SAS Advocates

Why the SAS Advocate role was created

The SAS Advocate role emerged from the 2021 SAS contract reform discussions, in response to evidence and continuing concern about SAS doctors' health, wellbeing, bullying and harassment. Joint BMA and NHS Employers guidance describes it as a strategic role with both proactive and reactive elements. It is normally an additional responsibility for an existing employee and requires adequate time and organisational access.

The role is intended to improve the experience and visibility of SAS doctors, help individuals navigate support and bring recurring themes to senior attention. It is not a statutory office and local implementation varies. Doctors should therefore check who holds the role, which staff groups it covers, how much time is allocated and what local agreement governs it.

• Visible access for SAS doctors.
• Individual help and informed signposting.
• Organisational learning from recurring wellbeing and dignity themes.

What an advocate can do

An advocate can listen, help a doctor organise the issue, explain available internal routes and signpost to the appropriate service. Depending on local arrangements, they may liaise with SAS Tutors, medical leadership, the local negotiating committee, occupational health, wellbeing leads, equality teams and speaking-up roles. They may help ensure that a doctor is not left trying to navigate an unfamiliar system alone.

At organisational level, an advocate can map the SAS workforce, examine whether wellbeing and career conversations occur, establish forums, raise aggregate themes, encourage consistent access to support and help leaders understand how policies operate in practice. Effective advocacy connects an individual experience to proportionate system learning without turning a confidential conversation into a report about the person.

What an advocate is not

The advocate is not the doctor's therapist, treating clinician, trade-union representative, lawyer, defence-organisation adviser, investigator or decision-maker. They do not determine whether bullying or discrimination has legally occurred and should not promise a particular outcome. They should not draft formal allegations beyond their competence or take control away from the doctor.

The role is distinct from the SAS Tutor, whose principal focus is education and development, although the two should cooperate. It also does not replace HR, occupational health, Freedom to Speak Up, dignity-at-work processes or emergency services. Good advocacy means making these boundaries clear and helping the doctor reach the right expertise.

The first contact

A doctor may approach an advocate because they feel distressed, excluded, unsure of process or frightened of repercussions. The first conversation should establish what the doctor wants, whether anyone is at immediate risk, whether a deadline or formal process exists and what help the advocate can safely provide. The advocate should explain their role before inviting a detailed account.

Useful questions include: What has happened? What is the immediate concern? What outcome would help? Who else is already involved? Is there a patient-safety, health, employment, equality or regulatory dimension? Does the doctor want listening, navigation, a supported contact or help preparing for another conversation? The answer may require several coordinated routes.

Confidentiality, consent and limits

The advocate should explain what notes are kept, where they are stored, who can access them, what will be reported in aggregate and which circumstances may require further action. Confidentiality is essential but should not be described as absolute. Immediate danger, safeguarding, serious patient risk, legal obligations or organisational duties may make limited escalation necessary.

Obtain consent before identifiable sharing wherever possible, disclose only what is necessary for the agreed purpose and tell the doctor what was shared. If the advocate also holds a managerial, educational, appraisal or investigative role, they should explain the conflict and consider transfer to another advocate or support route. Trust cannot depend on ambiguous dual roles.

Support and signposting

Signposting should be active rather than a list of telephone numbers. The advocate can help the doctor decide which contact fits the need, prepare questions, understand likely confidentiality and arrange a follow-up. Health concerns may require a GP, occupational health or specialist service; an employment process may require union representation; a clinical complaint may require a defence organisation; discrimination may require specialist equality advice.

Where immediate safety is involved, the advocate should not attempt to hold the risk alone. They should use urgent services and local procedures. Where no emergency exists, the doctor remains the decision-maker and should be supported to choose proportionate next steps.

Working with organisational roles

An advocate needs credible routes to medical leadership and the trust or health-board structure, while retaining enough independence to challenge. Regular links with the LNC, SAS Tutor, occupational health, wellbeing services, equality leads, speaking-up contacts, HR and staff networks reduce duplication. Each relationship should have a defined purpose and must not allow informal exchange of identifiable case information.

A doctor should be told when the advocate is acting as an individual supporter, when they are raising an anonymised theme and when another formal role has taken responsibility. The advocate can help coordinate interfaces but should not become the hidden case manager for every SAS issue.

From individual experience to system learning

Repeated concerns about workload, job planning, exclusion, development, behaviour or access to support can indicate an organisational problem. Advocates can collate themes, examine relevant workforce data and recommend action. Reports should use sufficiently aggregated information and suppress small numbers where grade, specialty, location or timing could identify a person.

Impact should be measured through access, response time, resolved barriers, policy changes, improved induction, fairer opportunities and feedback from SAS doctors - not through the number of confidential stories presented to a board. The advocate should agree an annual plan, resources, reporting method and succession arrangements with the organisation.