The next generation of doctors – is the system ready?

In 2023, the UK government committed to double the number of medical student places by 2031 in the NHS England (NHSE) Long Term Workforce Plan (LTWP). For a profession crying out for more doctors, this felt like a major win. But good intentions alone don’t make things happen.

In their paper, Sassoon et al ask a simple question: how ready to expand medical school places is the UK health system? The answer, unsurprisingly, is complicated.

A plan without a plan?

The 2023 NHSE LTWP set out bold ambitions but left many wondering how it would actually work. This scoping review found only 23 articles that focused on the challenges of medical student expansion. The majority of these were opinion pieces – suggesting that the evidence base underpinning any recommendations is rather thin.  

What’s standing in the way?

Five main challenges to the expansion of medical school places came up repeatedly as key themes:

• Funding: many articles highlighted a lack of clarity about how expansion will be paid for – and whether placement providers will see any additional money. This was the most frequently raised challenge, mentioned in over half of all papers.  
• Capacity: from a shortage of clinical academics to a paucity of clinical placements, around a third of papers felt the existing system didn’t have sufficient infrastructure in place to cope with more students. 
• Stakeholder engagement: students, educators and doctors often felt excluded from discussions – especially around proposals like 4-year undergraduate medical degrees (AUMDs) or the currently paused medical doctor degree apprenticeships (MDDAs). 
• Widening access: despite claims that AUMDs might improve access, there were fears of increasing the financial burden on students from lower-income backgrounds (who would have less chance to earn while they learn) or due to reduced number of hours in clinical training, potentially create a tier of doctors who could only practise medicine in the UK.
• Burnout and safety: around a quarter of papers warned of the risk to patient safety if required hours of medical training are reduced. Others flagged concerns around student wellbeing, citing evidence that 25% of students on accelerated programmes in the USA voluntarily extend their education due to high stress. 

Why does this matter?

The percentage of the NHS budget spent on health education has been steadily falling (from 5% in 2006-07 to 3% in 2018-19 to roughly 2.8% of the current total annual NHS budget of £181.7bn). The current funding model for undergraduate medical education is unfit for purpose, routinely labelled as expensive, and often perceived to be less important than the delivery of care.  

Given a global shortage of clinical teaching staff, training vastly more medical students will require a corresponding expansion in the number of clinical academics and teaching fellows, with dedicated career structures and training pathways to support them, in addition to protected time in doctor’s job plans to deliver teaching and supervise students.

The RCP has long lobbied for a plan to support educators, supervisors, mentors and trainers by working with employers in the NHS to increase capacity for medical education and training.

The 2023 NHSE LTWP is vague and lacks detail. During the transition of NHSE into the Department of Health and Social Care (DHSC), national leaders will need to think carefully about where the responsibility for medical education will sit.

It’s now crucial that we see some long-term thinking and a clear steer from the centre on the importance of high-quality training. The RCP was one of the main voices to call for an expansion of medical school places – we still think this is needed and we call on government to develop a considered implementation plan to make it a success. The 10 Year Workforce Plan for England, due later this year, must set out the granular detail of how and where medical school places (and commensurate postgraduate training places) will be increased.

What needs to happen now?

The FHJ article calls for:

• clarity of message and better two-way communication from DHSC on strategy and funding, especially as the 10 Year Workforce Plan is developed for publication later this year
• more research into what actually works – particularly around placement models, wellbeing and learning outcomes – and the intersection between healthcare workforce planning and medical education. 

The medical profession must remain engaged in the process of moving the plan forward into reality – the 10 Year Workforce Plan must uphold the commitment to expand medical school places, and the UK government must proactively engage the medical community in the implementation of this policy. Doctors and medical educationalists should be proactive in providing evidence where possible and in carefully and critically reviewing and commenting further on the workforce plan when published.

The future of the medical profession as we know it is at stake, and doctors (both current and future) must be part of that conversation and ultimately, any solution.

Dr Seán Coghlan 
Chair
RCP Student and Foundation Doctor Network