There have been a number of important developments concerning Modernising Medical Careers, regarding:
2008 recruitment and selection process
Medical graduates from outside the European Economic Area - document for discussion and FEEDBACK
MMC Inquiry led by Sir John Tooke
Please click on the link below to read a press release concerning these developments:
Medical Graduates from outside the European Economic Area - Document for discussion and FEEDBACK
The Department of Health has set out proposals for managing applications for National Health Service foundation and specialty training programmes from medical graduates from outside the European Economic Area (EEA).
A discussion document has been published seeking views from a wide variety of stakeholders and representatives about the proposals for 2008
Monday 8 October 2007 12:14
Department of Health (National)
Locally led, staggered recruitment for specialty training in 2008
No national IT system for applications
Agreement reached following support of BMA and the Academy of Medical Royal Colleges
Deaneries will organise their own recruitment process for specialty training in England in 2008 and junior doctor start dates will be staggered, Health Minister Ben Bradshaw announced today.
Ministers have accepted in full the proposals submitted by the Modernising Medical Careers (MMC) Programme Board for specialty training in 2008. The board included representatives from the BMA, the Academy of Medical Royal Colleges, as well as representatives of the NHS.
Plans for specialty training recruitment in 2008 broadly reflect arrangements for Round 2 recruitment in 2007, when the national IT system was not used. Arrangements for 2008 will include:
Devolution to deaneries
- Deaneries will organise their own recruitment process for most specialties.
- Their responsibilities will include: advertising vacancies; using their own or speciality-based application forms, which must be structured, CV-based forms with speciality-specific questions; using their own shortlisting criteria and scoring systems; interviewing and selecting successful applicants; making offers and receiving acceptances.
No national IT system for applications to training
- Deaneries will arrange their processes locally, building on the arrangements they had in place for Round 2 in 2007.
- The Programme Board agreed to develop a user-friendly and secure national IT system for use in the future.
Staggered start dates and recruitment
- Deaneries and specialities will determine entry dates, rather than one entry point on August 1 introduced in 2007.
- There will be a maximum of three recruitment processes a year. Recruitment for the August intake will continue to be the major recruitment, particularly for the ST1 level.
These are interim arrangements for 2008. Formal plans for 2009 and beyond will be discussed in light of Sir John Tooke's independent review of MMC.
Health Minister Ben Bradshaw said:
"I am delighted that the Department and the medical profession have worked together on arrangements that are good for doctors and good for the NHS. These ensure deaneries can deliver a flexible response to the needs of applicants as well as safeguarding national standards.
"We have learned important lessons from the difficulties with this year's recruitment process and have apologised to junior doctors for any distress caused to them and their families. We said we would listen to doctors and their representatives and today's announcement reflects this.
"If new or national systems are to be used in the future, they must be rigorously tested and agreed with doctors, the NHS and others involved.
"Excellence and high achievement have always been at the heart of medical training in this country. As we continue to work with stakeholders on the future of Modernising Medical Careers this pursuit of excellence will continue."
Today, the Department of Health also launched a consultation setting out proposals for managing applications for foundation and specialty training programmes from medical graduates from outside the European Economic Area (EEA). The Department is seeking views from stakeholders and their representatives before making a decision on guidance for recruitment in 2008.
In England in 2007, there were nearly 28,000 applicants for around 15,500 training places, a ratio of roughly 2:1. There were more international graduates competing for places than UK graduates. It is likely that competition will be more intense in 2008 with a forecast ratio more like 3:1 and over half of the applicants are likely to have trained outside Europe.
Health Minister Ben Bradshaw said:
"Increased investment in medical training since 1997 means that the NHS no longer relies so heavily upon doctors from outside Europe. We now have four new medical schools and medical school places in England have increased from 3,749 in 1997 to 6,451 in 2007.
"It can cost up to £250,000 to train a UK medical student and we have a responsibility to get the most from taxpayers' investment. If UK medical graduates are unable to access specialist training because of a large number of applicants from outside Europe, then it is only right that we should consider what needs to be done.
"It is also important to recognise that most International Medical Graduates (IMGs) who come to work or train in the NHS don't stay very long - 80 per cent leave within four years of joining the NHS. Ultimately, the NHS loses the trained GPs and consultants it needs when IMGs leave.
"The choice facing us and the medical profession is whether we accept that international medical graduates will displace UK medical graduates, or that we decide to maximise the opportunities for UK medical graduates and the taxpayers' investment in them. Most other countries give a priority to their own medical school graduates when appointing to specialist training posts.
"This is clearly an important issue and that is why we are consulting the medical profession on all the available options."
