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End the limit on medical training places to reduce dependency on overseas doctors

  • Axe bursaries and replace them with loans that the government will repay – on condition that students work for the NHS after graduating
  • Number of overseas doctors applying to work in the UK higher than the number of British doctors being trained
  • Large number of retirements in the next few years set to exacerbate dependency on overseas doctors
  • The UK spends up to £12 million a year training international medical students who are free to leave the UK at the end of their course

The cap on medical training places should be scrapped and new funding arrangements introduced to incentivise doctors to commit their careers to the NHS, a new Civitas report urges.

Despite a severe shortage of doctors in the NHS, medical school places are restricted by the government to just over 6,000 a year. This is exacerbated by many of newly-trained doctors quickly leaving the NHS to work for agencies, private providers or overseas.

Civitas healthcare researcher Edmund Stubbs proposes scrapping the upfront public funding of medical training and instead requiring students to take out loans which would then be paid back by the government – to the same value as upfront funding is currently available – on the condition that doctors then work in the NHS.

Stubbs writes: “The only way to solve the current medical staffing crisis is to find a way to train more medics in this country. What we need is a far larger pool of medics from which we can produce a stable, permanent workforce. It is also imperative we ensure that doctors continue to work for the NHS after the UK taxpayer has made such a major investment in their training.”

In ‘Supplying the Demand for Doctors’, Stubbs suggests that instead of Health Education England (HEE) making upfront payments for the training of its medics (via bursaries, fifth year tuition fees and clinical placement fees), medical students should be required to take out a loan from the Student Loans Company to cover the total cost of their training.

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 train the number of doctors it needs.

This training loan would then 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.

The extent of staff shortages in the NHS is demonstrated by the increasing proportion of doctors employed by the NHS from overseas or through staffing agencies. Of the 23,544 doctors who applied to the GMC in 2014 to be registered as ‘fit to practise’, 15,201 were from the UK, 4,621 from the EEU and 3,722 from non-EU countries.

The number of overseas doctors applying for GMC approval in 2014 (8,343) is higher than the total number of commissioned UK medical school places in the same year (6,071). Meanwhile, thousands of UK-trained doctors are leaving the UK to work abroad each year.

These shortages are set to worsen given the high numbers retirements that are thought to be imminent and the expansion in the workforce that is needed in the coming years:

  • About 13,500 consultants and GPs are set to retire in the next five years.
  • The consultant and GP workforce must grow by around 9,400 posts between 2015 and 2019 to meet projected

The failure of centralised workforce planning is illustrated by the fact that the NHS is using up to £12 million per year from its training budget for overseas students to study in the UK – who are free at the end of their course to leave the UK.

International students who study undergraduate medicine are given their placement fees (at £34,000 per year) – the same as any UK national student.

“The NHS, faced with a staffing crisis and serious underfunding cannot reasonably be expected to fund the training of medics who have no desire to work for the organisation,” Stubbs argues.

“Those medics who want to work in the private sector or abroad after qualifying might, in the light of the proposed scheme, be encouraged to consider undertaking their medical education overseas or even in the rapidly expanding private medical university sector.

“It is possible that some private or overseas healthcare employers might be prepared to repay student loans on behalf of their employees as an incentive to work for their enterprises.”

“The fact that we fully fund the placements of international students is alarming. The money saved from the NHS no longer paying clinical training placement fees on behalf of such students could fund the training of many more UK medics.”


‘Supplying the Demand for Doctors: The need to end the rationing of medical training places’ is released Thursday June 2nd. A PDF of the text can be accessed below.

Edmund Stubbs is Healthcare Researcher at Civitas. He studied Biomedical Science at the University of Sheffield and has a Master’s degree in Health, Population and Society from the London School of Economics and Political Science. Edmund also worked as a healthcare assistant for four years at Addenbrooke’s Hospital, Cambridge, and as a freelance health consultant for one year.

For further information contact:

Jack Mason, communications officer
T: 0207 799 6677


Edmund Stubbs, healthcare researcher
T: 0207 799 6677

Supplying the Demand for Doctors: The need to end the rationing of medical training places

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