Memorandum by the Department of Health
CLINICAL ACADEMIC CAREERS
1. The Science and Technology Select Committee
expressed concerns about the position of clinical academics in
its 1995 report Medical Research and the NHS Reforms. In
response, the Committee of Vice Chancellors and Principals (CVCP)
commissioned the Task Force on Clinical Academic Careers chaired
by Sir Rex Richards. The Richards Report, which the CVCP published
in July 1997, described the pressures on clinical academics and
made recommendations on how these pressures might be alleviated.
2. The Select Committee interviewed Sir
Rex Richards and members of his team in November 1997 and subsequently
published a short report Clinical Academic Careers. In
this report the Committee welcomed the initiative by the NHS Executive
and the Higher Education Funding Council for England (HEFCE) to
establish two joint Department of Health (DH)/HEFCE task groups.
This initiative was a positive response to concerns about the
outcome of the 1996 Research Assessment Exercise (RAE) in relation
to clinical health services research and the interrelationship
between research, teaching and patient care. The Committee also
welcomed, and appended to the report, Sir Alan Langlands' letter
of 24 November 1997 which summarised a number of other developments
which had taken place since Sir Rex Richards began his inquiry.
Further progress continues to be made as set out below.
3. The Richards Report recommended that
"any increase in the target numbers for medical student admissions
must be accompanied by a corresponding increase in the numbers
of clinical academic staff and the facilities to accommodate them".
In July 1998, the Government accepted the recommendation of the
third Report of the Medical Workforce Standing Advisory Committee
(MWSAC) that the intake of students to medical schools in the
United Kingdom should be increased by about 1,000 places per annum
(about 20 per cent) to about 6,000. The need to accommodate a
significant increase in the numbers of clinical academics nationally
was one of the factors reflected in the planned phasing of the
increase over the period 2005.
4. Most of the additional medical student
places will be in England, and the HEFCE was advised in the allocation
of places by a Joint Implementation Group (JIG) co-chaired by
the Permanent Secretary of the Department of Health and the Chief
Executive of the HEFCE. The increase in students in Wales was
35 in the only Welsh undergraduate medical institutionthe
University of Wales College of Medicineand there may be
more following consideration by the National Assembly for Wales.
Northern Ireland and Scotland did not plan any significant increase.
Scotland will continue to produce more doctors than its proportion
of the UK population would indicate.
5. The JIG required all bidders to satisfy
it on the availability of suitable clinical academic staff. The
JIG bidding form, which was sent to all Universities and NHS Chief
Executives in England on 8 January 1999, required all bidders
to comment specifically on:
". . . the numbers of clinical academic
staff, currently engaged, additional recruitment implied by the
proposal, and anticipated ease of recruitment. . . ."
6. The need to ensure effective academic
support was reflected in the linking of new centres of medical
education to existing medical schools. Three have been announced
Durham, Stockton Campus (Newcastle).
WITH NHS COLLEAGUES
7. The Richards Report referred to clinical
academics' longstanding concern about pay parity with NHS colleagues;
progress on this issue was reported in Sir Alan Langlands' letter
of 24 November 1997.
8. Pay parity has been maintained between
clinical academics and their NHS colleagues. In order to meet
the terms of the new DfEE condition of grant in relation to clinical
academic pay announced in November 1996, the HEFCE wrote on 14
March 1997 to all institutions which had received Council funding
for teaching and/or research in clinical medical and dental subjects.
The letter said that their recurrent grant payment for March 1997
would include an allocation to meet additional costs arising from
the Government's award to clinicians following the Review Body
recommendations, for the period April 1996 to July 1997. This
took into account HEFCE's most recent estimates of clinical academic
staff costs to the sector, and the differential between the clinical
pay award over the period and that for other academic staff. Further
funds were allocated for the academic years 1997-98 and 1998-99.
9. In Scotland, the SHEFC concluded that
further resources were not required for 1997-98 because of an
additional £15 million allocated to teaching this year and
because the differential would be small enough to be easily absorbed
by the institutes. Parity has thus been maintained for 1997-98.