Notes to Editors:
1. The Department of Health's consultation paper on International Medical Graduates is available via the MMC website at
2. The Modernising Medical Careers Programme Board comprises representatives of the BMA (including the Junior Doctors Committee), the medical Royal Colleges, the NHS, Deaneries and the Department of Health.
3. Further details of the recruitment process for England for 2008, including detailed information for applicants, will be published shortly.
Modernising Medical Careers - Proposals for managing applications from medical graduates from outside the European Economic Area
Response from the British Medical Association
22 October 2007
The BMA believes that the timescale for consultation on this document has been insufficient and is extremely restrictive. On important issues such as these the BMA requires reasonable time to consult its members and conduct informed and detailed debate. Furthermore, the limiting nature of the questionnaire, which forces respondents to agree or disagree with questions relating to a narrow Department of Health agenda, is unacceptable and, instead, the BMA has given a more general response to the issue.
The BMA is also very concerned about the terminology used within the discussion paper. The term International Medical Graduates (IMGs) is being used incorrectly and will lead to misunderstandings and misapplication of the guidance. This is because the term refers to the place of qualification and does not reflect immigration status; a more appropriate term would be ‘doctors subject to the immigration rules’. Whilst a significant number of IMGs will be subject to the immigration rules, and therefore affected by the proposals contained within the document, there are some who are not. It is wrong to suggest that an individual’s place of qualification should determine their right to work in the UK. Some IMGs are British/EEA nationals, hold indefinite leave to remain, or have permission to work without requiring a work permit, meaning that legally they must be considered on an equal footing with UK/EEA nationals who are UK medical graduates, for example.
Introduction
The BMA has sourced opinion from all its main representational committees and its International Committee. The BMA’s policy on doctors subject to immigration rules is already well established and consistent. All doctors who have entered the UK with a valid expectation to train or provide a service, and who do not require a work permit, should be eligible to apply for all posts on an equal footing with UK and EEA applicants.
However, it is acknowledged that due to poor workforce planning, restrictions on funding and a failure to expand the consultant grade as promised, the Department of Health is seeking to reduce competition for specialty training posts. If this is to be the case, it is the responsibility of the Department of Health to advise non-EEA nationals, currently outside the UK, wishing to relocate to work in the NHS or study medicine at a UK medical school, that employment prospects in the UK are minimal.
We would recommend that this is done as a matter of urgency.
It is crucial that any such advice makes it clear that this does not affect doctors subject to the immigration rules who are currently in the UK.
Highly Skilled Migrant Programme
The BMA would like to highlight that in relation to holders of the Highly Skilled Migrant Programme (HSMP) visa, the BMA sought legal advice in 2006. This advice confirmed the BMA’s belief that doctors on the HSMP should not be restricted by the duration of leave to remain that they have under the HSMP. BMA policy reflects this and the view that HSMP holders should be regarded in category one when competing for posts.
UK trained medical students
The BMA has always maintained that non-EEA nationals studying medicine in the UK should be able to complete their entire postgraduate medical training in the UK. This is especially the case for those who had accepted a place on a medical degree course or commenced their studies before the immigration rules were changed and therefore came to the UK in good faith believing they would be able to compete on an equal footing for postgraduate training posts. Reneging on this assurance would not only be perceived as a breach of faith but would also mean that the UK will no longer be an attractive place to study medicine.
International medical students pay significantly higher tuition fees: £13,000 for their pre-clinical years and £23,000 for their clinical years. If the prospect of application to UK postgraduate training posts is removed, those who face returning to countries with low salaries will have immense difficulty in repaying any outstanding debts incurred during training. It would also be expected that when conducting workforce planning the number of UK medical graduates would not be assessed by immigration status and indeed up until this point non-EEA students at UK medical schools have been included in all workforce planning. These people are expected to graduate, work and train in this country.
For these reasons, the BMA could only accept a prospective decision on this issue, and we insist that, if such a decision were to be taken, any guidance would need to be absolutely clear to prospective future applicants to UK medical schools.
The BMA is also concerned that a change of status for these people would discourage potential international applicants from applying to medical school in the UK. This could have serious financial consequences for UK medical schools who reap the benefits of the high tuition fees. In this scenario it would be unacceptable to pass the financial burden on to UK students or to make significant cuts to UK medical school budgets. DH and the Department for Education and Skills would have to find this money from elsewhere.
Refugee doctors
The BMA does not support the proposed DH guidance but, should it be implemented, current and future refugee doctors must be exempt, and thus permitted to compete directly with UK/EEA nationals.
When asylum seekers are first given a positive decision they are granted indefinite leave to remain. This would mean that a significant number of refugee doctors applying for posts in the UK would fall foul of the proposed DH policy guidance and be excluded from applying for posts on an equal footing with resident workers.
