Contribution
I add my congratulations to the noble Lord, Lord Roe, on an excellent maiden speech.
I welcome the Minister’s explanation of the Bill’s priorities, which I broadly support, but I have some concerns about the possible unintended impact on the UK’s medical training reputation, especially given recent investments in international recruitment. While some predict that artificial intelligence may reduce demand for doctors, I believe that medicine remains fundamentally human, and current shortages make such predictions rather unconvincing. The NHS continues to face consultant-level vacancies and low morale among doctors. I agree with the noble Earl, Lord Howe, about the need for a significant increase in training placements.
Competition for medical jobs is long-standing. Certainly when I qualified—a long time ago now—there was no guarantee of specialty training at all. There was an assumption that the majority of graduates would proceed into general practice. But a shortage of specialty training placements now prevents both domestic and international graduates from progressing. This situation is made worse by poor workforce planning over many years, despite well-forecast numbers of medical students. It is this systemic issue that needs urgent attention. There are some key questions, such as whether this Bill is the best solution, whose investment in training is at risk, and how affected students and doctors will be notified and understand the impact for themselves. Many correspondents have shared their anxiety about the Bill’s career impact for them.
I will not repeat the arguments made by the noble Lord, Lord Clement-Jones, regarding the Queen Mary’s students in Malta. Similar arguments apply to students at City St George’s Cyprus campus, who follow the UK curriculum, meet GMC standards and are awarded UK-recognised qualifications yet will be deprioritised simply for studying overseas. They have taken identical exams and have committed significant time and money based on assurances that they could compete for UK foundation programme posts. Changing eligibility rules just as they graduate is unfair; it undermines confidence in our system and risks leaving qualified graduates without posts, damaging both the NHS and, of course, the reputation of City St George’s.
As an emeritus professor at City St George’s, University of London, I asked the dean for more information about the contracts that City St George’s has with students in Cyprus. Paragraph 3.4 of its contract says:
“On successful completion of the Programme, SGUL shall grant to the Student an award certificate to which he or she is entitled under the provisions of SGUL Policies and Regulations and will provide the Student’s name to the GMC in accordance with GMC requirements to enable students to be registered with the GMC as having a Primary Medical Qualification”.
This means that graduates were able to apply for the foundation programme and be considered equally alongside students who had studied in the UK. The issue of any visas required by graduates, of course, is outside the contract, as work permits for the UK sit under UK Immigration Rules. The question is whether there will be any legal risks. If a legal challenge was successful, presumably it would be financial, and presumably it would be the Government who would be accountable. I am not sure that the university could be held accountable for a breach of contract if the breach is the result of a change in law.
I also urge that consideration be given to whether those studying in overseas campuses might be included in the priority group, or at least to phasing in the changes prospectively for the sake of those already in training. Excluding such students devalues these important collaborations. I would be interested in the Minister’s response on whether there could be some valid legal challenges.
Fair workforce planning seems to be essential. Without adjustments, the Bill threatens morale and may drive talented doctors away. I have been thinking about proposing an amendment to ensure that graduates with UK medical degrees are prioritised for foundation programme entry, regardless of study location, which would seem to be fairer. One final point is that, for these overseas campuses, the numbers are actually quite small.