Royal College of Physicians publishes blueprint for reducing pressure on NHS workforce

The Royal College of Physicians (RCP) is to publish a blueprint for the doubling of medical school places that it considers essential to get the NHS workforce back on a sustainable footing over the next decade. This work began before the pandemic but COVID-19 has highlighted the importance of increasing the number of doctors we have, as well as nurses, other clinicians, beds and equipment.

The RCP wants the government’s lifting of the cap on medical school places in England this year to be maintained with a larger, ongoing increase in the numbers of places, acknowledging that workforce shortages have hampered the NHS’s ability to provide care during the pandemic and placed additional pressure on staff.

Launching at the RCP’s Medicine 2021 conference on Thursday (7 January), ‘Double or quits: a blueprint for expanding medical school places‘ follows up the call for expansion made at the organisation’s annual conference in 2018.

While the RCP welcomed the £20 billion of additional funding given to the NHS by the last government, delaying decisions about the NHS workforce until the postponed comprehensive spending review has an impact on what that funding can achieve.

‘Double or quits: a blueprint for expanding medical school places‘ recommends that the government:

• doubles the number of medical school places from 7,500 to 15,000 per year, at an annual cost of around £1.85 billion – this is less than a third of what hospitals spent in 2019/20 on agency and bank staff (the RCP’s 2019 census found that on average locums account for around 10% of consultants in UK hospitals, with 4% having 30-40% locums)
• ensures that an expansion of places and the process of allocating places incentivises an increased focus on widening participation in medicine
• builds on the successful work of the previous expansion (in 2017 the UK government announced an increase of 1,500 places) to provide medical school education across the whole of England
• undertakes further detailed work to fully understand the potential undergraduate applicant pool, asking UCAS to carry out research with potential applicants to medical school and other science subjects to understand the appetite for places and the perceptions of the entry process to medicine
• considers an increase in undergraduate foundation years for medicine as part of a strategic approach to NHS workforce planning.

In addition, the government and regulators should consult with medical schools about moving towards an apprenticeship style final year of medical school when developing expansion plans, to help new doctors feel better prepared for practice. At present, arrangements for increased clinical setting experiences in a student’s final year vary and the RCP wants formalisation of a final year apprenticeship model to be explored.

The NHS should address the challenges and opportunities facing the clinical academic workforce in its people plan, including year-on-year growth and the development of clear clinical academic career pathways to meet future demand, as well as widening the pool of clinical educators to facilitate expansion.

Medical schools should review their curricula to ensure they create cohorts of doctors with a broad base of skills, able to develop into specialists as their careers progress. Expansion also provides an opportunity to consider the make-up and demographics of medical students to make them more representative of society.

The cost of increasing medical school places would depend on the scale and pace of expansion and would fall across several financial years and likely at least two different parliaments. In time, the expansion of the workforce will bring savings by reducing locum costs, including by relieving some of the pressure on doctors which results in sickness absence.

To support the development of its blueprint, the RCP commissioned York Health Economics Consortium (YHEC), which estimated the total discounted cost for a 5-year undergraduate medical course in England as £207,418. The total ‘public’ cost is £192,981 and the total ‘private’ cost £14,437.

The cost per medical school place comprises the cost for teaching incurred by higher education institutions, the healthcare placement providers and the cost of living to the medical student.

The public cost includes the tuition fee loan provided to students and paid to institutions. Analysis by London Economics estimates that medical professionals will repay significant amounts of their student loan over their career.

Expansion also offers an opportunity to realign the graduate attributes of medical school students with the needs and realities of the health and care system. From 2009 to 2019, the number of consultant physicians working less than full time grew from 14% to 23%. The NHS must become a more flexible employer if it is to retain staff and full-time equivalent (FTE), not headcount, must be planned for to ensure that enough doctors are trained.

Alongside efforts to improve public health and social care, expansion will help reduce the pressure on the current workforce and create an opportunity for governments, medical schools and the NHS to ensure that medical school programmes are aligned with the needs of the UK’s health and care system, while not removing the responsibility to improve the working lives of the current workforce.

The NHS is heavily reliant on international staff and will continue to be so in the short term, and while it is important to consider the ethics of recruiting staff into the NHS from countries which may themselves have workforce shortages, the RCP is proud to have called for a ‘new deal’ for international staff working in the NHS and social care to recognise their contributions to healthcare.

Ahead of launching ‘Double or quits: a blueprint for expanding medical school places’ at the RCP’s Medicine 2021 conference, RCP President Professor Goddard said:“Since I first made the call for a doubling of medical school places at our annual conference in 2018, the NHS has faced the biggest challenge in its history with COVID-19, but the pandemic has also inspired a new generation to pursue careers in the NHS.

“The lifting of the cap on medical school places in England this year was welcome and the government should now cement this change and build upon it, to signal its ambition for the NHS. We need to offer more places next year, and even more the year after that. We know that 2020 will be a year to remember and we want 2021 to be the year we took the opportunity to invest much more in a homegrown medical workforce.

“The challenges our health service faces will not disappear overnight but if we do not act now we are storing up potentially bigger challenges for the future. More than that, investing in a sustainable NHS workforce is also investing in a healthier population and that is something I believe we are all ready to buy into.”