Refugee doctors are ready trained professionals and should be given the opportunity to practise their profession in the country that has granted them asylum, rather than being left to deskill. Furthermore, unlike migrant workers who choose to come to the UK, refugee doctors are not in a position to seek employment elsewhere.
Restriction of choice
The BMA is opposed to restricting doctors subject to immigration rules currently in the UK to apply only for short-term training grade posts, such as FTSTAs. Such a restriction would run the risk of exploitation and stigmatisation of this group of doctors.
Conclusion
The BMA maintains that doctors subject to immigration rules who are currently in the UK with a valid expectation to train or work in the NHS should be treated equally with UK and EEA nationals.
The BMA has always expressed concern at the immediacy of the application of the changes to the rules relating to the postgraduate doctor and dentist category and the effect they had on doctors in training who were subject to the immigration rules. The BMA initially called for a period of grace for those doctors already in the UK and would urge the DH to take the interests of this group into account before implementing new policy guidance.
Any new policy guidance should be widely publicised in the UK and internationally to ensure that any potential applicants see it and are adequately informed. Any new guidance must be consistent with Home Office rules to prevent having a two-tiered immigration system which unfairly disadvantages members of the medical profession. Doctors already in the UK should be given as much assistance as possible to conclude their postgraduate training. In addition, any doctor subject to immigration rules who has been allocated to a training post cannot have this retrospectively removed.
The BMA urges the Department of Health to consider the impact that the provision of training for overseas doctors has globally and that the needs of countries that rely on their doctors receiving some training in the UK should be taken into account. We also recommend careful thought about potential consequences should the UK once again require overseas doctors to staff the NHS in the future. If these proposals are implemented in full, regardless of the legitimate expectations of many overseas doctors currently working in the NHS, future overseas doctors are unlikely to apply for posts in a country which has treated their predecessors so unfairly.
British-born medics should not be given training priority over foreign doctors already in the UK, the British Medical Association (BMA) has declared.
A government consultation has been launched after a report said thousands of UK doctors could not find jobs because of soaring foreign applicants.
The BMA said medical immigration did need to be controlled, but not at the expense of those already here.
Many had spent thousands of pounds of their own money on training, it said.
Ministers promised to look into the issue of applications from outside the European Economic Area (EEA) following a key report by Sir John Tooke.
He had looked into the recruitment problems in the wake of a new training system, and had concluded that the number of overseas applications had exacerbated an already difficult situation.
Some 16,000 of the 30,000 graduates chasing 20,000 jobs this year were foreigners.
Around 13,500 of these were from beyond the EEA. Around 10,000 were on the UK's highly skilled migrant programme, and many of the others were paying to attend medical school here.
There would be legal issues with giving UK graduates preference over those from European member states, but this would not apply to those born outside of the EEA.
'Scapegoats'
The BMA said all non-UK nationals who were currently studying medicine in the UK should be able to complete their entire training in the UK.
Most other countries give a priority to their own medical school graduates when appointing to specialist training posts
Department of Health
In addition, those on the highly skilled migrant programme should be allowed to compete for posts on the same basis as UK graduates.
"The thousands of overseas junior doctors currently providing essential services in UK hospitals must not be scapegoated for the government's poor workforce planning," said Dr Terry John, chairman of the BMA's International Committee.
"They came to the UK in good faith and in the honest expectation of training opportunities in the NHS."
A spokesperson for the Department of Health said: "Most other countries give a priority to their own medical school graduates when appointing to specialist training posts.
"The proposal only affects post-graduate and specialty training. It does not affect the thousands of NHS service jobs which doctors from outside the EEA can apply for."
Foreign doctors 'scapegoat' warning
Press Association
Wednesday October 24, 2007 3:03 AM
Foreign doctors already working in the UK must not be "scapegoated" as the Government tries to cut medical immigration, the British Medical Association (BMA) said.
The Department of Health is considering changes to the rules for medical graduates from outside the European Economic Area applying to specialist training posts next year.
But the BMA, giving evidence to the consultation, has said that while medical immigration should be better controlled, the thousands of doctors and medical students from overseas who are already in the UK should not be penalised.
Dr Terry John, chair of the BMAs International Committee, said: "Long-term, the UK should be able to produce its own medical workforce and managing medical immigration in the future will be necessary.
"However, the thousands of overseas junior doctors currently providing essential services in UK hospitals must not be scapegoated for the governments poor workforce planning.
"They came to the UK in good faith, and the honest expectation of training opportunities in the NHS.
"The BMA is particularly concerned about overseas students currently spending large amounts of money an average of 23,000 a year during their clinical years to study at UK medical schools.
"International medical students are often making huge personal and financial sacrifices in order to study in the UK.
"If they are not allowed to apply for postgraduate training posts, and are forced to return home, they could face a huge struggle in repaying outstanding debts."
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