Senedd committee calls for more medical school places

(Pic : BBC Wales)

Medicine is already one of the most competitive and academically-demanding university courses. On top of that it's becoming a struggle for Wales to recruit and train tomorrow's doctors – subject to an inquiry by the Health & Social Care Committee (pdf).

Chair of the committee, Dai Lloyd AM (Plaid, South Wales West) said:

"We believe there is a clear case for increasing medical school capacity in Wales if we are to address the current recruitment and retention issues....There is a clear need to take a message out to schools across Wales that medicine is a....realistic and achievable aspiration for students from all communities."

Key Recommendations:

• An outline plan for establishing a single national medical education body (Health Education Wales) should be published by September 2017.
• The Welsh Government should work with the Wales Deanery to secure a sustained increase in the number of students living in Wales studying medicine in Wales, including a plan to develop undergraduate medical courses at Bangor University and further develop rural medical training.
• Medical schools should include more general practice time in undergraduate clinical training and increase training places in specialities with staffing pressures.
• The Welsh Government should ensure quick clarity on the position of EU nationals living and working in the UK, particularly medical professionals.

Wales currently has two undergraduate medical schools, based at Cardiff and Swansea universities respectively. Cardiff offers five-year, six-year and four-year (graduate) medicine courses, while Swansea offers a four-year graduate only course. The Wales Deanery is responsible for postgraduate medical and dental training.

The recommendations of a 2016 report by Prof. Robin Williams called for the establishment of a single Health Education Wales body to integrate the Wales Deanery and NHS workforce education services. Health Education Wales is expected to go live in April 2018, but the Committee demanded a clear action plan.

The number of students living in Wales applying to study medicine fell by 15% between 2015-2017 compared to the UK average of 5%. In 2016, only 30% of medical students studying in Wales were actually from Wales, with many cases of Welsh students applying to study at a Welsh university being rejected and ultimately studying in England.

The problem here is that, after graduation, students usually end up remaining in the area they studied in; there's an obvious impact on the Welsh language and areas with pronounced recruitment problems like north Wales. There was almost overwhelming support from witnesses for establishing a medical school at Bangor University, but worries over a lack of clinical training places in the north. One witness suggested establishing regional training academies to include more GP placements in particular.

Engagement with schools is another priority so students consider studying medicine in the first place. Some of the reasons for the decline in applications from Wales may be high entry requirements, low career expectations/ambition and a lack of preparation for medical school interviews.

Although hospital medical vacancies often make headlines, the Welsh NHS is said to be walking into a GP recruitment crisis. Younger doctors prefer to work in urban areas, while GPs are already concerns about heavy workloads and an ageing population who have increasingly complex medical needs. As a consequence, more GP practices are being run directly by local health boards instead of the traditional partnership model. While demand for GPs has increased, the number of training places in Wales has remained at just 136 a year when it should be closer to 200.

There were calls to allow more experienced junior doctors (F2 grade) to take a "taster" in primary care without committing to the formal GP training programme.

In hospitals, there are particular problems across Wales in recruiting to posts in psychiatry, general medicine, anaesthetics and general surgery. This means local health boards spent £88million on locums in 2015-16 – almost double what was spent in 2014-15.

Amidst the gloom, there's some good news. Wales has a reputation for more supportive medical training, a better work-life balance, lower living costs (useful when you consider how expensive medical school is), offers more attractive contracts to junior doctors, while trainee doctors (with the exception of trainee GPs) have lighter workloads than their counterparts in England.

Why should this matter to you?

The Welsh NHS has long been over-reliant on temporary/locum doctors and immigrant labour from inside and outside the EU. The first are often expensive, the latter are likely to be put off coming here after Brexit (depending on UK immigration policy).

Fewer doctors mean longer treatment waiting times, poorer training environments, heavier workloads for all other doctors and may even threaten some services – like local GPs. The long-term solution is to recruit and keep as many Welsh-trained doctors as possible, but that's going to mean better education before university, investing in medical education and providing a better offer to newly-qualified doctors.

If the recommendations are followed through, more prospective doctors from Wales will be able to study here instead of going elsewhere and probably staying there - but you can only lead a horse to water.