Introduction Locally Employed (LE), Speciality, or Specialist (SAS) doctors comprise a significant, diverse and growing proportion of the NHS medical workforce. Many have significant clinical experience yet may be treated differently to speciality trainees as their positions are often created to meet workforce gaps. Likewise, despite sufficient clinical experience, transition onto SAS contracts is not guaranteed. SAS doctors may also struggle to attain leadership roles, adversely affecting wellbeing and retention and resulting in the loss of experienced frontline clinicians or failing to develop tomorrow’s leaders. LE and SAS doctors are reportedly the fastest growing cohort within the NHS medical workforce. Accordingly, we are creating initiatives to support and promote leadership amongst these diverse doctors who choose not to follow classical training pathways. We seek their views and to discover how they can be supported.

Aims and objectives of the research project or activity Two Postgraduate Medical Education fellows working at one site of a central London NHS foundation trust, with past experience working as LE and SAS doctors, aimed to understand more about these doctors’ working lives and aspirations to improve wellbeing and develop sustainable leadership. There is a drive within the trust to help LE doctors move onto SAS contracts; we are involved in making the business case to facilitate this transition. This is the first step towards devising our strategy for change. We will disseminate our findings to all SAS/LE doctors, HR, and the trust executive team to help develop strategies for improving LE/SAS doctor wellbeing, supporting training and development needs including CESR applications, creating contracts correctly reflecting their clinical experience, and encouraging SAS doctors to gain experience of leadership roles. Although this project does not directly involve patients or carers, improving staff morale, wellbeing, recruitment and retention enhances patient care.

Method or approach A 32-question survey devised using SurveyMonkey was sent to all SAS (roughly 50) and LE (roughly 350) doctors believed to be employed at the trust. Regular email reminders and posters with embedded QR codes advertised the survey. Information on specialty, years of experience, working conditions, job satisfaction, wellbeing, career aspirations, opportunities for training and development was collected. The survey went live on 9th October and closed on 24th November. Several LE and SAS doctors also agreed to meet us to provide broader feedback about their experiences of the aforementioned issues.

Findings 184 doctors across multiple departments completed at least part of the survey; (112) 61% of these answered all questions.

12% (8/67), 56% (10/18) and 90% (9/10) who had worked 1–4 years, 5–9 years and 10–14 years respectively were on SAS contracts.

None working 5–9 (n=18), 10–14 (n=10) or 15–20 (n=5) years were taking steps to leave the trust within the next year, whereas 16/49 (32.7%) working <1 year and 13/67 (19.4%) working 1–4 years had such plans.

24/74 (32%) were collating evidence for CESR; 1/74 (1.3%) had submitted evidence. On a score 0 – 100, 72 respondents averaged 33 when asked how supported they felt collating CESR evidence.

88/117 respondents (75%) had a job plan/PDP; 96/120 (80%) had an educational supervisor.

Happiness and feeling valued scores were equal (mean 62 of 0–100).

Scores (0–100) per cohort (happiness): <1 year (60); 1–4 years (64); 5–9 years (54); 10–14 years (71); 20+ years (20).

Scores (0–100) per cohort (feeling valued): <1 year (64); 1–4 years (63); 5–9 years (52); 10- 14 years (71); 20+ years (21).

Key messages Only around half of those working between 5–9 years were on SAS contracts. Morale and employment duration appear linked – those in post 10+ years (the vast majority of whom are on SAS contracts) have higher ‘feeling happy and valued’ scores. Where leadership and experience is recognised, morale and willingness to remain in the trust is higher. Free text and focus group comments included a desire for greater access to career development opportunities and being on contracts accurately reflecting clinical experience and responsibility. We met the trust’s HR representatives to discuss how LE doctors with sufficient clinical experience could move onto more appropriate SAS contracts, whether experienced SAS doctors could supervise junior colleagues, and are joining the trust’s LE doctors’ contract review steering group. Valuing LE/SAS doctors and investing in their development will improve contentment and retention. This is essential to supporting medical workforce numbers, optimising patient care, and fostering tomorrow’s leaders.