at The Royal College of Surgeons
35/43 Lincoln’s Inn Fields London
0207 869 6681
Professor Ian Cummings
Health Education England 1st Floor
Blenheim House Duncombe Street
Leeds LS1 4PL
8th September 2017
Dear Professor Cummings,
RE: ‘PAs and physios could study medicine part-time to boost doctor numbers’
The Association of Surgeons in Training (ASiT) is an independent professional body and registered charity (No. 274841) which works to promote the highest standards in surgical training. ASiT’s council has representation from all ten surgical specialties, and across the UK and Ireland.
While ASiT welcomes the valuable contribution that graduates from other areas bring to medicine, ASiT has serious concerns about recent proposals made by Health Education England regarding the introduction of part-time primary medical qualification degrees for allied healthcare professionals.1,2 The current proposal does not offer a satisfactory long-term solution to current medical workforce recruitment and retention issues, for the following reasons:
1. The proposals lack insight into morale and recruitment issues across healthcare professions
We feel this proposal undervalues the important work of the multidisciplinary team and risks “robbing Peter to pay Paul”. Doctors, nurses, physiotherapists, physicians associates (PA) and other allied healthcare professionals are all an important part of the multidisciplinary team responsible for patient care. Already, the Royal College of Nursing have expressed concern nationally about nursing staff shortages. In the wake of Brexit, the UK has already seen a reduction in job applications from EU nurses3, and the abolishment of NHS bursaries has generated a decline in nursing degree applications.4 The proposal for part-time medical degrees to be undertaken by nursing, PA and physiotherapy staff therefore neglects existing recruitment and morale problems within these disciplines.
2. There is no evidence that allied healthcare professionals would seek to complete a medical degree.
All members of the healthcare team have already completed years of training and postgraduate qualifications within their respective fields. Junior doctor morale is at an all time low5, and applications to study medicine have reduced by 13% since 20136. There is little evidence to suggest that a significant proportion of allied healthcare professionals would wish to transition into a career as a junior doctor. In reality, many of the aspects of the underfunded NHS that affect junior doctor morale have a similar impact on the morale of other members of the multidisciplinary team, for example low nursing staffing ratios and cancellations of elective patient treatment.
3. A part-time medical degree would not accelerate the training of new doctors
We would also draw your attention to the Medical Act 1983, which states that a part-time medical degree would still need to fulfill the minimum requirement of 6 full years or 5500 hours of teaching to achieve full General Medical Council registration. Although ASiT is supportive of flexible options for training, the notion of a ‘part-time’ medical degree in this scenario is by no means a shortened or accelerated course (16 hours per week, for 44 weeks a year, would require registrants to be in programme for 7.8 years) and would have little benefit to alleviating the growing service gap.
4. Increasing exposure to less popular specialty training pathways will not improve recruitment
Recently, in their open consultation on increasing medical school places, the Department of Health concluded that allocation of these spots would be made to medical schools which place greater emphasis on underfilled areas of medicine, such as psychiatry and general practice. Again, there is no evidence to suggest that this is an effective strategy to improve recruitment. Fundamental issues surrounding the delivery of primary care, overbearing workloads and poor job satisfaction still underpin poor GP recruitment and retention levels which must first be addressed.
5. Surgery is facing reduced representation in undergraduate medical curricula.
ASiT is also concerned about the potential impact that a reduction in surgical exposure during medical school will have on undergraduate surgical training, which is already considerably varied across UK medical schools.7,8 Early exposure is a crucial motivating factor towards a career in surgery9; competition ratios for core and specialty surgical training are already declining rapidly. Altering the content of the undergraduate curriculum to be weighted towards general practice or psychiatry at the expense of other areas is shortsighted and will only exacerbate existing difficulties in recruitment to other medical specialties, which also remain underfilled.10 For those who do not become surgeons, undergraduate level surgery is a key time for them to gain knowledge of surgical disease to enable them deal with patients presenting in the community for postoperative care for example. Whilst not all students go on to practice surgery, some surgical knowledge is of importance to other specialties, particularly high volume referrers such as primary care.
ASiT encourages Health Education England to directly address issues in Junior Doctors’ morale and wellbeing, rather than seeking alternative and impractical routes to filling medical workforce gaps. Solutions may include:
Improve staffing ratios within the multidisciplinary team to reduce individual workload, reduce stress and burnout levels, and facilitate highest quality of care
Ensure adequate resource and staffing to avoid cancellation of elective theatre lists
Minimise rota gaps by attracting high quality trainees from the UK and abroad into training schemes, incentivising applications to medical school, and paying fair and
equitable rates to internal locum doctors.
Invest in training organisations to ensure high quality future delivery of care within the
Ensure flexible training options for trainees are funded and supported across all
specialties, including less than full time and clinical academic training.
The JCST/ASiT/BOTA morale survey11 will provide further insight into the issues affecting trainee morale across specialties and we urge HEE to engage with these survey reports for the betterment of UK specialty training and patient care within the NHS.
ASiT Medical Student Representative
on behalf of the Association of Surgeons in Training (ASiT) Council
Matthews-King A. PAs and physios could study medicine part-time to boost doctor numbers [Internet]. Pulse Today. [cited 2017 Jul 22]. Available from: http://www.pulsetoday.co.uk/your-practice/practice-topics/education/pas-and-physios-could- study-medicine-part-time-to-boost-doctor-numbers/20034834.article
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Davis CR, Toll EC, Bates AS, Cole MD, Smith FCT. Surgical and procedural skills training at medical school - a national review. Int J Surg. 2014 Jun 5;12(8):877–82.
Lee MJ, Drake TM, Malik TAM, O’Connor T, Chebbout R, Daoub A, et al. Has the Bachelor of Surgery Left Medical School?-A National Undergraduate Assessment. J Surg Educ. 2016 Jul;73(4):655–9.
Association of Surgeons in Training. ASiT Medical Student Survey. 2016. [Unpublished]
BMJCareers-Specialtytrainingvacanciesincreaseby30%inayear[Internet].[cited2017 Jul 22]. Available from: http://careers.bmj.com/careers/advice/Specialty_training_vacancies_increase_by_30%252 5_in_a_year
Joint Committee on Surgical Training, Association of Surgeons in Training, British Orthopaedic Trainee Association. JCST/ASiT/BOTA joint survey of trainee morale. 2017.
ASiT - the pursuit of excellence in training Registered Charity 274841