NHS: Can We Train Those New Doctors?

The Government has confirmed 500 new medical school places for next year as a much-needed PR boost in the political “silly season” while ministers are on holiday. But the doctors` union, the British Medical Association, has warned that a lot more support will be needed to deliver the proper training promised for 1500 extra student doctors from 2020.

Training posts

In response to a consultation by the Department of Health, the BMA said that “with student debt exceeding £80,000 for many medical graduates, in addition to the investment in medical education made by the NHS, medical academic staff, universities and taxpayers, the Government has both a moral and fiscal responsibility to ensure that medical graduates are able to secure a high quality training post upon qualification.”

The association also warned that it can take 10 years to train a doctor to a senior level and so improving staff retention within the profession is crucial to keeping current senior doctors in the system and making sure the enlarged student intake continues up the career ladder.

Infrastructure

There is no shortage of applicants for medical courses but opening up new places requires investment in teaching environments that in many cases are already dilapidated and unfit for existing cohorts. While the association welcomes the new places it stresses the underlying requirements to make the increase sustainable rather than just seeking a good headline.

“This requires front-loading investment in both university training infrastructure (lecture theatres, access to teaching labs and equipment, tutors, assessment, etc.) as well as both trust-based and primary care clinical teaching placements,” the BMA said.

The same pressure applies to improving postgraduate opportunities to develop more niche expertise. “Expanding research opportunities could also attract graduates into primary care and shortage specialties. However, this would require the necessary infrastructure being in place in these specialties and a means of meeting the financial implications this would bring.”

International Students

The government has tried to cut back on training international students, according to the consultation response, as it believes that such training represents more of an investment in the health services of other countries than a boost to the “domestic” medical workforce.

“The consultation outlined the Government’s intention to increase domestic supply and charge international students the full costs of their course from 2018-19,” said the Department’s document.

The BMA criticised that approach as a dangerous threat to staff numbers, especially post-Brexit. “We disagree that paying for the clinical placements of international students takes away funds from training the domestic medical workforce,” it said. “The high fees paid by international students subsidise places for UK/EU students. We are also concerned about the impact of Brexit on the supply of students from EU countries if it means they will be charged higher fees.”

That view was taken into account in the Health Department’s final response to the consultation. “Following feedback provided through the consultation these changes will commence in 2019-20 and not in 2018-19 as indicated in the consultation,” the BMA said. “This means the Government will continue to fund clinical placements for international students commencing study at English universities in 2018-19.” That was explained as a move to better organise the change for 2019-20, so the problem has simply been delayed rather than solved.

Nevertheless the BMA agreed that a cap on international students was required so that universities would not take on a disproportionate number of those students, who are more attractive to university administrators because they are charged higher fees than their UK counterparts.

 

by Stewart Vickers

 

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