The BMA resident doctors committee, public health medicine registrars subcommittee, and joint academic trainees subcommittee are concerned about changes which will limit the opportunities for resident doctors in public health to participate in academic training in England.

Public health is a medical specialty with a well established multiprofessional route of entry. For academic training, there are parallel but broadly equivalent pathways with medical applicants eligible for the National Institute for Health and Care Research ACF (academic clinical fellow) scheme and multiprofessional applicants eligible for training through the NIHR predoctoral award scheme.

The NIHR’s ACF scheme is a highly valued component of the integrated academic training pathway offered to doctors and dentists in England and was established to increase the number of medically and dentally qualified academics in the UK, recognising that there are substantial career barriers faced by resident doctors who wish to enter academic medicine.

The NIHR’s predoctoral award scheme provides structured training which supports other professionals in establishing an academic career – including public health trainees from (BoTM) backgrounds other than medicine. The split ensures applicants from all backgrounds can access academic training in public health in a fair manner.

Despite these existing arrangements, proposals were made and have since been implemented to extend eligibility to the ACF programme to public health trainees from BoTM. On learning of this we raised our concerns about the effect on medically qualified public health registrars with NIHR. We remain concerned that medically qualified applicants will be at detriment arising from the changes to widen scheme eligibility.

This comes at a time when medical unemployment is rising and training bottlenecks expanding. While the proponents of the changes suggest the proposal will improve equity in academic public health training, the reality is that it will worsen equity in access. Under the new pilot multiprofessional applicants will have access to two routes of academic training – the ACF scheme, as well as the existing predoctoral award scheme. Resident doctors, however, are not eligible for the predoctoral award scheme. There is also no commitment to expand the number of places available. 

Widening eligibility for ACF posts will exacerbate competition ratios during a medical recruitment crisis. The proposal will also reduce the number of medical academics being trained at a time when the UK is rapidly losing medical academics (1). With the risk of resident doctor unemployment increasing and the medical academic workforce shrinking, it is not appropriate to implement the proposals as they stand.

The BMA is greatly concerned that these changes could lead to the possibility that appointment to an ACF post in public health becomes unachievable for foundation year 2 resident doctors as they will be competing with often more experienced BoTM candidates. This directly contradicts with the very intent of the ACF scheme – to provide structured, early-career academic training to resident doctors.  

It is common for a single ACF post to be open competitively across multiple specialties such as public health, general practice and psychiatry. These new ‘pilot’ posts are being advertised in competition with specialty trainee 1 in these postgraduate specialties. With only one post available, this means that medically qualified applicants will face higher competition ratios and potentially lose out on a job.  It is difficult to see how a fair approach to recruitment for these posts can be achieved. Similarly, rules around previous degrees are likely to advantage applicants from a multiprofessional background under the existing shortlisting criteria.

We are also not aware that any formal evaluation processes are being deployed alongside the changes. Piloting such a significant change to the ACF recruitment process without any evaluation is not in keeping with the evidence-based approach potential future medical academics rightly expect those leading academic training to use. Given the potential detriment and unintended consequences we have described above, the apparent lack of agreed evaluation criteria is even more concerning. If an evaluation is proposed, the BMA has not been included as a key stakeholder in any consultation.

On behalf of its members, BMA has raised these concerns to partners involved in the delivery of integrated academic training (the MDRS, NIHR, and NHS England) and suggested several options to improve equity or mitigate the potential harms. We urge partners to delay these proposals and listen to the concerns raised by the workforce. We will continue to oppose these proposals and push partners to delay implementation.

Jack Fletcher is chair of the BMA resident doctors committee, Jonathan Gibb is chair of the joint academic trainees subcommittee and Chad Byworth is chair of the public health medicine registrars subcommittee

(1) Strain D, Gibb J. The UK is rapidly losing medical academics and without them the NHS 10 year plan is at risk BMJ 2025; 390:r1808 doi:10.1136/bmj.r1808