Take a large dose of cooperation...

April 24, 1998

Colin Campbell urges medical schools to work together in their bids to train the 1,000 new students a year Britain urgently needs

SINCE the medical workforce standing advisory committee, which I chair, published its third report last December, there has been much speculation about the implementation of its recommendations. The government has broadly welcomed the report, stating that a number of the recommendations "chime with the government's own thinking", but it has delayed making any decisions pending its comprehensive spending review.

My committee's main recommendation - that the annual intake to United Kingdom medical schools should increase by 1,000 students (20 per cent) - has been discussed widely in university medical schools and elsewhere. All concerned accept the need to train more doctors to help bridge the gap between supply and demand but the cost of providing the additional places and where to locate them has been much debated.

The committee suggested that the expansion could be met in a number of ways: increasing provision in existing medical schools; widening the geographical spread of clinical teaching facilities; extending postgraduate provision to cover undergraduate education; or opening one or more undergraduate medical schools. The committee was not attracted to a single solution but it did want to ensure that expansion was cost effective.

It has been estimated that the increase would add an additional cost of about Pounds 200 million a year, once the extra students were in place, but the committee was reasonably confident that it would be possible to implement the additional numbers more cheaply. The final cost will depend on how any increase is implemented.

The Higher Education Funding Council for England will work out all extra costs to the education sector as a result of more students. This will mean contacting all medical schools in England, together with those universities likely to wish to become involved in undergraduate medical education. National Health Service regional offices, the NHS Executive HQ and the Department for Education and Employment will also need to be heavily involved.

We must maintain our high quality medical education provision. Funding for additional students must be appropriate and realistic to ensure that our enviable international reputation is preserved. It is necessary therefore that university medical schools cooperate in their bids to train extra doctors. They must avoid short-term measures that will lead to cost-cutting. It is only through such cooperation that we can ensure that quality is maintained.

This is not to say that we must continue to train all doctors through the traditional undergraduate route and that there is no room for further efficiency gains. My committee also recommended, for example, that shorter medical courses should be developed for graduates of other disciplines. This would provide different models and broaden the field from which doctors are recruited.

The committee also highlighted the importance of improving the retention of doctors as well as improving recruitment. More attention needs to be given to flexible working arrangements if we are to retain doctors. Appropriate career planning, counselling and training for existing medical staff is needed. There is little point in training more doctors if they then decide to leave the profession. Working patterns are changing throughout the labour market and the medical profession needs to adjust its thinking to meet the needs of, among others, women who choose to have career breaks to bring up children. We cannot afford to lose highly trained staff.

It is also extremely important that more people from Britain's ethnic groups are attracted to the medical profession and are properly represented in senior management. Much more attention needs to be given to ensuring that applicants for medical training, doctors as well as nurses, are representative of the population. We need to think about what deters members of ethnic groups, and women, from applying for places at medical schools and then do something about it. More research is urgently needed in this area.

The medical workforce standing advisory committee's recommendations do not provide a quick, cheap solution to deal with the imbalance between the increasing demand for medical care and doctors and the supply of highly trained staff.

In addition to the well-recognised shortage of GPs there is also a shortage of consultants.

We must therefore make a start on implementing the committee's recommendations as a matter of urgency.

Professor Sir Colin Campbell is vice-chancellor of the University of Nottingham and chairman of the medical workforce standing advisory committee.

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