1 Career progression and your intended destination

Begin with the work you want to do

Career progression can be difficult to discuss because people use the phrase to mean different things. One doctor means a more senior clinical role. Another means formal recognition of responsibility already carried. A third wants access to teaching, leadership or a new area of practice. A manager may hear a request for a vacancy when the doctor is asking for a development conversation.

Before deciding what evidence to collect, write down what you want to change. Try to describe the work and the responsibility, as well as the title. “I want to become a Specialist” identifies a destination. “I want a role in which I lead this defined clinical service, contribute to its development and have those responsibilities recognised” begins to explain why that destination matters.

Your starting statement can include uncertainty. Describe existing work accurately and record questions about the intended role or process.

The principal purpose of this handbook is progression from Specialty Doctor to Specialist SAS. It also recognises that development has value within an existing role. You may decide that your current priority is a better job plan, an educational role or a more sustainable clinical scope. That does not make your career unsuccessful. The important point is that the choice is informed and not simply the result of never being offered a meaningful conversation.

Several decisions sit behind one ambition

There are at least three people involved in many progression discussions: the doctor who knows their experience, a colleague who can comment on their practice and a person who can authorise resources or make a workforce decision. They may be different people. A supportive consultant cannot necessarily create a post. A manager may control time but need clinical advice about scope. An appraiser may help you clarify a development objective without holding authority to approve a grade change.

Separating those decisions prevents frustration. If the immediate need is an opportunity to lead a particular activity with support, ask for that opportunity and its review arrangements. If the need is an assessment under a regrading policy, establish that process. If the destination is an advertised post, obtain its criteria. A vague ambition can become a sequence of concrete questions without becoming a rigid ladder.

Do not confuse eligibility with the whole decision. Meeting an experience condition does not, by itself, explain how you practise. A convincing clinical portfolio does not, by itself, establish which employment process applies. A service need does not remove the need to assess capability. These questions interact, but each deserves an answer in its own terms.

Different starting positions

A doctor preparing to lead an unfamiliar clinical activity needs a defined opportunity, appropriate support and a way to review the work. Previous experience may already cover much of the proposed scope. Preparation should focus on the decisions or circumstances that are genuinely new.

A doctor already leading an established activity may face a different problem: the job description is generic and the portfolio gives little account of the decisions made. The first task is to describe those responsibilities, identify corroborating evidence and clarify the route through which recognition can be considered. Further learning should address an identified need.

Neither doctor's position can be inferred from grade alone. Each needs a response based on their practice and evidence.

The duration of preparation depends on the starting position, intended role, available evidence and access to development. Agree review points against specific objectives. Neither elapsed time nor completion of a fixed sequence of courses and placements establishes readiness for a Specialist post.

A useful first conversation

You do not need a finished portfolio before asking for a career discussion. Bring a short account of your present role, what you would like to explore and the questions on which you need help. A page is often more useful than an unstructured folder of documents.

For example: “I would like to review whether my present work and evidence are consistent with preparation for a Specialist role. I have described the activities I currently lead. I would value your view on the scope, any areas needing development and the process that would apply here.” This identifies the evidence and the decision on which advice is needed.

If your aim is different, make that clear: “I have not yet had the opportunity to lead this activity. I would like to agree a supported opportunity, with feedback, so that we can assess what I can already do and what I need to develop.” A manager can then consider the actual opportunity and resources rather than respond only to a distant grade aspiration.

The meeting should establish who can answer each question. It is reasonable for some answers to require follow-up. It is less useful to leave with “keep doing what you are doing” when no one has explained what that work is meant to demonstrate or when it will be reviewed.

Choosing a destination without losing your present role

Career planning takes place alongside service delivery and personal commitments. You may be working less than full time, supporting family, returning after an absence or protecting your own health. These circumstances affect how opportunities can be arranged; they should not be treated as evidence of low ambition.

A feasible plan describes what can happen within your actual working pattern. An ambitious but impossible schedule produces delay and self-blame. If a proposed opportunity routinely occurs on a day you do not work, the problem is access. The appropriate conversation concerns an alternative arrangement, rather than a judgement about your motivation.

Exploring the role does not commit you to an application. Understanding it can help you decide whether and when to proceed.

Start with a short account of where you are

Set aside one working session to bring together your current job description, job plan, CV and most recent development objectives. Read them beside one another. Ask whether someone who knows none of your colleagues could understand your principal responsibilities from these documents. The exercise often reveals an important difference between the work and its description before any new evidence is collected.

Write a short starting statement in four sentences. Describe your present clinical work. Identify one responsibility you want recognised or developed. Explain why that matters to your intended career. Name the decision or advice you need next. This is a working account, so it can change after discussion.

For recognition of established practice, a starting statement could read: “I lead the scheduled medical review in our inpatient service and coordinate the resulting medical actions with the team. My job plan lists ward duties but does not describe the decisions I lead. I want to explore recognition through a Specialist SAS role. I need a review of the scope, the available evidence and the process that applies to my employment.”

For development of a new activity, the request could instead read: “I want to develop the capability to lead this particular review activity. I need to agree the opportunity, clinical support and a review of my decisions before taking on the proposed responsibility.” Each statement identifies a decision that can be discussed before a formal application is prepared.

Keep the first task small enough to finish. Finding twenty certificates may feel productive, but it will not resolve an unclear destination. A factual starting statement gives the first meeting a purpose and provides a point against which to judge whether later activity is helping.

Decide what a worthwhile outcome would look like

A useful career discussion can produce several outcomes before appointment becomes possible. You might obtain an agreed scope description, a supported opportunity, a clear answer about the route, or specific feedback that changes your plan. These outcomes matter because they reduce uncertainty and create something on which the next decision can rest.

Choose an outcome you can recognise. “I want to feel more supported” is understandable, but difficult to review. “I want to know who will review my clinical evidence and when the job-plan request will be decided” gives both you and the service something concrete to work towards. Keep the wider ambition visible while making the next decision manageable.

What the service needs to arrange

The service should identify an appropriate person for the discussion and distinguish educational advice from formal decision authority. A useful response recognises the doctor's starting position, asks what evidence is available and makes clear which opportunities or processes can be explored. Encouragement is valuable when it leads to something actionable.

Where no immediate post exists, say so clearly and discuss what development would still be worthwhile. Do not let the absence of a vacancy become an excuse never to discuss career development, or let a development plan imply that a vacancy has been promised. Where a regrading policy applies, the service should consider that route on its own terms.