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On 20 March 2018 the long-awaited details of the 1,500 new medical school places were announced by the Higher Education Funding Council for England.
Five new medical schools will be created in Sunderland, Lancashire, Lincoln, Canterbury and Chelmsford, with a further expansion of student places across England. There is also talk of the expansion of medical student places in each of the devolved nations. On the face of it, this is very good news. In the long-term, it should help with the medical workforce problems currently facing the NHS, although it must be remembered that it will take at least 7 years before we see an increase in registered trainee doctors.
All the reports on this growth in numbers, however, have overlooked one vital question: who will be training and educating these new cohorts of medical students? When asked how these medical students will be trained the Secretary of State (SoS) for Health responded immediately that “the NHS would train future NHS doctors”. This sweeping statement fundamentally fails to recognise that providing a good grounding in medicine takes time; time that is currently spent providing direct patient care. Medical academics - the doctors who traditionally lead on medical education - have been declining in number over recent years. The consultants, GPs and trainee doctors who provide much of the student’s clinical teaching on placements in the NHS, are already over-stretched and under pressure from clinical duties. Without investment in the time of and facilities for NHS staff to pursue these academic activities, and in dedicated academic staff to plan and manage this, medical students will not get the education that they expect and deserve. These proposals are said to be specifically designed to increase the number of GPs. However, in order to train more GPs, more practices that can offer placements to students and more academic GP educators will be required. To enable a growth educational provision in primary care, the Department of Health and Social Care (DHSC) will need to provide the further investment in education that it has so far failed to do – despite persistent lobbying from the BMA and others. Even with the ostensible desire to increase the number of doctors, the Government has not made a commitment to fund a comparable number of new foundation doctor places in the NHS. Unless this occurs, there is the potential for these newly qualified doctors to be left with a minimum of £45,000 debt and unemployed without the basic registration needed to practice elsewhere. Alternatively, they may displace graduates from existing medical schools, depriving them of the opportunity to progress. Neither option is acceptable or good value for money for the taxpayer.
On behalf of all doctors who are about to be asked to increase their teaching activities, the BMA’s medical academic staff committee is calling for clarity from the DHSC about where the funding for this activity is coming from. How will the SoS ensure that patient care is not adversely impacted by the time commitment expected of academic and clinical staff alike? And what reassurances are there for students about to embark on this vocation, and a mountain of debt, that they will have the prospect of a long-term career in the NHS?
These are the questions that need answering before we welcome the new student places unreservedly.
Dr David Strain, member of MASC Executive and clinical senior lecturer
Dr Carmen Soto, Co-Chair of the Joint Academic Trainees Subcommittee
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