What the NHS bursary means to medical students
With cuts to the nurses’ bursary, what’s the future for financial help for UK medical students?
The NHS bursary for nurses, midwives, and allied healthcare professionals is to be withdrawn from 2017, with students having to take out loans instead to cover tuition fees and living expenses.
Currently, more than 60 000 students benefit from this means tested bursary each year, and in June 2016 protests under the name of #bursaryorbust took place in London against the closure of the bursary scheme and the damaging effects it could have on the NHS’s future.
Medical students also have access to the means tested NHS bursary and, although this is not affected at present, it is feared that the government will eventually look to replace the bursary with loans. Student BMJ talked to medical students about the impact of the NHS bursary on their education and what its withdrawal might mean.
Impact on students
“There’s no way I would have considered going into medicine without it,” says Ross Kelly, a pharmacist now in his third year studying medicine at the University of Birmingham. As a graduate student, Ross receives a contribution towards tuition fees and a small amount towards living expenses. He says without that bursary, studying medicine would have been “unachievable.”
Ross isn’t the only one. Most medical students in England receive an NHS bursary to cover tuition fees from their fifth year—different rules apply to graduate students and those on accelerated programmes (see box)—and most will also receive some help towards living expenses, although a portion of this is means tested.
Rebecca Boys, a fifth year medical student at University College London, says she would not be able to study without it:
“I’m one of four [siblings] and it’s just my mum. She can’t afford to pay for us all to go to university. I’ve been reliant on finance throughout. A six year course is incredibly long and not something I could have done without [the bursary],” she adds.
Would she have decided not to study medicine if the bursary had not been available? “Quite possibly, or I might have gone to university but my siblings might not have been able to,” she says.
Tom Rock, a final year medical student at the University of Bristol and chair of the BMA Medical Students Committee’s finance subcommittee, has calculated that replacing the bursary with a student loan would add an additional £18 000 (€21 450; $23 892) to £36 000 to the average medical graduate’s student debt, before interest. “If you remove the NHS bursary and add to the existing level of debt, you would see students with over £100 000 of debt. It’s horrendous,” he says.
Threat to the bursary
In light of what is happening to the nurses’ bursary, can medical students expect a similar change to their funding in the future? The Department of Health, in its announcement about the ending of the NHS bursary for nurses and midwives, said that the government is working with Health Education England (HEE) and other delivery organisations to consider the delivery models and funding options for healthcare courses outside the remit of the reforms.
At the time of publication, a spokesman from the Department of Health said there were no current plans to remove the bursary from medical students “that I am aware of.” Rock is cautious about alarming students, but points out that government thinking seems to be moving in the direction of replacing bursaries or grants with loans.
The Department of Health says of the scrapping of the NHS bursary for nurses: “This will enable universities to provide up to 10 000 additional nursing, midwifery and allied health training places by 2020, so more applicants will have the chance to become a health professional.” It claims that the change to a loan only system is both a “better funding system” and “a sustainable model for universities,” which will enable universities to offer more course places.
Rock counters this argument: “We have already seen 9% fewer people applied [for medicine] in England for the 2015-16 application cycle. This year’s figures look like it’s getting worse. We’ve got a government that says cutting corporation tax and capital gains tax encourages activity but increasing the cost of education doesn’t affect activity.”
Mita Dhullipala, a fourth year student at Glasgow University and the BMA’s student committee spokeswoman for widening participation, fears withdrawing the NHS bursary would be “putting the nail in the coffin,” for attempts to attract students from less traditional backgrounds to apply to study medicine.
“You hear lots of stories of students getting to the final year and they can’t quite make the fees for the final year, and not being able to graduate. It makes such a difference to so many people,” she says. “Students don’t realise [that] when they get into the clinical years, it’s a full time job. You’re on the wards from eight till five every day. When is there time to do part time work to support yourself?”
