What you should know about the 1500 increase in medical school places
From 2018, there will be 500 more medical school places available in England and this will increase by a further 1000 in 2019
Jeremy Hunt, secretary of state for health, made an ambitious pledge to make the “biggest annual increase in medical student numbers in history,” in his speech at the Conservative Party conference in 2016. For the September 2018 entry, an additional 500 medical school places will be available in England, and a further 1000 places are scheduled for the following year.
The government estimates that this will cost £100m (€112m; $132m); however, the BMA calculates that 1500 places at £220 000 each— the average cost to train a doctor—would cost £330m. This extra spending, however, is at odds with the government’s target for the NHS to find £22bn in efficiency savings by 2020.
Hunt has proposed two changes designed to fund these new places. The first proposal is for doctors to work in the NHS after qualifying for a set period of time or to pay for some of their training, which would be akin to introducing a minimum length of service in the NHS. This would cover the cost of putting each student through medical school. However, this looks unlikely to go ahead because the Department of Health has said that this plan is being reconsidered. The second proposal is to charge international students for undertaking clinical placements. Currently, international students do not contribute to the cost of their clinical placements; instead, they are funded through government grants to the healthcare provider. It is hoped that this revenue will help to offset the cost of funding extra places at medical school.
Timeline — what we know so far
- September 2016—Royal College of Physicians published a report, Underfunded. Underdoctored. Overstretched. The NHS in 2016, which highlighted that the UK does not produce enough doctors to meet demand.
- October 2016—Hunt announced he was going to increase the number of medical school places.
- September 2018—500 extra medical school places will be allocated to medical schools via a competitive bidding process.
- September 2019—1000 extra medical school places will be allocated, as above. International students could be charged the full costs of their course—that is, costs of clinical placement.
- 2027—Hunt wants the UK to be self sufficient in doctors by this point.
- To be confirmed—Discussions continue about making it compulsory for all UK medical graduates to work for the NHS for four years after graduation.
Why is the number of medical school places increasing?
The government wants to make the UK “self sufficient” in the doctors it produces and decrease its reliance on employing doctors from abroad. Currently, international medical graduates are an important part of the NHS workforce, representing around 25% of the 150 000 doctors in the UK.  The motivation for increasing the number of home grown doctors is not entirely clear; however, it could be seen as a reaction to the number of international doctors working in the NHS leaving the UK after its decision to leave the European Union.
How will the new places be allocated?
There were 6071 places for students to study medicine in England for September 2017 entry. Of the 500 new places allocated by the Higher Education Funding Council for England, King’s College London received the highest number (27) and University College London the least (12). Private medical schools (Buckingham, University of Central Lancashire) were not granted any places. The remaining 1000 places will be allocated by 2019-20, when it is expected that six new medical schools, which have registered with the General Medical Council, will also compete for the new places.
The government says these places will be allocated to medical schools which have a track record and commitment to taking candidates from lower socioeconomic backgrounds and which can contribute towards increasing recruitment to undersubscribed specialties and underserved areas of the UK, such as rural or coastal locations. It is not a given that all medical schools will want extra places because it is unlikely to drastically increase their revenue, owing to the cost of training a medical student.
What we don’t know yet
Simply increasing the number of medical school places will not solve the retention problem in medicine in the UK. Harrison Carter, chair of the BMA’s medical students committee says, “We mustn’t forget that this promise won’t tackle the immediate shortage of doctors in the NHS which could become more acute following Brexit.
“As such we require equal focus on retaining existing doctors in high quality jobs, which will provide more immediate relief to an overstretched medical workforce.”
The BMA has also criticised plans to enforce four years minimum service in the NHS. They point out numerous uncertainties around this plan, including what would happen if a doctor was unable to continue practising in the NHS before the end of the four year period, whether as result of taking time out to have children, pursue academia, or recover from sickness. These criticisms seem to have been taken on board, as the Department of Health in England is reconsidering its plans.
Another question is whether the number of foundation and specialty training places will match the number of new medical school places being generated. The UK foundation programme is often oversubscribed, so investment in more training places will be vital to avoid medical graduate unemployment. The Medical Schools Council has already stated that medical graduates will not be guaranteed a foundation training post in the future.
A more immediate concern for students is how the increase in the number of medical school places could affect the quality of teaching and supervision, and how this will impact on students’ overall satisfaction. Carter says, “Any increase in places must be matched with sufficient funding, and an increase in the number of university-based teachers to ensure universities are able to maintain educational standards and provide a high-quality educational experience for students.”
As medical schools compete for these new places we may see a greater diversity in applicants accepted into medical school over the next few years, as part of the widening participation in medicine agenda. However, despite the aim to allocate these places to medical schools that try to widen participation in medicine and encourage students to opt for undersubscribed specialties, there is no guarantee that medical schools will definitely achieve this in the short term or that it will be sustainable in the long term. The government still needs a more comprehensive plan to increase recruitment in certain specialties and improve working conditions for doctors.
Another uncertainty is what “UK trained” means. It does not necessarily mean that these additional places will go to applicants born and bred in the UK and it is currently unclear whether we will see a lift in the cap on places for international students, who pay fees that are three to four times higher than UK applicants.
Will it work?
An additional 1500 places will not remove the UK’s need to recruit international doctors any time soon or the reliance on locum and agency doctors to fill rota gaps. It will take several years to see if this ambitious plan has worked.Preeti Mahankali-Rao,
University of Exeter and 2017 Student BMJ Clegg scholar in medical journalism
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
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