{"id":61227,"date":"2026-03-31T13:37:47","date_gmt":"2026-03-31T12:37:47","guid":{"rendered":"https:\/\/www.promedical.co.uk\/?p=61227"},"modified":"2026-03-31T13:37:47","modified_gmt":"2026-03-31T12:37:47","slug":"the-hidden-workforce-is-no-longer-hidden-locally-employed-and-sas-doctors-are-the-staffing-model","status":"publish","type":"post","link":"https:\/\/www.promedical.co.uk\/healthcare-leadership\/the-hidden-workforce-is-no-longer-hidden-locally-employed-and-sas-doctors-are-the-staffing-model\/","title":{"rendered":"The \u201chidden workforce\u201d is no longer hidden: locally employed and SAS doctors are the staffing model"},"content":{"rendered":"<p>If you listen to workforce debate in the UK, you might think the medical workforce is basically three groups: consultants, GPs, and trainees.<\/p>\n<p>The GMC\u2019s Workforce report 2025 makes it impossible to keep telling that story. In 2024, 87,151 licensed doctors were on neither the GP nor specialist register and not in training.<\/p>\n<p>That is not a rounding error. It\u2019s a major segment of the workforce and it is increasingly central to how services are staffed, how rotas are held, and how patient care is delivered across specialties.<\/p>\n<p>This blog explains what the report shows about this group, why it matters to safety and sustainability, and what leaders should do differently if they want a workforce plan that matches reality.<\/p>\n<p>&nbsp;<\/p>\n<h3>First: who are \u201cdoctors on neither register, not in training\u201d?<\/h3>\n<p>The report describes this as a diverse group, spanning:<\/p>\n<ul>\n<li>early career UK graduates (including those taking time out after F2)<\/li>\n<li>recent international joiners<\/li>\n<li>doctors with many years of experience who work in one specialty area but are not on the specialist register<\/li>\n<li>locally employed (LE) doctors<\/li>\n<li>SAS doctors (specialty and associate specialist)<\/li>\n<li>doctors in roles with consultant contracts (not on the specialist register), in specific circumstances<\/li>\n<\/ul>\n<p>This group is often \u201cin plain sight\u201d in hospitals: they staff wards, night shifts, specialties under pressure, and service delivery that cannot be left to trainees alone.<\/p>\n<p>But they are frequently undercounted in mainstream narratives because they don\u2019t map neatly onto familiar professional categories.<\/p>\n<p>&nbsp;<\/p>\n<h3>The England &amp; Wales lens: job role breakdown reveals scale and insecurity<\/h3>\n<p>The report uses NHS contracts data (limited to England and Wales) to segment doctors in this group more precisely.<\/p>\n<p>In 2024, there were 66,292 doctors on neither register and not in training in England and Wales (within the broader UK-wide 87,151). Among this England\/Wales group:<\/p>\n<ul>\n<li>58% held a locally employed (LE) doctor contract, 38,394 doctors<\/li>\n<li>19% were on a SAS job role, 12,577 doctors<\/li>\n<li>7% held a consultant contract while not being on the specialist register, 4,670 doctors<\/li>\n<li>16% had no NHS contract data, 10,651 doctors<\/li>\n<\/ul>\n<p>Even without overinterpretation, this tells you something critical:<\/p>\n<p>The NHS is being staffed at scale by doctors whose roles are structurally outside training and outside the specialist\/GP register framework.<\/p>\n<p>That is not a temporary phenomenon. It\u2019s a workforce model.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>International doctors are disproportionately represented across these roles<\/strong><\/p>\n<p>The report also shows that in 2024, all of these contract types had more non\u2011UK than UK PMQ doctors.<\/p>\n<p>The most striking figure: among those on consultant contracts but not on the specialist register, 85% were non\u2011UK PMQ. SAS doctors were 81% non\u2011UK PMQ, and LE doctors were 69% non\u2011UK PMQ.<\/p>\n<p>This is not about whether international doctors \u201cshould\u201d be in these roles. It\u2019s about recognising what the data implies:<\/p>\n<ul>\n<li>international doctors are sustaining core service delivery,<\/li>\n<li>often in roles with less security and less structured progression,<\/li>\n<li>and any policy that reduces international inflow or progression will hit the \u201chidden workforce\u201d first.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>The post-foundation reality: the LE workforce is also \u201chome-grown\u201d<\/h3>\n<p>There\u2019s another reason the LE workforce is growing: UK graduates spending longer outside formal training.<\/p>\n<p>The report notes that 12,755 doctors who were in F2 between 2012 and 2023 were licensed in 2024 but had not moved into specialty or core training thereafter.<\/p>\n<p>It also states that the post-foundation LE doctors group has become larger than all specialty groups except surgery and the broad \u201cmedicine\u201d umbrella group.<\/p>\n<p>That is a major structural shift in early-career medical pathways and it has implications for supervision, wellbeing, and retention.<\/p>\n<p>It also undermines the simplistic idea that LE work is only an \u201cinternational doctor\u201d phenomenon. The data suggests it\u2019s becoming a mainstream pathway for many.<\/p>\n<p>&nbsp;<\/p>\n<h3>Employment conditions: LE is the least secure part of the model<\/h3>\n<p>Perhaps the most operationally important section of Part 2 is where the report compares employment types.