The rise of private medical schools in the UK
What will be the cost of medical education going private?
“You will be part of a transformative moment in British higher education as you join an adventurous Medical School with progressive teaching, no cap on international students and a condensed four and a half year programme.”
This is the commitment made in the prospectus of Buckingham University, which is launching the first private medical school course in the United Kingdom. Sixty six students are due to enrol in January, with the university promising smaller class sizes, putting an equal weighting on teaching primary and secondary care, and claiming to put the student first. By offering these benefits it hopes to attract a new wave of medical students—but at a price.
Medical students at the existing 34 medical schools in the United Kingdom currently pay £9000 (€11 000; $14 000) a year. This is paid for by a student loan, and the government covers the remainder of the cost of students’education. By contrast, private medical schools will charge in the region of £35 000 a year in fees, which must be covered privately by the student, with no government subsidy.
Buckingham University is not alone in charging these fees, and it represents a new type of medical school emerging on the medical education landscape. A second private course is scheduled to start in September 2015 at the University of Central Lancashire, and a third at Birmingham’s Aston University in 2017.
This article looks at their plans and considers the implications this could have for students at other medical schools and prospective applicants.
The new schools
The University of Buckingham was the UK’s first private university, and it is offering undergraduate medicine for the first time. The course will be four and a half years long, with annual fees of £35 000. Entry requirements will be AAA at A level, and students will not need to take the UK Clinical Aptitude Test or BioMedical Admissions Test.
“There are a huge number of well qualified students seeking places who cannot currently gain a place, and an obvious need for more doctors in many parts of the world,” said Mike Cawthorne, head of Buckingham’s medical school.
Buckingham’s first intake will be small, with an initial cohort of 66, and this will rise to an annual intake of 100 in five years. Cawthorne promised small class sizes throughout the course in line with the 11:1 student to staff ratio in the rest of the university; this compares with an average of one member of staff to every 17.5 students in other UK universities.
“Our small size and focus on the student experience will enable us to ensure that the progress of students towards the [General Medical Council’s Tomorrow’s doctors] outcomes is very well supported,” he said.
Although all schools have to comply with curriculum requirements of the General Medical Council, Cawthorne said Buckingham will make “evolutionary” changes: “Primary care will carry equal weight in the course as secondary care.”
He said the school is well prepared for its launch in January. “We have got all the important pieces in place. These are the ability to obtain a curriculum under licence, the availability of an experienced Director of Medical Education who is able to guide us through the regulatory process and establish the course, and the availability of significant clinical placements at Milton Keynes NHS Foundation Trust.”
Another new private medical school, at the University of Central Lancashire, was recently forced to delay opening by one year after a critical report from the General Medical Council. It had originally planned to open in September 2014. While noting “commitment and enthusiasm” to establish a new school, the report said there was still “much work to be done in order to meet the standards set out in Tomorrow’s Doctors.” A spokesman for the university told Student BMJ: “We reviewed our progress and felt that additional time was needed to ensure that partnerships and placement opportunities were fully in place and additional senior staff were recruited.”
The University of Central Lancashire course will be a five year programme and is aimed at overseas students from outside the European Union. “British higher education is a hugely successful global export with students from around the world keen to access a British standard of university education,” said a university spokesman.
Aston University, also opening a private medical school, will offer 80 places a year to international students, who will be charged £35 000 a year in fees. Their plans include offering 20 free additional places to study medicine to students who live in deprived areas within the West Midlands. These places will be subsidised partly by the overseas students’ fees and partly by the university. The university hopes to identify these students during secondary school and to coach them through the process so they obtain the grades required to study medicine. The university plans to offer places on the basis of predicted A level grades of AAB and will weight its decision based on the candidate’s empathy, evidence of care service, camaraderie, and perseverance for entry to the programme. When studying on the course students will focus on primary care and be encouraged once qualified to return to practise in their local community.
Foundation programme concerns
A major concern with the new schools is the impact that they will have on the already overstretched foundation programme. Although overseas students at the University of Central Lancashire will have to return to their home countries after graduation, international and UK graduates from Buckingham and Aston will have the option to enter the programme alongside other graduate applicants when they eventually qualify.
In a response to oversubscription of the foundation programme, the numbers of medical school places funded by the state have been cut. Harrison Carter, co-chair of the BMA’s Medical Students Committee, said: “Private medical schools will not have this [cut] imposed upon them and theoretically could offer an unlimited number of places. This means that the problem of oversupply of medical graduates remains unresolved and risks potential graduate unemployment for those students who study at [conventionally] funded Universities.”
Cawthorne denied that private schools pose a threat. “This is a fear story,” he said. “We have been assured that our students will qualify for foundation placements and that our 70-100 students per year can be absorbed into the system. Our discussions with the Foundation Office suggest that they are more concerned about the quality of students entering Foundation rather than quantity.”
