COUNCIL OF HEADS OF MEDICALSCHOOLS
AND DEANSOF UK FACULTIES OF MEDICINE
1. Academic Medicine (i.e. medical schools and their broadeducation, research and service agendas), supported by close partnership withother university disciplines, other health professions and with NHS service, iscrucial to:
the quality of the NHS workforce and leadership;
the development of NHS quality and service innovation;
one of the most substantial areas of the UK researchbase on which biotech developments are heavily dependent;
industry, particularly the pharmaceutical and devicesindustries;
innovation and the economy in local regions;
2. At the core of Academic Medicine are around 3,000'clinical academic' consultants employed by the universities but holdinghonorary NHS consultant contracts. Onethird of the Medical Directors for the major Teaching hospitals, the majorityof the Royal College presidents, the majority of the medical signatories to theNHS Plan, and about half of the NHS czars are clinical academics. Following the report by Sir Brian Follett tothe Secretary of State for Education and Skills in September 2001, on his Review of appraisal, disciplinary and reporting arrangementsfor senior National Health Service and university staff with academic andclinical duties, there is now effective joint management and planning betweenuniversities and NHS Trusts. A jointappraisal scheme has been introduced and there are joint planning bodies atlocal level.
3. UK academic medicine has made a huge contribution toboth UK NHS and UK Plc as well as to global health. Medical education has been a great success story, being bothflexible (e.g. Tomorrows Doctors, GeneralMedical Council, 2002) responsive tochange, e.g. the new undergraduate medical curricula, and medical research hasprovided the basis for healthcare innovation, better health and greaterlongevity in the UK and beyond.However, there is a risk that implementation of policy decisionsfollowing the White Paper and other recent developments may inadvertentlydamage a generally very successful but deeply complex system. [Notethat academic medicine's role in clinical leadership, innovation and service,in undergraduate (and to a substantial extent postgraduate) teaching, and inclinical research are strongly interdependent.Clinical academic departments contribute centrally to all three and thegreat majority of individual clinical academics do so, though not necessarilyall at the same period of their careers.Many junior clinical academics change track to become excellent NHSconsultants. The reverse is also seen.]
4. The expectation of what medical schools will bring, forexample, to the regions with the advent of the new medical schools, flows fromthese interdependent functions. Therisk to new medical schools from some elements of the Higher Education WhitePaper and associated funding decisions is of great concern, in particular withthe absence of mainstream funding for research before the next ResearchAssessment Exercise (or its successor).The General Medical Councils TomorrowsDoctors states explicitly that every medical student should during theirundergraduate training use research skills to develop greater understandingand to influence their practice. Thisimplies that they should learn in a research-rich environment. Funding decisions with respect to the newmedical schools are, therefore, at risk of compromising their ability to fulfilthe GMCs requirements. Their abilityto recruit and retain high quality staff is equally threatened by the fundingdecisions. These problems also riskseriously damaging some existing Schools if current trends in funding becomeintensified.
5. Currentlythere are several major issues, which unless effectively resolved risk veryseriously damaging the complex synergies between the clinical and academicroles and between medical schools, the NHS and regional economies:
Intense pressure of short-term clinical service-led goalsand for immediate clinical delivery
The unresolved uncertainties on the NHS consultant andGP contracts for clinical academics
Concern that there is no reference to teaching in the GPcontract
The reform process on Modernising Medical Careers in theNHS and its impact on academic medicine
The impact of the White Paper on the Future of HigherEducation and associated funding decisions:
- Top-up fees for tuition and financial support formedical students
- Increased research selectivity and concentration, resultingin overall reduction of approximately 7% in research funding for 2002-3 andmajor reallocations between medical schools for 2002-3 and 2003-4
[Cuts in research funding forMedicine are a result of:
6% cut in the weighting for clinical research for 2002-3
Transfer of Generic Research funding, which waspredominantly related to medical charity funded research, to mainstream QRfunds for 2002-3, and therefore spread more widely
Reduction in the weighting for charity funded researchfor 2003-4
Loss of funding for RAE 3a-rated research andsubstantial reduction in funding of 4-rated research for 2003-4 and possibilityof loss of remaining funds for 4-rated research in the future
- Reduced teaching funds for Medicine to allow wideningparticipation in other disciplines (e.g. approximately 5% reduction in Englishuniversities teaching grant for Medicine for 2003-4)
However, the severity of any damage will depend on how far theuniversities of which the medical schools form a part are able to protect theirmedical faculties.
6. Thus, in developing policy Ministers and Departmentsneed to be aware of these complex and interdependent issues and of the risk ofunexpected damage if they are not taken into account in policy decisions andtheir implementation. CHMS suggeststhat further consideration be given to the working of the partnership betweenthe Education and Health Departments, the Office of Science and Technology, andHEFCE including the strategic alliance between HEFCE and the Department ofHealth having regard to the central role of academic healthcare and theincreasingly important interconnectivity within universities between theclinical and bio-sciences, and more recently the other social and physicalsciences.
7. The range of issues arising from the White Paper andrelated policy developments are complex.The implications must be adequately investigated and modelled so that asustainable approach to the provision of healthcare education and service, andthe conduct of research to support healthcare innovation, can be developed.
Council of Heads of Medical Schools
March 2003