The UK’s expansion of medical training is on life support

Places at British medical schools have long been coveted by the country’s best and brightest students. As government-imposed caps limit the number of would-be medics a university can take, most accept only straight-A students, with the exception of those coming through access programmes designed for students from non-traditional backgrounds.

At the same time, the severe shortage of staff, including doctors, across the NHS is contributing to the deterioration of the UK’s public healthcare system, characterised by long waiting lists and mounting concerns about patient safety.

In light of this, it might seem illogical that the British Medical Association (BMA) is demanding that the expansion of medical school places be paused. But the union, which represents UK doctors and medical students, argues that expanding places will not fix a broken system – it will simply leave more medical graduates jobless and drowning in student debt.

Medics are far from the only ones experiencing this paradox. Earlier this year, newly-qualified paramedics in Wales were informed of a recruitment freeze following a “UK-wide mismatch” between the number of new graduates and the number of roles available. Similarly, graduate midwives held demonstrations across England in April because of a lack of jobs, despite care reviews finding staff shortages have compounded pressures on stretched maternity services.

“Over recent years, the health system…has been operating under massive financial constraints,” said Kathryn Marszalek, senior fellow at the Nuffield Trust. For hospitals, tight budgets often result in recruitment freezes, leaving graduates struggling to secure a job in the occupation they are trained for, despite persistent understaffing in those very professions.

Medical graduates have to contend not only with a lack of jobs for qualified doctors, but a shortage of places on the training schemes necessary to gain that qualification. “We are in this crisis because successive governments chose the politically expedient option of rapidly expanding medical school places without investing in the infrastructure needed to support such an expansion,” said Henry Budden, co-chair of the BMA medical students committee.

Places at medical schools are strictly capped as the government pays significant subsidies for each student. The cost of educating a medical or dental student is thought to be about £230,000, with students contributing approximately £65,000 themselves through the student loan system.

Expanding medical schools is, therefore, an expensive decision. But as the NHS has experienced increased demand and politicians have sought to reduce waiting times, medical training has been seen as the obvious solution.

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According to the BMA, medical school intakes increased by 39 per cent between 2013 and 2024 across the UK, while the number of medical schools increased from 33 to 49 from 2013 to 2025.

But the expansion of places has outstripped the availability of training opportunities for graduates, particularly as UK-trained doctors have found themselves increasingly competing with overseas medics for these spots. The current government has taken steps to address this mismatch, most notably passing the Medical Training (Prioritisation) Act in March 2026. This new law means those who have studied in the UK will be prioritised for training places.

While the change has been welcomed by many, including the BMA, it is not seen as the sole solution to the issues medical students face – especially as it focuses on foundation training, the first stage of postgraduate training, with slightly looser rules for the second stage, known as specialty training.

“I think more needs to be done to support the NHS to increase the number of [training] posts available, and that’s beyond just creating those posts,” said Jamie Roberts, policy manager at the Russell Group. “That’s actually addressing some of the current workload issues within the NHS because trainee doctors also need the supervision of more senior colleagues and that takes up capacity.”

Expansion of places in the middle of the medical hierarchy is also needed. James Gray, director of student recruitment at the University of Sheffield’s medical school, said that while all the institution’s medical graduates tend to secure foundation places, there is a “bottleneck” at specialist training level. Yet even addressing that issue would not be a complete solution because if “all the foundation doctors get specialist training, the bottleneck comes at consultant [level because] there is a finite amount of money to employ doctors at that senior level.”

As medical places expand, there are also quality concerns. Earlier this year, the BMA’s Scotland branch said “surging class sizes” are putting medical education standards at risk. A report documenting students’ experiences highlights examples of some being forced to sit on the floors of full lecture halls and classes being cancelled because clinical staff were too busy to teach.

According to the BMA, the issues are particularly acute in the devolved nation. “Scotland now has almost twice as many medical students per head of population as England – but unlike in other UK nations, these increases have largely been absorbed within existing medical schools, rather than through the establishment of new institutions, and without considering training capacity,” said Joe Payne, chair of the BMA’s Scottish medical students committee, following the report’s publication.

“We are seeking an urgent reassessment of student numbers to be carried out to ensure class sizes support high-quality education,” Payne told Times Higher Education.