Derek Gallen, recruitment lead and director of the UK Foundation Programme Office (UKFPO), acknowledged that the new schools will have an impact on oversubscription in future. “However, workforce planning does not fall within the UKFPO’s remit; our aim is to allocate the best quality medical graduates into foundation programmes regardless of where they were educated,” he said.
If the quality of graduates is the primary concern of the UKFPO, increased competition for jobs could be a way to increase the quality of UK doctors, ending the relatively protected position of UK medical graduates, who are all but guaranteed an NHS job.
Chris McManus is professor of psychology and medical education at University College London. He believes the problem is with the foundation programme’s capacity, not with private medical schools. “The Foundation programme is crowded but the UK also takes in many international medical graduates at FY2 [foundation year 2] or later and at present the UK is definitely not generating enough doctors to supply the NHS’s needs. So if the foundation programme is too small, that merely suggests that it needs expanding.”
The UK health departments are responsible for tackling oversubscription and workforce planning in the United Kingdom. A spokesman for Health Education England (HEE) said that “in June HEE submitted its report on the options for ensuring suitable graduates of UK medical schools are able to secure registration,” and that the report was for the Department of Health to consider.
Access for all?
Although these new courses offer more choice for students, there is a concern that they will attract a certain type of applicant and will reinforce the idea that medicine is a pursuit for the children of the rich.
The existing system of publicly funded universities already has major inequalities. Aphra Smith, applying to study medicine, said: “The university loans system already heavily penalises those who have parents who cannot support them through university but who do not qualify for grants or bursaries, meaning that even training at a public medical school has required me to take a gap year to work to supplement my maintenance grant for my degree.”
However, Cawthorne said that the fees charged at Buckingham would not restrict the course to the super rich. “The vast majority of our students have applied to other medical schools in the UK. Clearly, they have to pay fees of £35 000 per year but this may well be done by second mortgages and bank loans. Many parents value a medical education for their offspring and will take steps to find the fees,” he said.
Medical school applicant Sam Neal said: “Re-mortgaging [my parents’] home in order to fund my medical degree would be out of the question; no matter how supportive my parents are of me.”
Despite these reservations, some students clearly are applying to private medical schools. “Slightly more than 50% of the students [at Buckingham] will be coming from the UK,” said Cawthorne.
“We have had a lot of interest and a large number of applications already,” the University of Central Lancashire spokesman said. Particular interest was from students in Canada, India, Mauritius, Hong Kong, the United Arab Emirates, and Nigeria.
A private medical education does have potential advantages. Small class sizes, new facilities, and freshly designed courses are just some of the promised benefits. But with them come risks: how will the quality of the courses be viewed by future employers? Are the courses financially robust, and will they continue to remain financially viable? The problems with the opening of the University of Central Lancashire’s school are a reminder of how tricky establishing and maintaining a new course can be.
In terms of quality assurance and financial robustness, Cawthorne said that “the course at Buckingham is monitored by a review team from the General Medical Council in the same way as any new Medical School,” and that the costs have been calculated using a “bottom up approach on the real costs of a medical education.”
However, Katie Howl, who is also considering applying to medical school, said: “At a cost of £35 000 a year it seems inconceivable that all but a minority of aspiring doctors in the UK would be able to afford to attend a private institution even if they wanted to.
“Cost aside, I would feel apprehensive embarking on a medical degree which has yet to be approved by the GMC and would rather attend an established university with both significantly cheaper tuition fees and the guarantee of an accredited qualification.”
New models for new doctors
There is increased demand for doctors in the future, both in the UK and internationally. The UK medical degree is a desirable, marketable product, and as the government will not fund new medical school places, universities are taking an opportunity for novel models of medical education. In an era of increasing privatisation within the NHS, perhaps it was inevitable that private medical schools would be encouraged to provide doctors at low cost to the taxpayer.
Asif Ahmed, from Aston University, said his institution is “one model, and Buckingham is another. We will need a number of different models to meet this high demand.”
Private medical schools will produce new doctors, and while these graduates may flood the already oversubscribed foundation programme, the increased competition for places may increase the quality of doctors starting work in the NHS.
Copyright: GivenGuy Rughani, foundation year 1 doctor
1Royal Free Hospital, London NW3 2QG, UK
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
- University of Buckingham Medical School. Undergraduate prospectus. www.buckingham.ac.uk/wp-content/uploads/2013/10/Undergraduate-Medical-School-v2.pdf.
- University of Buckingham, Staff:student ratio. www.buckingham.ac.uk/about/ratio.
Cite this as: Student BMJ 2014;22:g6877