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Can apprenticeships solve the NHS workforce crisis?

Without proper planning, the commitment to expand medical training outside of traditional routes risks creating a two-tier system.

By James Hadlow and Chris Farmer

The NHS workforce plan has finally arrived – and just in time for the NHS’s 75th Birthday. The plan even warranted a Downing Street press conference to announce future plans on staffing. As junior doctors begin their longest strike in NHS history, with thousands of operations and appointments expected to be cancelled over the five-day walk-out, it has never been more crucial to address the recruitment and retention problems facing the NHS.

One of the most striking features of the NHS workforce plan is the move towards an apprenticeship model across the NHS, including for medicine. The words “apprentice” and “apprenticeship” features 99 times in the plan. By contrast, the word “doctor” features 90 times. This gives a sense of how apprenticeships are seen as a way out of the current recruitment and retention crisis.

But are apprenticeships really the solution? Medical school places are already over-subscribed. The current Ucas cycle data shows there were 26,820 applicants for medicine in 2023. There is clearly no shortage of people wishing to study medicine. Indeed, as part of the plan, there is a welcome increase in the number of medical school places, with a planned expansion to 15,000 places by 2031/32, and with a focus in geographical areas that are short of doctors such as remote, rural and coastal regions. However, even with this increase in places, there will still be a surplus of people wishing to pursue a career in medicine based on current figures. 

The well-intentioned rationale behind medical apprenticeships is widening access to medicine to those who may not have been able to apply previously, with the added benefit of increasing diversity within the NHS. This is, of course, to be actively encouraged. It also has the admirable and vital aim of doctors in healthcare settings better representing the communities that they serve.  

However, comparatively, there is a striking lack of detail in the plan on increasing postgraduate training places to match the increased undergraduate supply. Whether coming into the profession via medical school or apprenticeships, it is difficult to understand where the additional newly qualified doctors will end up. 

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The announcement has not been without criticism, particularly from doctors on the ground who will presumably be primarily responsible for delivering this “on the job” training. Given the reaction from clinicians, it is clear there is a huge amount of work still to be done regarding engagement with the medical community, and this sadly hasn’t happened at the scale necessary to implement such a radical and controversial change.

Many questions remain regarding medical apprenticeships. Who will train the apprentices? What support will be given to doctors and other staff who are already struggling to provide clinical services to their patients in a stretched system? What work will apprentices do whilst learning, and how will a balance with formal learning be managed? What is the long-term career trajectory for these additional medical trainees when there isn’t a similarly ambitious expansion in postgraduate training programmes?

Despite reassurances from the government that training and examinations will be as rigorous as traditional medical degrees, it’s not clear how two distinct medical training programmes would work in practice or be equitable. Would anyone choose to go to medical school with rising student debt during a cost-of-living crisis over a paid apprenticeship programme where student tuition fees are waived? Regardless of best intentions, there is a risk that apprenticeships will not be viewed in the same way as traditional medical degrees by future employers, putting newly qualified medical apprentices at a disadvantage.

Any scheme that is fundamentally reshaping medical training needs to be robust and fair. It’s clear that however good the intention and theory on paper, the reality is that this apprenticeship model has a long way to go to get to this point. Carrying out such a scheme requires thoughtful consideration, engagement and even more careful implementation. It may not be fair or ethical for a whole cohort of individuals (and their trainers) to embark on medical apprenticeships without a clear direction of travel that is equitable to that of their traditional medical school counterparts.

It is imperative that the path the NHS intends to embark on, to safeguard our future workforce and widen access to medicine, does not do precisely the opposite by creating two distinct medical training systems, which are viewed differently. Perhaps enhanced funding in the form of “community scholarships” to sponsor additional medical school places for candidates in areas of need, alongside a long-term expansion in medical school places, would be simpler, more logical and more equitable solutions to reduce inequalities and tackle staff shortages.

The NHS workforce plan we’ve been asking for has finally arrived – and whilst some questions have been answered, we may have been left with even more.

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