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3 October 2005 HEFCE logo Department of Health logo
To  Heads of HEFCE-funded higher education institutions
Chief executives of Strategic Health Authorities

Circular letter number 25/2005

For further information contact Clare Streatfield at HEFCE, tel 0117 931 7234, e-mail c.streatfield@hefce.ac.uk;
or Jonathan Firth at the Department of Health, tel 0113 254 6321, e-mail Jonathan.Firth@dh.gsi.gov.uk

Dear Colleague

Increasing medical student numbers in England

1.    We are writing for two purposes:

  1. To invite expressions of interest in bidding for additional medical student numbers in England in 2006-07 and 2007-08.
  2. To seek your help with an exercise to scope the capacity for further increases in medical student intake in England from 2008-09 onwards.

2.     The first of these is likely to be relevant to universities with existing medical schools, although others may be interested in forming new partnerships with existing medical schools. The second could be of interest to all higher education institutions (HEIs) with the capacity for, or interest in, medical education.

3.     The deadline for expressions of interest, and for responses to the scoping exercise, is 31 October 2005.

Context

4.     The Joint Implementation Group (JIG) of the Higher Education Funding Council for England (HEFCE) and the Department of Health (DH) met on 2 September to consider the need for expansion of undergraduate medical education in England. A joint statement was issued on 8 September (see Annex A).

5.    Given the time it takes to fully train a doctor there is a need to consider now the demand for doctors in the future, and the implications for the number of places available for medical education. Many factors may affect future requirements for the NHS workforce. The supply of doctors is influenced not only by domestic factors, such as the demographic profile, but also by international labour market conditions. Future participation rates in higher education also need to be considered, with changing social attitudes likely to affect the demand for doctors in a number of ways. The impact of the European Working Time Directive and new contractual arrangements for GPs and consultants will also be important. Factors such as these may influence patient expectations and referral patterns.

6.     In this context the JIG has commissioned work to review in detail the long-term NHS requirements for doctors, to inform a possible joint DfES/DH bid to the Government’s 2007 Comprehensive Spending Review. We are therefore asking for information on the capacity for expansion in universities as part of preparatory work for the review.

7.    In the meantime, HEFCE has agreed to use existing resources to increase the number of funded places for undergraduate medical students by 100 – from 6,078 to 6,178 (adjusted for recent increase in overseas numbers) with effect from October 2006. These additional places will be allocated through a two-stage bidding process which is outlined below.

Additional medical student places: invitation for expressions of interest

8.     In response to the need to expand the number of medical student places, the JIG will allocate 100 home/EU student places from 2006 through a targeted two-stage process. The first stage is intended to identify the overall potential and suitability of institutions for expansion, in relation to the criteria agreed by the JIG, set out below. Given the limited numbers available we expect to target the growth in line with NHS workforce requirements.

9.    The DH is concerned to see that the workforce reflects the population it serves, in terms of both size and diversity. In targeting the available student numbers the JIG will give priority to areas of highest NHS need. In assessing this need, we will have regard to the relationship between medical school intakes and the size of the population. The table at Annex B shows:

  1. The number of medically qualified Health and Community Health Services (HCHS) doctors and General Practice Medical Services (GPMS) doctors per 100,000 population as at the September 2004 Census
  2. The planned clinical student intake per 100,000 population, on the basis of the intakes issued in February 2005.

10.    These figures broadly indicate that the South West, North West, Eastern and South East regions have significantly fewer medical students than their populations justify. The West Midlands and Yorkshire and Humber regions have a balance of intakes to population, but provide practice placements in NHS Trusts that can struggle to recruit UK-qualified doctors. The North East, East Midlands and London regions have a higher intake than their populations justify, although some do export doctors to other parts of the country – and this is reflected in the ultimate distribution of doctors per 100,000 population.

Criteria and evaluation

11.     The JIG will be looking for proposals that:

  1. Provide evidence that new medical places will be in areas of the country with the highest NHS need for doctors.
  2. Encourage innovation, including for example graduate entry, outreach training, developments in academic primary medical care, and joint teaching with other members of the medical team.
  3. Demonstrate a good track record of quality in the subject provision. Supporting information might include results from Quality Assurance Agency institutional audits and General Medical Council (GMC) inspection visits.
  4. Offer value for money, which will be assessed by the quality and fitness for purpose of the proposal measured against the overall cost.
  5. Offer improved access for excluded groups, through schemes such as outreach programmes with schools and sixth form colleges, access courses and close monitoring of selection processes.