Katie Petty-Saphon, chief executive of the Medical Schools Council, warned that expansion is difficult without investment in clinical academics – the healthcare professionals who also teach in universities, as well as delivering biomedical and health research.

While she is supportive of the idea of expanding medical school places, she said targets set by previous governments were unfeasible. Most notably, the former Conservative administration announced in 2023 a plan to double medical school places to 15,000 by 2031.

“It actually wasn’t possible to do it because we don’t have sufficient numbers of clinical academics,” said Petty-Saphon. “You need the people to staff the medical schools to provide a good student experience with a reasonable student-staff student ratio.”

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The challenge of recruiting and retaining clinical academics is one that has been rumbling on for a long time. According to the Russell Group, the number of clinical academics has fallen by 6 per cent over the past decade, with a 24 per cent drop at senior lecturer level. And the clinical academic workforce is ageing, with 35 per cent of clinical academics aged over 55 and nearly two-thirds of clinical professors falling in this age group – double the proportion two decades ago.

Following negotiations between the Department of Health and Social Care and the BMA, universities are now required to match NHS pay structures for staff members who split their time between teaching and clinical practice to prevent these employees from losing money because they work in a university. However, “because the Department for Education wasn't involved in the negotiations…it didn’t feel it had an obligation to provide the money to give to the universities,” said Petty-Saphon. Hence, “the universities were lumbered with an extra £20 million a year to find. The end result is instead of having an expanding clinical academic workforce, we’re having people being made redundant.”

The well-documented financial pressures on universities are also having an impact on health courses more widely. A number of universities have closed some of these programmes in recent years, having knock-on effects on staffing in local NHS trusts.

When, last year, the University of Nottingham decided to suspend its children’s and mental health nursing courses, Paul Morris, East Midlands regional director at the Royal College of Nursing, said the decision was “not only a tragedy but deeply damaging to local health needs”.

Nottingham declined to comment.

“Universities are being forced to make difficult decisions about their provision, including consideration of course viability and staff restructures,” said a spokesperson for the Council of Deans of Health. “Despite the undeniable value of healthcare programmes, they are expensive to deliver, so universities are having to work hard to sustain their provision.”

The council added that as a result of the restructures and redundancies happening across UK universities, the sector is “losing experienced and knowledgeable academic staff who can educate the future healthcare workforce”.

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Regardless of the financial challenges, many universities are keen to expand their healthcare education, including medicine. The University of Surrey, the University of Hertfordshire and St Mary’s University, Twickenham, are among those that have opened or are planning to open new medical schools in recent years.

However, the domestically capped system has created another paradoxical situation where, despite the furore over British students missing out on training places that led to the recent law change, these institutions will initially cater exclusively to international students who pay the full cost of their education.

Irene Ctori, dean of Hertfordshire’s School of Health, Medicine and Life Sciences, said the new medical school, which will open in September 2026, has been set up in response to the need for more medics in the East of England.

She said international students will be joining the first cohort from countries including Canada, France, Nigeria, the US and Hong Kong.

“We are ready to mobilise into welcoming home students as soon as that is made available to us,” she continued. “In a way, having the international students first is allowing us to have the medical school up and running, and then we’re very quick to be able to respond to that local need as soon as we’re able to.”

The government is expected to publish its NHS Workforce Plan imminently – although the recent departure of former health secretary Wes Streeting has cast further doubt over the government’s plans for the system. 

“What both sectors [universities and health] need is a truly long-term plan that has cross-party support and draws in expertise from universities and NHS trusts,” said the Russell Group’s Roberts: “a truly collaborative approach to some of these challenges.”

For the Medical Schools Council’s Petty-Saphon, “gentler expansion” targets than previous ones could “give time for people to come up with new ways of doing things and can perhaps be more interesting, more efficient, and good ways of taking things forward – but it’s going to take a bit of time and it needs support”.

For others, if wider financial problems in the NHS are left unaddressed, the BMA’s call to pause expansion may be the only solution to ensure students aren’t left jobless after spending years training to join the healthcare system.

“I actually think we are doing our young people a disservice if we are funnelling them through medical school, which is an expensive and demanding undertaking… and we get to a situation where ultimately…a chunk of them will hit the buffers somewhere,” said Sheffield’s Gray.

“We do them a disservice by increasing medical school places purely to satisfy political statistics.”