Written evidence submitted by the British
Medical Association (BMA) (SV53)
EXECUTIVE SUMMARY
1. The British Medical Association (BMA) is an
independent trade union and voluntary professional association
which represents doctors from all branches of medicine throughout
the UK. It has a membership of over 141,000 doctors.
2. This response sets out points that the BMA
would like to bring to the attention of the Home Affairs Committee
in relation to the inquiry into the impact of proposed restrictions
on tier 4 migration:
- The BMA is concerned that closure of the Tier
1 Post Study Work Route will result in the NHS losing out on the
benefits from its significant financial investment in doctors'
training and that NHS service delivery will be compromised due
to a shortfall of specialty trainees.
- Non-EEA students studying for medical degrees
at UK universities have made a significant financial commitment
with the reasonable expectation of embarking upon specialty training.
It would be morally unjust to remove this option whilst they are
partway through their training by closing the Tier 1 Post Study
Work Route.
- Removing the opportunity to progress to specialty
training may well force prospective international students to
undertake medical studies in countries other than the UK. The
BMA is concerned that the reduction in the funding stream that
international students provide to UK medical schools could be
a serious to blow to the future provision of medical education.
- Clinical placements are of vital importance in
providing medical students with the skills to graduate and enter
the Foundation Programme. The BMA has serious concerns about the
government's proposals to change the ratio of study-work on courses
including work placements from 50:50 to 66:33 and the potentially
detrimental impact upon the quality of medical training in the
UK.
WHETHER THE
POST STUDY
ROUTE SHOULD
BE CONTINUED
3. One factor which should be taken into account
when considering whether to close the Tier 1 Post Study Work Route
is the investment made in doctors who have studied in the UK as
international students. It costs in the region of £250,000
to train a newly qualified doctor in the UK and in addition to
this the NHS makes a significant investment in terms of the salary
paid to those who undertake the Foundation Programme.[86]
4. According to the Medical Schools Council there
are 3,000 non-EEA students studying clinical medicine in the UK.
Attrition rates for students graduating from UK medical schools
are extremely low and the vast majority of UK medical graduates
proceed onto the Foundation Programme. Following completion of
the Foundation Programme, they have the opportunity to apply for
specialty training, If they are successful in securing a specialty
training post, they would then transfer to the Tier 1 Post Study
Work Route in order to take up their duties.
5. Given that the 3,000 non-EEA students referred
to above have already been included in UK medical workforce planning,
closure of the Post Study Work Route has the potential to undermine
the provision of healthcare in the UK, even taking account of
the scope for variation in medical workforce needs between devolved
nations.
6. There is a real risk that some of the most
competent and talented UK-trained doctors applying for specialty
training will be lost to the NHS. The NHS could potentially lose
out on some of the benefit of the investment made annually in
Foundation Programme salaries (£39 million[87]
at present)
7. Non-EEA students make up to 7.5% of those
studying in programmes in clinical medicine at UK universities.
Their tuition fees amount to more than £100 million annually.
Such students make significant contributions to their local economies
through living and accommodation expenses. It should also be recognised
that these students have made these commitments with the wholly
reasonable expectation of embarking upon specialty training. The
BMA strongly feels that to remove this option whilst they are
half-way through their training would be completely wrong and
morally unjust.
8. The Medical Schools Council, in previous submissions
to the UKBA, has highlighted that Transparent Approach to Costing
(TRAC) methodology demonstrates that overseas students are a very
profitable aspect of business for higher education institutions
and help support teaching and research in other parts of institutions.
Despite the recent increase in university tuition fees for UK
nationals, the BMA is concerned that any reduction in the funding
stream that international students provide to UK medical schools
could have serious knock-on effects to both the provision of undergraduate
medical training and to higher educational institutions in general.
Prospective international students may well select other destinations
to undertake their medical studies due to the limited opportunities
now afforded to them in the UK beyond the Foundation Programme.
The resulting decline in international medical students in the
UK would mean a sharply reduced income for individual medical
schools through the loss of the significant fees paid by this
group of students (between £25,000 and £35,000 per year
depending on the medical school).