Rock adds: “The BMA has been working very hard to encourage participation from non-traditional backgrounds and we know money has an effect on that. We know those from worse off backgrounds are less likely to study medicine, and anything that makes the cost of studying medicine more expensive could decrease applications from non-traditional backgrounds.”
Dhullipala also points to the drop in applications to study medicine in line with increased fees. “We have a shortage of staff across the NHS and students are being out-priced from the education market,” she says. She further states that cutting the bursary could affect the willingness of students to continue working in the NHS after graduation. “The bursary encourages people to stay in the NHS—people say, because I’ve had that and feel helped and supported, I feel like staying in the NHS,” she says.
Few would argue that the NHS bursary system is without its faults. Finding out what you are entitled to can be difficult, and the rules are complex, say some students.
“The information given by the NHS is quite cryptic and complex. It’s difficult to see what you’re entitled to—I relied on my medical school publishing its own information on how to claim. It is quite confusing,’ says Ross Kelly.
Dhullipala agrees: “It is a pretty complex process of applying. People are confused—it’s not transparent and we need guidance on how it is calculated.”
Rock says that if you are a medical student in financial difficulties you should call the BMA, who may be able to work out whether you are entitled to additional financial help.
Despite his concerns about the fairness of the bursary, Kelly believes it’s worth defending: “It is a very enabling thing. It’s really important that it stays if we’re going to widen access.”
Rock says: “We would strongly resist any attempts to remove [the bursary] . . . If medical students are concerned about the future of the bursary, the best way to support it is to support our nursing, midwifery, and healthcare professional colleagues, both because it’s the right thing to do but also because we are one profession.”
The NHS bursary explained
What is it?
The NHS bursary is an annual payment to help with living costs while you are studying an eligible course. It also includes tuition fees, which are paid directly to the university. The bursary is partially means tested, meaning the amount you receive is calculated according to your income, or your parents’ or spouse’s income.
Who can apply?
Currently, students studying medicine, nursing, dentistry, midwifery, and a range of other professions allied to medicine can apply for an NHS bursary (although you should check with your university that the course is funded by the NHS). From August 2017, new nursing, midwifery, and allied health professionals will no longer receive NHS bursaries but will have to use the student loans system.
Medical students can apply for the bursary from the fifth year of study onwards. If you are on the accelerated entry programme, you can apply for funding from year two. If you are a postgraduate and exempt from the earlier years of study, you can apply from year five of the course programme.
What does it cover?
The NHS bursary may cover or contribute towards tuition fees. There is a small non-means tested grant, and a means tested basic award, both of which are intended to contribute to general living expenses. Some people are eligible for a range of other awards, including a dependants’ allowance, childcare allowance, and disabled students’ allowance.
How is it calculated?
Your eligibility and the award you are entitled to are calculated on a range of criteria. You will be assessed as either independent or dependent, based on your age, whether you have worked (and for how long) before starting your course, and whether you are married. If you are assessed as independent, your bursary will be calculated based on your income; if dependent, it will be calculated based on your parents’ or spouse’s income. If you are a parent or have dependants, or you are disabled, you may be entitled to other allowances.
- gov.uk overview of NHS bursaries: www.gov.uk/nhs-bursaries/overview
- NHS bursaries by Money 4 MedStudents: www.money4medstudents.org/nhs-bursaries
- The BMA’s Medical student finance guide: www.bma.org.uk/advice/work-life-support/your-finances-and-protection/guide-to-medical-student-finance
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
- Merrifield N. Nurses call for alternative to “appalling” bursary removal. Nursing Times 2016. www.nursingtimes.net/news/education/nurses-call-for-alternative-to-appalling-bursary-removal/7005726.fullarticle.
- Cory H. Views from the NHS frontline. Guardian 2016. www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2016/jun/20/grassroots-campaign-fighting-nhs-bursary-cuts.
- Department of Health. NHS bursary reform. 2016. www.gov.uk/government/publications/nhs-bursary-reform/nhs-bursary-reform.