During #SASweek26, we are showcasing a unit that is supporting SAS and Locally Employed doctors to achieve their full potential and thrive in their roles. Read our guest blog from College Tutors, Diane Nzelu and Neera Balachandran, who share how UCLH has secured educational supervision for early career SAS and LEDs, ensuring all doctors feel valued and supported.
Identifying the need
At University College London Hospitals NHS Foundation Trust (UCLH), approximately half of the doctors staffing our labour ward, clinics and theatres are Locally Employed doctors (LEDs) or Specialty, Associate Specialist and Specialist (SAS) doctors. Like many units, we could not run a safe service without them. Their value has long been recognised here at UCLH which has provided educational supervision for LEDs and SAS doctors for many years.
Yet provision of educational supervision and ensuring equity in quality and recognition are different things.
SAS and LEDs are a diverse group with a wide variety of experience, each doctor will require different support from an educational supervisor.
In our department, as in most, allocation of programmed activities (PAs) for educational supervision is ring-fenced for the number of trainees, with no additional funding provided for LED and SAS doctors. So, in other words, Consultants supervising an LED were doing so in addition to their recognised workload, out of goodwill.
Although this is admirable, work that is not formally recognised, goes uncounted and is unfunded. This is not sustainable. It depends entirely on the generosity of whoever the supervisor is, rather than being embedded within the structure and resources of the department.
In addition to funding, there was a second gap. The requirement for supervisors to have trust mandated accreditation was only necessary for the supervision of trainees. In practice, this meant that an LED or SAS doctor could be allocated a supervisor who had never been trained or assessed for the role. Equity of access without equity of quality is only half the job.
Delivering the change
First, was the question of funding. There was no new money. What we changed is how the work sits on top of the funding that was provided through the deanery. Every LED and SAS doctor is now allocated to a supervisor who already holds funded supervisory time, and nobody carries more than one or two. The unfunded element is spread thinly and evenly, rather than falling on a few willing people.
Where a supervisor ended up with three doctors, we found them a further session between us. We put every doctor onto a single allocation grid – so there was transparency in each supervisor’s whole educational caseload.
Second, we made accreditation universal — every supervisor completes it, whoever they supervise. No exceptions.
Importantly, this was a concerted effort. Our divisional management and clinical leadership teams drove it alongside the SAS and LE doctors themselves — colleagues who had benefited from supervision at UCLH in completing the Portfolio Pathway but had also experienced its inconsistency first-hand.
Impact and next steps
LED and early career SAS doctors who work at UCLH are now supervised by consultants whose time is recognised and who are accredited to the same standard as supervisors of deanery doctors. This reflects the value placed on SAS and LEDs at UCLH and ensures that all doctors are supported to develop.
The next stage, led by Amos Tetteh who navigated the GMC Portfolio Pathway himself, is building a structured educational programme designed to support doctors at UCLH considering or already undertaking the Portfolio Pathway. The aims of this programme are to map clinical experience to the curriculum and provide guidance on writing structured reflections and work-based assessments with an local annual review of progress - mirroring the RCOG matrix of progression and Annual Review of Competence Progression (ARCP) process.
Implementing this programme in a sustainable way requires protected time in job plans and appropriate funding: the same argument we made about educational supervision. We are working through this now and hope to be able to provide an update on our progress.
Advice for others
Put everyone on one list first. Once supervisors see their total workload against what they are credited for, the case makes itself. The inequity becomes impossible to ignore, and even harder to defend!
You may not be able to find the additional funding — we couldn’t. But you can spread the workload, so that every LED is allocated a supervisor who already holds funded time, and nobody supervises too many.
Make trust accreditation universal from the outset to ensure quality control of the supervision provided.
Finally, champion educational supervision with the support of your divisional management and clinical leaderships teams together with the LED and SAS doctors themselves.
Find out more:
- Access resources and guidance for SAS and LE doctors in O&G.
- Visit the RCOG Educational Supervisors’ Toolkit, which includes a module on supporting doctors outside of a formal training programme.
- SAS in senior positions should have the opportunity to be Educational Supervisors themselves. Visit SAS as educators for further information.
- Explore additional RCOG SAS Week content.
About the authors
- Diane Nzelu, Consultant in Maternal Fetal Medicine, Lead Obstetrician for NCL Maternal Medicine Network and College Tutor in Obstetrics and Gynaecology, University College London Hospitals NHS Foundation Trust. College Tutor for since December 2026
- Neerujah Balachandren, Consultant Gynaecologist and Subspecialist in Reproductive Medicine and Surgery, University College London Hospitals NHS Foundation Trust. College Tutor for since December 2026
- Amos Tetteh, Specialist in Obstetrics and Fetal Medicine, University College London Hospitals NHS Foundation Trust. Lead Doctor for Maternal Fetal Assessment Unit and Lead for Non-Cephalic Presentation.