The then Scottish Office Education and Industry Department nevertheless
advised that the SHEFC needs to consider extra funding for that
part of the 1998-99 financial year which falls within the 1997-98
academic year and also to recognise the ongoing requirement for
parity with clinical academics. For 1998-99 (and 1999-2000) a
condition of grant was applied and the SHEFC has made a specific
allocation to institutions to maintain parity. These will be reviewed
and adjustments made as necessary from within the SHEFC's resources.
The Scottish Executive welcomes the inclusion of clinical academics
in the Review Body's consideration.
10. In Wales as in England it was agreed
that pay parity between clinical academics and their NHS colleagues
should be maintained. The Secretary of State's letter of 15 December
1998 to the HEFCW stated that it was a continuing condition of
grant funding of the HEFCW that the Council enables institutions
to meet any additional costs for medical schools from the Government's
award to clinicians following the Doctors' and Dentists' Review
11. The Richards Report recommended that
the recognition of academic distinction in the award of discretionary
points be kept under annual review. The report also expressed
concern about the absence of an equivalent mechanism for rewarding
academic GPs. As part of the consultant contract negotiations
between the UK Health Departments and the BMA, a review of the
discretionary points and distinction awards schemes is being undertaken.
12. As the Select Committee is aware, in
response to concerns over the implementation of the Calman reforms
to higher specialist training and their effects on clinical academic
medicine, the Department of Health (on behalf of the four UK Health
Departments) issued an Academic and Research Medicine supplement
to the Guide to Specialist Registrar Training to explain
the flexibilities and opportunities which exist under the new
training arrangements. This was incorporated into the revised
version of the Guide which was published in February 1988.
13. The Academic and Research sub-group
of AGMETS, which was pivotal in producing the supplement to the
Guide to Specialist Registrar Training, continues to provide
a forum for the academic and research community to discuss matters
of mutual concern with senior DH officials. The sub-group meets
approximately twice-yearly under the chairmanship of Professor
John Temple. The current work programme includes a joint JCC/DH
Symposium on Careers in Academic Medicine which is being held
in Birmingham on 5 October 1999. The symposium aims to publicise
the action which has been taken to address the disincentives to
academic careers, to disseminate examples of good practice and
to identify solutions for outstanding problems. Health Department
representatives for Wales, Scotland and Northern Ireland will
also be involved.
14. Following the request from the Council
of Deans of Dental Schools (CDDS) and the CVCP and some discussion
at meetings of the Steering Group on Undergraduate Medical and
Dental Education and Research (SGUMDER), the Dental Schools and
Dental Hospitals Priorities Group was set up in June 1998 under
the chairmanship of the Chief Dental Officer for England. The
membership is representative of those bodies with an interest
in Dental Schools and Dental Hospitals in England. The Group's
remit is to consider the implications for undergraduate and postgraduate
education and training of England's current and future need for
dentists, to determine the priorities for dental schools and dental
hospitals in meeting that need, and to make recommendations to
appropriate bodies. The Group is expected to report its findings
to SGUMDER and other appropriate fora in autumn 1999. A separate
group is considering the position in Scotland.
15. The Richards Report drew attention to
the impact of the 1996 RAE. In England, the first of the two joint
DH/HEFCE task groups, which were announced by Sir Alan Langlands
and Sir Brian Fender in their letter of 26 June 1997, was asked
to consider how health-related research should be handled in the
next RAE. The Task Group was jointly chaired by DH and HEFCE officials
and the membership included representatives of NHS R&D and
academic advisers to the HEFCE. The Group has considered the units
of assessment to be used in the RAE, the criteria for assessment,
assessment panel membership and whether special initiatives might
be taken to encourage investment in developing areas such as health
services research and primary care.
16. The Task Group issued a consultation
document in August 1998 and in the light of the response made
a number of specific proposals on how the RAE might best deal
with DH and NHS strategic issues in respect of health services
research. For the next RAE in 2001: sub-panels will cover strategic
interest areas; and ratings for subject areas agreed by each of
the sub-panels will be published.
17. The final report from Task Group I has
been submitted to HEFCE and DH.
