Could the A-level results fiasco help solve the GP workforce crisis?

Medical schools are set to be inundated with students who have met their offers after the government's U-turn on A-level results. Could the extra students help solve the GP workforce crisis?

Exam chaos (Photo: sajoiner/Getty Images)
Exam chaos (Photo: sajoiner/Getty Images)

The RCGP has warned that there need to be 'at least 20% more medical students at undergraduate level' to sustain general practice into the future.

For 2020, 7,500 medical school places had been made available. But health and social care secretary Matt Hancock has confirmed the cap on places will be lifted - opening the door to a significantly larger intake of students.

Doctors' leaders from the RCGP, BMA and the Royal College of Physicians have warned that more places will be needed at medical schools this year after the government's U-turn on the system for calculating A-level results meant many more students than usual achieved the grades to take up offers of a place at medical school in 2020.

But what are the implications for medical schools and the medical profession? Is the potential surge in medical student numbers a potential boon for the health service - and for general practice - down the line?

How many medical students could there be in 2020?

Medical school places are normally capped because the costs of training a doctor outstrip even the significant fees medical students pay over the course of their time in university. Training a GP has been estimated to cost the state up to £250,000.

So the total number of places that can be offered beyond the current 7,500 cap will depend to an extent on the government's willingness to fund additional places.

The RCGP says 'every student who has met the entry criteria to study medicine this year' should be enabled to do so. It's not clear at this stage how many students have met the grade targets in their medical school offers - but data from the Universities and Colleges Admissions Service (UCAS) show that more than 11,200 applicants have already been placed on medicine and dentistry courses starting this September, a figure 2% above last year's total.

UCAS figures show that a record 23,700 people applied for medical school places starting from September this year, and universities routinely offer more places than they have available on the basis that some students will not achieve the grades required in their conditional offers.

However, the government's decision to award A-level results this year based on teacher assessments - after scrapping the unfair algorithm used initially - means that many more students will have met the grades required than usual. Evidence cited by the Medical Schools Council showed that a comparison of teacher predictions and exam results in previous years showed '44.7% overpredicted, 6.5% underpredicted and 48.8% accurate at the level of individual A-level subjects'.

Could the extra students ease the GP workforce crisis?

Despite government promises to increase the GP workforce, GP numbers remain in decline. The profession lost 712 fully-qualified, full-time equivalent doctors in the year to March 2020.

Numbers of doctors in GP training are at record levels - but the profession is still losing doctors faster than it can replace them - so more potential GPs coming through is key.

RCGP chair Professor Martin Marshall said: 'We have previously estimated that there needs to be at least 20% more medical student places at undergraduate level and the equivalent training places for subsequent specialty medical training just to sustain general practice into the future.

'It is vital for the future of general practice that we have enough doctors training and qualifying to meet the needs of our growing population.'

He added: 'We’re delighted that the government has heeded our calls to lift the cap on medical school placements this year, and that all aspiring medical students who have met their eligibility criteria to enter medical school will be given their chance to become doctors. We have a severe shortage of GPs across the UK, and hopefully many of these students will eventually choose to work in NHS general practice, helping us to deliver care to more than 1m patients every day.'

What are the implications for medical schools?

Doctors' leaders have warned that medical schools will need more funding to cope with a rise in student numbers - and the RCGP has welcomed government assurances that this will be provided. But medical schools have warned that even with more funding, capacity to expand is limited.

BMA medical academic staff committee co-chair Dr David Strain said: 'For universities, student fees alone do not cover the cost of teaching doctors of the future. With falls in other streams of income since the COVID-19 pandemic, such as charitable research grants, medical schools find themselves under extreme financial pressure, leading to calls for voluntary redundancies and early retirement of clinical teaching staff.

'We already have a shortage of senior medical academics, and by increasing student places without the necessary support, inevitably quality of medical training will suffer. This will be to the detriment of all students, who will be impacted by staff-to-student ratios, relationships, and mentorship, as well as having implications on the future medical workforce. We know that having medical role models plays a significant part in the specialties that students ultimately choose.'

RCGP chair Professor Martin Marshall called for 'effective support for universities' to absorb a larger intake of pupils. He said: 'Taking on a larger cohort of students will have significant financial and administrative implications. Extra resource and consideration will also need to be given for subsequent academic years, as this will no doubt have a knock-on effect. Expansion of the other parts of the medical training pathway would also need to be sustained as these students progress through their education and training.'

The Medical Schools Council, however, suggested only a 'modest increase in numbers' could be absorbed by medical schools - warning that it was not the case that 'all applicants who now meet the conditions of their offer will be able to start medical or dental school in 2020'.

The Medical Schools Council has promised to work with the government to expand places if possible - but warned that medical schools' ability to expand would be 'limited by specialist facilities for subjects such as anatomy, clinical placement opportunities' and the quantity of available specialist equipment.

How could the exam fiasco affect who gets into medical school?

The RCGP has called for assurances that 'aspiring medical students from disadvantaged backgrounds and areas are not being disproportionately and negatively affected by the current A-level results fiasco'.

With exams cancelled due to the COVID-19 pandemic the government initially awarded results by using an algorithm that adjusted grades predicted by teachers. The algorithm was ditched after widespread concerns over unfairness - with the government opting to award results in line with teacher predictions.

Institute for Fiscal Studies director Paul Johnson wrote this week that the algorithm made it 'almost impossible for students at historically poor-performing sixth forms to get top grades, even if the candidates themselves had an outstanding record at GCSE'. The Labour party has said its discriminatory impact was potentially unlawful.

Universities awarded places based on the initial results published on 13 August - but the change in methodology has meant that many pupils whose results were initially downgraded have now been increased. Many now have the results to claim medical school places - but are struggling to claim them because students who fared well under the initial process have already been accepted onto courses.

In a letter to education secretary Gavin Williamson this week, the BMA said the algorithm approach had proven 'more discriminatory against high performing students from low income backgrounds than even we had feared'.

It added: 'There are clear benefits of improving diversity in medical education and in the medical workforce – it allows for doctors to be more understanding and representative of the populations they serve and thereby helps to ensure better engagement with health services.'

BMA representative body chair Dr Helena McKeown said: 'The medical workforce needs to be far more reflective of the diverse patient population it serves, and following the U-turn by government earlier this week, we have urged medical schools to review the applications of those who were earlier denied places due to the unfair grading process.'

An increase in medical school places this year could yet benefit the profession - but an increase borne out of a fiasco involving A-levels could also prove damaging. As the Medical Schools Council warned: 'All graduates are required to undertake foundation training in the NHS and any substantial increase in student intake in the current or subsequent years will have major funding consequences for DHSC/NHS for many years to come.

'Whilst the expansion in numbers of medical and dental students and future doctors and dentists is undoubtedly required, it should be undertaken in a fully planned and funded manner rather than in response to a crisis in A-level assessment.'

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