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A faulty production line

Replace doctor trainee bursaries with loans, think-tank recommends

The Government should make medical students pay for their training via student loans, repayable on the condition that they work in the NHS, a think-tank has recommended.

Civitas said that the 'severe shortage’ of doctors in England - and especially GPs - means that it is time the Government lifted a cap restricting medical school places at just over 6,000 per year.

It said that to finance this, Health Education England (HEE) should stop paying bursaries, fifth year tuition fees and clinical placement fees, and instead medical students 'should be required to take out a loan from the Student Loans Company to cover the total cost of their training’.

Civitas suggested that by transferring the ‘upfront cost’ of training doctors to the Department for Business, Innovation and Skills’ balance sheet, the Department of Health could afford to lift the cap on medical school places.

The report said: 'The eradication of upfront payments by the NHS would mean the current cap on the number of doctors training each year could be lifted and the UK could finally train the number of doctors it needs.

’Importantly, such a training loan would be repaid on behalf of each medic by the NHS through HEE on condition that doctors work for the NHS after graduating. If graduates leave the country to work abroad or transfer from the NHS into the private sector they would become liable for the repayment of these loans.'

Civitas argued that, as it stands, 'either of these career moves by a newly trained doctor leaves the taxpayers’ huge investment in such medics’ training wasted', but that its proposal 'would finally safeguard such an investment'.

It added: 'This proposal offers a means of training far more of our NHS doctors here in the UK, and thus ending a long-standing reliance on both overseas medics and agency staff to fill vacancies.'

But Dr Krishna Kasaraneni, chair of the GPC’s education, training and workforce subcommittee, said that to ‘financially penalise’ trainees at a time when applications to medical schools have fallen was unwise, and suggested that the Government cannot pressure doctors to work in the NHS.

He said: ‘Last time I checked we were not in a totalitarian state, so I think “utter nonsense” would probably be my position on this.’

The proposal comes as the Government's plans to lift the cap on nurse training places while removing bursaries has been widely criticised, including by the BMA, which argues that there is 'a clear link' between cuts to the NHS Bursary Scheme and reduced applications for medical training.


Readers' comments (24)

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  • Concept is reasonable. implementation is usually the issue.

    How many criticising the proposal on here would not have qualified to have it all paid off by HEE? Not many I guess.

    With the number of doctors the country is training at tax-payers expense, there needs to be a mechanism to ensure that they are coming into the NHS.

    Those who lose out should be those who do the training and take their skills elsewhere. Safety netting needs to be in place to protect those who either don't complete training or for exceptional circumstances cannot complete the requisite time in the NHS to qualify.

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  • 11.24 There needs to be a mechanism to ensure that they are coming into the NHS.

    Could always make the job attractive and worthwhile again. Carrot rather than stick

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  • At least they will only receive applications from people who are happy to be beated and oppressed. It will weed out people who will stand up for themselves. Bingo!

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  • Introduce this and along comes the next Jeremy Hunt with added power to impose appalling conditions on his captive Dr work force. 'I own you' he'll effectively say - 'Leave the NHS and you owe me thousands and thousands for your training'. Does anyone seriously think this wouldn't happen? Does anyone genuinely believe this kind of control wouldn't be shamelessly abused by the government with a complete monopoly in employment and financial penalty for any Drs walking away.
    It'd be like signing away your life to the devil.

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  • This was introduced in New Zealand 1990s. We have lost roughly a third of our trained docs to higher paying overseas posts. We have the highest number of overseas docs in the commonwealth. It penalises women and those doing reseach or postgrad studies whom live on windfall apples, and its lead to a hike in specialists and a "lost cohort" of indebited graduates whom opted higher paid specialist training to clear the loan or they couldn't get house, mortgage or car or kids. I left nz to pay the loan. its being looked st for scrapping in the states now. And it may just contribute to the demise of #gp plus junior doctor suicides. Less think tank, more shark tank. Tying debentures to loans failed miserably inAustralia, I watched the sad spouses abandoning their partners and flee....

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  • I may be financially naive here,but wouldn't this mean that it would be then cheaper overall for any given nhs england employer to employ -say-an EU non uk graduate doctor who doesn't have such a loan to be repaid by HEE rather than a uk graduate who does?

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  • The phrase INDENTURED SERVITUDE springs to mind . In the 18 th century people paid their passage to the New World by agreeing to work for an employer for several years . Debt slavery . The World Bank gives poor countries loans that they cannot repay and then claims their natural resources . For medics the natural resources are blood ,sweat and tears.

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  • would this come under the category of ''grooming for abuse''. Should adult safeguarding team be informed of these vulnerable adults!

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  • Presumably this think tank idea was thunk by people who have never been anywhere near med school. We do actually have to work hard, putting in hours of our own time away from any tuition in addition to undertaking unpaid work on the wards before graduating. This crowd seems to think it's a passive process, that we are somehow imbued with the knowledge to qualify and thereafter reap the benefits; I'm guessing they haven't been anywhere near life in the NHS either.

    It's a sad but telling indictment of current conditions in the NHS and the general lack of understanding by those not trying to do the job that the response to a high attrition rate is to make it harder to leave, not to wonder why people no longer want to stay and fix that.

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