<\/p>\n<p>Among 38,353 LE doctors in England and Wales in 2024:<\/p>\n<ul>\n<li>76% were on fixed term or fixed term temp contracts<\/li>\n<li>12% were bank (only)<\/li>\n<li>3% were locum (only)<\/li>\n<li>9% were on permanent contracts<\/li>\n<\/ul>\n<p>In contrast, among 12,575 SAS doctors:<\/p>\n<ul>\n<li>83% held a permanent contract<\/li>\n<\/ul>\n<p>The report calls the difference \u201cstark\u201d and explicitly states: LE is less secure employment, with 91% of contracts not being permanent.<\/p>\n<p>This is a workforce planning issue, a morale issue, and a patient safety issue, because insecurity drives churn, churn drives discontinuity, and discontinuity drives risk.<\/p>\n<p>&nbsp;<\/p>\n<h3>Why this matters: you cannot build stability on perpetual temporariness<\/h3>\n<p>The data invites a hard question: what does a workforce plan mean if a huge and growing share of doctors are in insecure, non-training, non-register roles?<\/p>\n<p>Leaders often treat LE roles as \u201cflexible.\u201d But flexibility and insecurity are not the same thing.<\/p>\n<p>A sustainable workforce needs:<\/p>\n<ul>\n<li>predictable career progression routes<\/li>\n<li>stable employment frameworks<\/li>\n<li>fair access to development and appraisal<\/li>\n<li>safe supervision ratios<\/li>\n<li>consistent induction and governance<\/li>\n<\/ul>\n<p>The report does not provide all those design answers, but it does provide the justification for asking the question urgently.<\/p>\n<p>&nbsp;<\/p>\n<h3>The critical interpretation: this is the NHS\u2019s \u201cshadow training pipeline\u201d<\/h3>\n<p>One of the report\u2019s clearest messages (across Part 1 and Part 2 together) is that the UK workforce increasingly functions like this:<\/p>\n<ul>\n<li>Many doctors (especially non\u2011UK PMQ, but also many UK PMQ post-F2) work in LE roles<\/li>\n<li>They then apply to training later and non\u2011UK doctors often do so after several years in LE work<\/li>\n<\/ul>\n<p>If training becomes harder to access (for anyone), the LE workforce grows.<\/p>\n<p>If training becomes less realistic for non\u2011UK doctors, the UK may lose international applicants who were motivated by the chance of progression and that could shrink the LE workforce too, because many join the system through that pathway.<\/p>\n<p>So the LE\/SAS workforce is not separate from the training system. It is part of the system\u2019s pressure valve.<\/p>\n<p>&nbsp;<\/p>\n<h3>What leaders should do: treat LE and SAS as core workforce strategy<\/h3>\n<p>If your organisation relies on LE doctors to keep wards safe and rotas covered, you need to stop managing them like temporary gaps.<\/p>\n<p>Three actions the report\u2019s data strongly supports:<\/p>\n<p>1) Build structured LE pathways with progression<\/p>\n<p>Create clear job families: entry LE \u2192 development LE \u2192 senior LE, with defined expectations, supervision, appraisal, and access to training opportunities (including CESR routes where appropriate).<\/p>\n<p>2) Reduce avoidable insecurity<\/p>\n<p>A workforce with 76% fixed-term LE contracts is a workforce designed for churn. You don\u2019t remove flexibility by offering more permanency; you remove fragility.<\/p>\n<p>3) Align workforce governance with reality<\/p>\n<p>If a large part of your service is delivered by doctors outside formal training programmes, your quality improvement, safety, and supervision structures must explicitly include them, not treat them as peripheral.<\/p>\n<p>&nbsp;<\/p>\n<h3>Conclusion: you can\u2019t \u201cfix training\u201d without fixing the hidden workforce<\/h3>\n<p>The report\u2019s numbers are a warning and an opportunity.<\/p>\n<p>They warn that a huge part of the workforce sits outside familiar planning categories and often in insecure employment. But they also offer an opportunity: if leaders design better structures for LE and SAS roles, they can improve retention, continuity, and patient safety and reduce the workforce anxiety that comes from a system where too many doctors feel they are in limbo.<\/p>\n<p>The hidden workforce is not hidden anymore. It\u2019s the model.<\/p>\n<p><em><strong>Source: GMC Workforce Report 2025<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you listen to workforce debate in the UK, you might think the medical workforce is basically three groups: consultants, GPs, and trainees. The GMC\u2019s Workforce report 2025 makes it impossible to keep telling that story. In 2024, 87,151 licensed doctors were on neither the GP nor specialist register and not in training. That is&hellip;<\/p>\n","protected":false},"author":26,"featured_media":61230,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"none","footnotes":""},"categories":[25],"tags":[],"class_list":["post-61227","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare-leadership"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/posts\/61227","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/users\/26"}],"replies":[{"embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/comments?post=61227"}],"version-history":[{"count":3,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/posts\/61227\/revisions"}],"predecessor-version":[{"id":61233,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/posts\/61227\/revisions\/61233"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/media\/61230"}],"wp:attachment":[{"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/media?parent=61227"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/categories?post=61227"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/tags?post=61227"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}