12.     Wherever possible we expect the case under each criterion to be backed by robust, quantifiable evidence.

13.     All proposals must demonstrate that they meet the requirements of the GMC Education Committee, which has statutory responsibility for setting the content and standards of undergraduate medical education. These requirements are set out in ‘Tomorrow’s Doctors’ (2003) which can be found on the GMC web-site: www.gmc-uk.org/education/undergraduate/tomorrows_doctors.asp

14.     For the first stage of the process, we ask universities and their NHS partners in consultation to complete the form at Annex D, and to return it by 31 October 2005.

15.    The form asks for the number of funded student places being sought. Capital funding will only be provided in exceptional cases, and requests for capital must be supported by evidence of need. We recognise that some details may need to be amended in the next stage of the bidding exercise, but we are looking for best current estimates of likely capacity to absorb more students and the associated costs.

16.    Given the student numbers available we would not expect bids for new medical schools, but may consider supporting new centres in collaboration with existing medical schools. We would not expect to receive any proposals for fewer than 10 students. For existing medical schools the baseline will be taken as the intake target, as agreed with HEFCE following the February 2005 allocation of extra overseas places (see Annex C).

17.    Proposals should make particular reference to the availability and numbers of clinical academics to take forward the increase in student places.

18.    Proposals will be evaluated by the JIG, which includes representatives from HEFCE, DH, the NHS and the GMC. Institutions that are successful in the first stage will be invited to provide further supporting information at stage two. It is intended that the HEFCE Board will take final decisions on the allocation of the 100 student numbers in April 2006. Institutions bidding for numbers in 2006-07 should note this timetable in planning for a 2006 intake.

19.    Submissions should be no more than four sides of A4 (with no additional annexes) and should be signed off at vice-chancellor level in universities and by chief executives of Strategic Health Authorities.

Scoping future capacity

20.    As part of the preparatory work for the Government’s next spending review, the JIG agreed to commission work to assess the NHS’ long-term requirements for doctors. Alongside this we are asking for help in assessing the future capacity for expansion in medical education from 2008-09.

21.    The exercise is intended to identify the overall potential for expansion, not the precise scope for expansion in any one HEI. For this reason we are only seeking broad-brush assessments at this stage. If, subject to the outcome of the spending review, we do proceed to a formal invitation to apply for new places, institutions will need to prepare more detailed estimates.

22.    The JIG has been asked to take account not only of the NHS workforce requirements for additional training of medical students, but also of capacity and cost implications, and of innovative and more efficient approaches to medical training. If there is significant expansion of medical places, this could be achieved not only through growth in existing medical schools but also through joint ventures between existing and new medical schools, or by establishing wholly new medical schools.

23.    A form is attached at Annex E for universities and their NHS partners to complete in consultation. This asks for general information. We recognise that in the time available the answers can only be broad brush: additional capital costs, for example, are likely to be particularly difficult to estimate. We would not expect to hold institutions to the information given here if there is a further bidding exercise. However, we do ask them to make a reasonably informed judgement of likely capacity to absorb more students and the associated costs. The responses should be signed off at vice-chancellor level in universities and by chief executives of Strategic Health Authorities.

24.    The responses should make particular reference to the availability and numbers of clinical academics to take forward the increase. In seeking information about costs, we make no presumption that it will be possible to fund any future expansion at full cost. As with the additional places already allocated, we would at a later stage need to take account of cost-effectiveness and the scope for matching contributions. But for now we are seeking best estimates of the full costs.

Further information

25.    Any enquiries about the invitation for expressions of interest or the scoping exercise should be directed to one of the joint project managers: Clare Streatfield at HEFCE or Jonathan Firth at DH.

Yours sincerely

Sir Liam Donaldson
Chief Medical Officer
Department of Health

Sir Howard Newby
Chief Executive
Higher Education Funding Council for England

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Annexes
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