University of St. Andrews - degrees and licenses in medicine and dentistry: consultation analysis

Annex D: University of St. Andrews

The University of St Andrews requests the reinstatement of its ability to award degrees in medicine. The consultation sets out well the University of St Andrews' situation vis-à-vis the 1966 legislation. In response to the consultation we highlight the following:

Legislation and present disadvantage for St Andrews

The University of St Andrews is committed to working with other Universities and the NHS to do our part to help create 'a more sustainable medical workforce and encourage more people into a career in healthcare, whatever their background' as Section 11 of the Consultation sets out. The Coronavirus crisis has shown the value of our NHS and building a sustainable future is a priority for us all.

The 1966 legislation preventing St Andrews from awarding degrees in Medicine today, did not originally intend to stop St Andrews from offering such degrees; see paragraph 9 of the Consultation. The historical legislation is now fundamentally unfair as such a prohibition does not exist for any other Scottish university. It was originally introduced by the Universities (Scotland) Act 1966 that saw the re-organisation of Scotland's Universities when the University of Dundee was founded with a medical school that has thrived ever since.

The staff in the School of Medicine in St Andrews are buoyed by the potential to have the same opportunities available as to other medical schools in Scotland through the reinstatement of St Andrews' degree awarding powers.

ScotGEM, the contribution to grow the number of GPs in Scotland and St Andrews

The University of St Andrews together with the Universities of Dundee and the Highlands and Islands is delivering Scotland's first graduate entry programme for medicine (ScotGEM) for which 55 entry places are funded by the Scottish Government. The ability to award medical degrees is a requirement for awarding jointly the MBChB degree by the Universities of St Andrews and Dundee. ScotGEM plans to graduate its first student cohort in 2022. Medicine in St Andrews is rated for its excellence by its students, see NSS results 2019, and this is a major attractor to the ScotGEM programme as students start their programme at St Andrews.

If St Andrews were unable to award the MBChB as part of ScotGEM, the degree would be awarded solely by the University of Dundee, which would not be the expectation of the students and would likely reduce the attractiveness of the programme to students. This would have a negative impact on the programme, on both Universities, Dundee and St Andrews, and on the planned outcomes to grow the numbers of generalist practitioners through an efficient four-year graduate entry medical programme tailored to meet the contemporary and future needs of the NHS in Scotland while focused on rural medicine and healthcare improvement.

Clinical Research at St Andrews

Clinical Research at St Andrews is small but set in the wider context of high quality science on the North Haugh of St Andrews, which includes the disciplines of Physics, Chemistry, Biology, Computer Science and Mathematics. Medicine's research approach has been to engage in a truly interdisciplinary and collaborative manner with these schools, along with other universities in Scotland. Much has been achieved. The University has pioneering work in Artificial intelligence and digital image processing^[3], Data-driven clinical trials in primary care^[4], Novel Diagnostics in infectious disease^[5], and Cell Biology relevant to understanding human disease,^[6] to highlight a few. Results of work from all these projects are of direct impact and relevant to Scotland and the way we approach health care.

Our clinical research strategy is to build on these strengths. The School of Medicine's success is recognised in the University's overarching strategy which includes health as a priority. In addition, the University has committed to the establishment of an interdisciplinary institute for the early detection of disease, the Sir James Mackenzie Institute^[7]. This brings together the Schools named above but with a heavy emphasis in Physics (photonics), mathematics (modelling) and computer science (artificial intelligence).

A School of Medicine's area of research is within clinical medical disciplines and most medical schools in the UK made a return to Unit of Assessment 1 (UoA1) in the Research Excellence Framework (REF) 2014, a position that is unlikely to be much different in REF 2021.

The School of Medicine at St Andrews also made a return to UoA1 in 2014 and in terms of outputs was mid-table pulled down by environment and impact. Strenuous efforts have been made to address this with focus on select areas of research (see point 3), and the establishment of innovative impact cases. The assessment of the environment, however, is limited by the perception that St Andrews School of Medicine is not a clinical school. This also impacts on our strategy to recruit clinical academics, who can see this as impacting their career considerations. Re-establishment of the primary medical qualification (PMQ) would allow St Andrews to pursue clinical research on an even footing with other medical schools within UoA1 type disciplines.

We are committed to the highest quality clinical research and have had some notable successes over the past 5 years, as can be seen also in the rise in the rankings from 17 to 8 in the Complete University Guide^[8], but it is certain that until we become a PMQ awarding School with clinical status, we will be unable to compete on an equivalent basis. Examples of this include not being allowed to hold SCREDS lecturers, the non-nodal/teaching Board status of NHS Fife and the consequential inability to sponsor clinical trials or attract the same level of NHS infrastructure funding.

Re-establishment of the PMQ in an unfettered manner would allow St Andrews to participate equally with the other PMQ awarding Universities in Scotland in medical research which is known to have benefits to patient outcomes as well as the economy.

Local impacts – NHS partnerships and St Andrews

St Andrews is committed to making sure that these developments have a positive impact for everyone living in Fife through our work. Research shows that academic partnerships with the NHS:

• Deliver better care - patients who are part of clinical research studies have better health outcomes and this is achieved through working with academic partners;
• Help retain NHS staff - research active Health Board areas are more able to attract staff and retain graduates which is especially important in rural areas;
• Help grow the economy - Medical Schools are integral to an areas capacity for economic growth, through engagement with the life sciences agenda.
• Strengthen the delivery of health provision in the local economy - St Andrews model of clinical placements for undergraduate education has developed away from a traditional tertiary hospital provider to a model that is based mainly in primary care and the community, which has benefits for patients.

Without St Andrews having degree awarding powers, the message for NHS Fife has been that it cannot have teaching board status. This has quite significant impact upon their funding from CSO. It also means that NHS Fife are not able to act as a sponsor of clinical trials. St Andrews is therefore in a position where its cognate NHS Board is not able to be equivalent to other Boards until the St Andrews PMQ is reinstated. This impacts on NHS Fife's ability to recruit and retain excellent clinical staff who wish to have research as part of their work plan and reduces the pool of NHS staff willing to engage in our research and teaching locally.

Students we train currently graduate elsewhere. Those who want to pursue a research career after graduation are very unlikely to return to St Andrews, preferring the university of their final graduation as the locus of their postgraduate research training. This has implications for other academic schools in St Andrews that would benefit from better access to clinicians, data and samples such as Biology, Physics, Mathematics& Statistics, Chemistry, Computer Science, Psychology and Neuroscience, Geography and Sustainable Development.

This also means that currently our key impacts are not local, our research activity is benefitting internationally or elsewhere in Scotland more than locally in NHS Fife, resulting in well qualified people leaving the area.

• We have a major contribution to make locally but are committed to working with partners across Scotland including the Highlands, Tayside, Dumfries and Galloway through ScotGEM and we have reached out to Borders, Forth Valley, and Lanarkshire for other plans in development and submitted to Scottish Government.
• The University currently has no plans or ambitions to offer degrees in Midwifery or Dentistry.
• The University of St Andrews does not believe there to be negative impacts on others through the reinstatement of the ability of the University to award degrees in Medicine.