THE IMPACT
DIFFERENT LEVELS
OF CUTS
MIGHT HAVE
ON THE
VARIOUS SECTORS
9. Currently, medical degrees in the UK consist
of an average of two years of pre-clinical training in an academic
setting and three years of clinical training at a teaching hospital.
There is considerable variation in the way in which medical schools
integrate these two elements in their curricula. Courses also
differ between schools, some emphasising problem-based learning,
others favouring lecture-based teaching.
10. Clinical placements are vital for providing
medical students with the requisite skills to graduate and enter
the Foundation Programme. It is through these placements that
students have the opportunity to interact with patients from a
range of social, cultural, and ethnic backgrounds and with a range
of illnesses or conditions. They also provide experiential learning
in specialties such as medicine, obstetrics and gynaecology, paediatrics,
surgery, psychiatry and general practice. The placements are designed
to reflect the changing patterns of healthcare and provide experience
in a variety of environments including hospitals, general practices
and community medical services.
11. In the final year, the student must use practical
and clinical skills, preparing for their eventual responsibilities
as an F1 doctor. These include making recommendations for the
prescription of drugs and managing acutely ill patients under
the supervision of a qualified doctor. A student will assist a
junior doctor and, under supervision, undertake most of the duties
of an F1 doctor. There is also a "shadowing" period,
allowing them to become familiar with the facilities available,
the working environment, the working patterns expected of them,
and to get to know their colleagues.
12. The BMA is therefore extremely concerned
about the proposal to raise the minimum ratio of study to work
from 50:50 to 66:33 and the potentially detrimental impact upon
the quality of medical training in the UK. Whilst we recognise
that the thinking behind it is to deter migrants seeking an easy
route into employment, we would also point out that clinical placements
are unpaid and are an educational component of the medical degree.
13. The BMA also notes that the consultation
does not clarify if the study-work ratio would be applied to the
whole course or individual years. This has major significance
for medical training; the clinical experience described above
takes place in years four and five.
14. Paragraph 7.4 of the UK Border Agency consultation
document, The Student Immigration System, provides for an exemption
from the 66:33 ratio, where there is a statutory requirement that
the placement should not exceed one-third of the total length
of the course. Whilst clinical training in the UK is not covered
by such a requirement, it is governed by European law. European
Directive 2005/36/EC allows European Union (EU) nationals who
hold an EU PMQ or specialist qualification to practise as doctors
anywhere in the EU. Article 24 of the Directive states that the
period of basic medical training must be at least six years of
study or 5,500 hours of theoretical and practical training provided
by, or under the supervision of, a university. From the introduction
of the licence to practise, "basic medical training"
is the period leading up to full registration with a licence to
practise.
15. The EU Directive 2005/36/EC also states that
basic medical training must provide assurance that individuals
acquire the following knowledge and skills:
- "Adequate knowledge of the sciences on which
medicine is based and a good understanding of the scientific methods
including the principles of measuring biological functions, the
evaluation of scientifically established facts and the analysis
of data."
- "Sufficient understanding of the structure,
functions and behaviour of healthy and sick persons, as well as
relations between the state of health and physical and social
surroundings of the human being."
- "Adequate knowledge of clinical disciplines
and practices, providing him with a coherent picture of mental
and physical diseases, of medicine from the points of view of
prophylaxis, diagnosis and therapy and of human reproduction."
- "Suitable clinical experience in hospitals
under appropriate supervision."
CONCLUSION
16. The BMA is concerned that the proposed changes
to tier 4, in conjunction with the changes to tier 1, will have
an adverse impact on non-EEA students studying for a medical degree
in the UK as well as workforce planning provision and NHS service
delivery.
January 2011
86 The Foundation Programme is a two-year postgraduate
training programme, the first year of which is compulsory in order
to gain full registration with the General Medical Council. Back
87
Figure based on the 2009 calculation that trainees are paid an
average of £74,200 over the two-year Foundation Programme
multiplied by 525, the number of non-EEA doctors entering the
Foundation Programme each year. Back
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