. In the same period the number of GPs rose by just 7%, from 60,690 to 65,160.

Charlie Massey continued:

‘These are skilled doctors who do hands on work but are not in training to become a consultant or a GP. Many have made a positive choice to work in non-training and non-specialist roles in secondary care, where they do hugely valuable work.

‘But we know there are significant numbers who want wider opportunities. Systems must adapt to make the most of their talents. We need fresh thinking about how these doctors are deployed, and how they can be best used to benefit patients.’

‘The UK’s health services are yet to properly understand how to make the most of these talented and able doctors. At a time when patients face unprecedented waits for care, now is the time to discard dated ideas and to tap into the skills and experience these doctors provide.’

 Report Conclusions

  • Growth in the UK medical workforce has been increasingly driven by international medical graduate (IMG) joiners, who outnumbered UK graduate joiners in 2021. It is encouraging to see that the UK is an attractive destination for IMG doctors, but our future medical workforce will become vulnerable if the high rates of IMGs joining does not continue.
  • There is a significant shift in the overall make-up of the UK medical workforce, with the specialty and associate specialist (SAS) and locally employed (LE) doctor group expanding the most. If the current trends hold until 2030, the SAS and LE doctor group will be the largest register group in the workforce. However, our data show this group are more likely to leave practice after a shorter period than other doctors, so it is vital that issues they have raised, around career progression and how they are deployed and supported, are addressed.
  • The GP workforce has had the slowest growth of all register types over the last five years. This has coincided with a reduction in the proportion that work full time and large proportions reporting feeling unable to cope with current workloads, showing the current state of fragility in this part of the workforce. Although the number of doctors in GP training is increasing (especially for IMGs), expanding those able to work in the service should be part of the solution. To do this, changes to the Performers List and the potential creation of a SAS grade in primary care should be considered, as well as the expansion of primary care career options for physician associates.
  • It is encouraging to see the workforce becoming more international, and increasingly ethnically diverse and gender equal. As the demographics and backgrounds of the workforce change it will become even more important to ensure all doctors work in supportive environments where diversity is embraced and inequalities are addressed. Tackling the barriers to career progression and more general exclusion that doctors can face will aid retention but will also mean the UK’s healthcare systems will get more from these doctors as they build skills and experience.
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