What did the BMA do ahead of the vote?
On 6 August 2014, BMA Scotland hosted a debate on what the referendum means for health. The debate was chaired by former BMA Scotland Chairman Dr Brian Keighley and speakers included Bob Doris MSP, Dr Richard Simpson MSP and journalist Pennie Taylor.
The big issues
Education and training
There is currently debate surrounding whether Scottish universities will be allowed to continue charging tuition fees for students from the rest of the UK.
Under existing arrangements, students residing in Scotland or most of the rest of the European Union (EU) are not required to pay fees. However, students living in the rest of the UK are required to pay fees set by the university of up to £9,000 per year.
Medical students considering an education in Scotland post-2014 will want to be assured that:
- Scottish universities will continue to receive funding sufficient to retain their world-class standing
- There is a clear and unambiguous position on tuition fee arrangements for students from the rest of the UK
- Students from lower economic backgrounds are not deterred from medicine on the basis of cost
- Scotland has a sufficient future medical workforce.
The structure of medical education and training (including the work of the GMC and the network of royal colleges) is currently the same throughout the UK and we view this consistency as constructive for doctors and health services, especially as the medical workforce is such a mobile one.
The Scottish Parliament does already have the power to develop different education and training structures for Scotland, but has so far chosen not to. However, independence could increase the likelihood of differentiation, therefore, in the event of independence, doctors will want to know whether:
- There would continue to be consistency of structure in medical education and training with other parts of the UK
- There will be mutual recognition of qualifications across UK borders
- The role of the medical royal colleges in setting standards and curricula would continue.
The medical profession is independently and centrally regulated by the GMC across the UK, which is ultimately accountable to the UK Parliament. An independent Scotland would have to re-establish the regulation of the medical profession in legislation and replicate the core functions of the GMC in Scotland.
The current system allows registered and licensed doctors to work in all four countries of the UK, which is especially important for those in the border regions, the newly qualified and those with highly specialised expertise. In our view, it would be preferable to maintain this ease of travel.
Therefore, in the event of independence, doctors will want to know:
- How the medical profession will be regulated
- How the responsibility for regulating the medical profession would be transferred to Scotland
- Whether there would still be a role for the GMC and what it would be.
Workforce, contracts and pay
As well as having the same training structure, UK health systems broadly employ doctors within very similar (often the same) payment structures and with the same job titles, this consistency further facilitates mobility across the four UK health services.
Since devolution, the Scottish Government has had the option to employ and pay its medical workforce in a different way to the rest of the UK but has largely chosen not to do so. We may see further divergence, particularly for general practitioners and consultants in coming years, and an independent Scotland could increase the likelihood of differentiation.
Doctors in Scotland will want to know:
- Whether the structure of the medical workforce will remain broadly similar to that in other parts of the UK
- How doctors' pay will be determined
- Whether contracts will be negotiated on a similar basis to current arrangements.
Under the Scotland Act, the UK Government has authority over decisions on the NHS pension scheme in Scotland. The Scottish Government does currently have some scope to develop separate pension proposals but, in an independent Scotland, it would be entirely up to Holyrood how far it deviated from arrangements in other parts of the UK.
It is currently possible - and not uncommon - for members of the NHS pension scheme in England and Wales to move to the health service in Scotland and to transfer their pension across to the Scottish scheme and vice versa.
Doctors will want to know:
- Whether such transfer arrangements would continue to be possible in an independent Scotland.
The UK Government is currently in charge of immigration and is operating a points-based tier system, as well as a cap on skilled migration from outside the European Economic Area.
Immigration policy is a complex area and is partly dependent on membership of the EU (of which an independent Scotland's is not yet certain).
Nevertheless, doctors, prospective doctors, NHS employers and universities in Scotland will be interested in a number of key issues relating to immigration, in particular:
- What will the arrangements be for students from outside Scotland to attend medical school in Scotland?
- What will their status be in relation to subsequent NHS employment in Scotland or elsewhere in the UK?
- On what basis will NHS organisations in Scotland be able to recruit medical staff from outside Scotland?
Scotland's world-class scientific research is a fundamental long-term investment in the country's future and must be maintained. Medical research improves the quality and efficiency of the NHS and it attracts further investment into Scotland.
Funding for university research is currently distributed on a UK-wide basis by seven research councils. Scotland punches above its weight in attracting funding, helping to attract medical academics from across the world to work in the country's universities and NHS.
Many aspects of research are subject to UK or European regulation and these existing arrangements will need to be replicated in an independent Scotland.
Scotland's universities and researchers must continue to have access to comparable levels of existing funding in order to maintain and develop its research excellence.
Doctors, in particular medical academics, will want to know:
- How Scotland would continue to fund medical research and retain Scotland's reputation for excellence.
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