Exclusive: Medical students face new NHS entry exam

If the proposals from Health Education England go ahead they would signal a major change to the way the NHS recruits and trains junior doctors. It is intended to lead to a change away from what HEE describes as there being the current “moral obligation” to give medical students NHS jobs and instead improve the standard of medics joining the health service.

It would also mean medical graduates no longer have to work for the NHS at the start their career in order to gain a licence to practise.

In a report, HEE said the change would “shift the moral imperative from the promise to medical students into a promise to patients for the highest quality care from the best candidates entering UK training”.

Wendy Reid, HEE’s medical director who wrote the document, said: “Patients have the absolute primacy of right in the system and at the moment doctors are in employment before we have that assurance for patients because that is how we register them.”

A driving force behind the proposals is that the current two-year hospital foundation programme for junior doctors is coming under pressure due to rising numbers of trainee medics. Successful completion of the programme is the only way for junior doctors to achieve a full licence to practise in the UK.

In 2012-13 there were 295 more applicants than places on the 7,242-place programme. Some were allocated spaces which became vacant but about 160 extra places were created to accommodate the oversubscription at extra cost to the NHS.

While training posts for doctors were cut by 2 per cent last year in England the demand for places is expected to continue rising due to more applicants from Europe and the development of private medical schools.

HEE told HSJ it could not continue to fund increased places and described its proposal as the preferred option.

It would see medical students in all four UK countries granted a full licence to practise medicine after graduating from university but in order to gain entry to the foundation programme a new entry exam would be created to ensure only suitable candidates work in the NHS.

Those who fail to gain entry to the foundation programme would still be able to work as a doctor abroad or privately.

The exam is also seen as one way of improving the quality of foundation trainees. In 2013, 531 doctors across both foundation years failed to be signed off with 378 doctors being identified as being a serious concern. Eighteen of them were referred to the General Medical Council fitness to practise process.

Professor Reid added: “Under this recommendation only the best people would get in and those who don’t would be registered doctors able to work and not left as they are now without a registered professional qualification.

“This is a big opportunity to change the relationship with patients and doctors and will make the medical schools programme focus on what it means to be licensed doctor with the GMC as regulator able to look at that.”

The plan, if approved, would require changes to the Medical Act which could be bundled into the Law Commission review of regulators in 2014. There will be a three month consultation on the final proposals, which could take five years to implement.

In August HSJ reported the Medical Schools Council wanted to see a similar change but that the General Medical Council had concerns over the plans.

Harrison Carter, co-chair of the BMA’s medical student committee, said: “HEE argues it will bring improvements in patient safety, but we worry that reducing basic medical education by a year will result in the opposite.

“The proposal could also mean that medical graduate unemployment is more likely, with more applicants to the foundation programme from Europe.  This would be an enormous waste of both public and student investment in medical education.”