18. A current issue for the employment of
clinical academics is the pressure on universities to substitute
research academic posts for clinical academic posts to reduce
their costs and to benefit their RAE position. The potential consequences
for teaching and clincial care are recognised as an issue in the
Richards' Report and for DH/HEFCE Task Group II. In Scotland this
has led to the funding of clinical lectureships through the Scottish
Council for Postgraduate Medical and Dental Education in order
to ensure that there is a sufficient input of medically qualified
clinical experience into the teaching process.
LIAISON: JMAC REPORT
19. Sir Alan Langlands' letter of 24 November
1997 informed the Select Committee of a joint initiative with
HEFCE to identify and disseminate examples of good NHS/university
partnership at local level. In 1998, the HEFC's Joint Medical
Advisory Committee (JMAC) commissioned the University of Manchester's
Health Services Management Unit to undertake a study of good practice
in NHS/university relations. The study was concerned with the
ways in which the NHS and universities are dealing with:
competing pressures on staff time
for teaching, research and patient care;
curriculum change and changes in
the pattern of clinical placements; and
issues arising from the implementation
of the Culyer Report on supporting research and development in
20. The study focused on the development
of good practice in five study sites (Aberdeen, Cardiff, King's
College London, Liverpool and Sheffield) but also gathered examples
from other locations.
21. The report Good practice in NHS/academic
links was published in March 1999 and has been distributed
to heads of UK higher education institutions, heads of UK medical
and dental schools and chief executives of NHS trusts, health
authorities and health boards.
22. The Richards Report recommended that
"more work should be done to explore the concept of the University
Hospital NHS Trust". Following some discussion of the Richards
Report at SGUMDER and other fora, Sir Alan Langlands met the Chairman
of CVCP's Medical Committee and the Chairman of the Council of
Heads of Medical Schools to discuss their concerns about relationships
between medical schools and NHS trusts and to explore how these
might best be taken forward.
23. It was agreed that new structures and
radical solutions should be avoided but that there would be benefit
in improving collaboration and joint management processes in line
with SGUMDER's Ten Key Principles. It was agreed to invite the
Nuffield Trust to organise and host a small seminar of key players
to discuss the development of ground rules to operationalise the
Ten Key Principles at local level. The Nuffield seminar was held
in November 1998. To inform the discussion, the Nuffield Trust
carried out a survey of medical school deans and teaching hospital
chief executives on the interface between medical schools and
NHS trusts. The survey results, which were circulated with the
JMAC report on Good Practice in NHS/academic links, confirmed
that there is scope for improvement in many parts of the country
but also identified some positive initiatives.
24. The November 1998 Nuffield seminar brought
together a number of chief executives of university teaching hospitals,
heads of medical schools, and other key players including the
chief executives of the NHS Executive and of the HEFCE, to address
the results of the survey and address the interface between the
NHS and university sectors. It was agreed to form a smaller working
group with the aim of considering a joint strategic appoach and
producing guidance for its translation into local relationships.
The November 1998 group will reconvene in October 1999 to consider
the working group's report.
LINKS: DH/HEFCE TASK
25. The second of the two DH/HEFCE task
groups was set up, under the chairmanship of Professor Alasdair
Breckenridge, to examine how best to take account of the interdependency
between research, teaching and patient care in the funding of
university medical schools in England. In particular, the Group's
terms of reference are to:
suggest what practical arrangements
might be put in place by the HEFCE and the DH to anticipate and
consider the potential impact of their funding decisions on university
medical and dental schools and NHS service providers; and
consider what practical steps universities
and NHS employers might agree locally to help reconcile the competing
pressures on clinical academics in delivering research, education
and patient care.
26. The Task Group's report was submitted
to Sir Alan Langlands and Sir Brian Fender in September 1999.
27. The Government recognise the importance
of academic and research medicine and has taken note of the findings
of the Richards Report. A considerable programme of work is underway
to strengthen the partnership between the NHS and the higher education
sector and address many of the issues which were highlighted in
the Report. The Government are committed to an approach which
takes full account of the key role of universities and of academic
medicine in delivering the NHS of the future, and will continue
to work with all the stakeholders to ensure that further progress
is made in removing disincentives to a clinical academic career.