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

Annex E: University Of Dundee

No, the University of Dundee believes that Parliamentary approval should be sought for the alternative option set out in paragraph 22 of the consultation, such that the prohibition is only lifted to the extent of enabling the University of St Andrews to award a Medical Qualification (PMQ) in respect of the ScotGEM programme.

The proposal would increase the number of potential providers of higher education in Medicine, Dentistry and Nursing/Midwifery in Scotland. This would have the effect of spreading the number of student places identified through Scottish Government workforce planning across a larger number of providers. Given existing providers can meet current demand and have capacity to expand their programmes in the event additional numbers are required, adding a further provider would be inefficient and represent poor value for public money. Existing provision in Medicine, Dentistry and Nursing/Midwifery is coherently distributed across a number of institutions in East and Central Scotland and is readily accessible to potential students. The proposal therefore runs counter to the Scottish Funding Council's core objective of delivering a coherent and sustainable system of higher education.

The ScotGEM programme was originally conceived as a joint programme delivered by the University of St Andrews and the University of Dundee, with the final degree to be awarded by the University of Dundee. However, prior to submission of the final proposal to the Scottish Government, the University of Dundee agreed to a revision of the application such that the final degree would be awarded jointly by both institutions. It did so on the basis that it would support the University of St Andrews to seek reinstatement of these degree awarding powers solely for the purposes of ScotGEM.

The alternative option set out in the consultation is therefore consistent with the basis upon which the University of Dundee entered into its partnership with the University of St Andrews and submitted the ScotGEM application.

The consultation document essentially proposes that: "The 1996 Act requires to be amended to allow the University to award a Primary UK Medical Qualification (PMQ) to Scottish Graduate Entry Medicine (ScotGEM) MBChB students, jointly with Dundee University. It is, however, proposed that the prohibition on all types of degrees under Schedule 6 is repealed."

The argument for doing so appears largely to be that it is just simpler to modify the law in this way rather than doing it once to award the joint degree, then again at a later date if St Andrews were to be awarded license to develop their medical school under the Scottish Government's Programme for Government (or other means).

ScotGEM was specifically designed to address the critical shortage of doctors in primary care and in particular in remote and rural areas. In all other aspects the situation is unchanged in Scotland since 1966, namely the buildings (Teaching Hospital) are still in Dundee and therefore the question must be asked: what has changed that makes it appear sensible for Scottish Government to support full and independent degree awarding powers to St Andrews University?

The Consultation paper argues that this is to allow St Andrews University to be "on an equal footing with the other bidders in the PfG process". But the 2019 Programme for Government is specifically designed to increase medical student numbers in order to address capacity issues in the future. Given that St Andrews has no teaching hospital, how would the ability to award a medical degree and bid for a medical school actually contribute to this? Here it is notable that the closest District General Hospital, Victoria Hospital in Kirkcaldy currently takes a large number of students from Dundee University, while Fife GPs also deliver significant teaching in primary care for both Dundee and ScotGEM students. If medical students from a new St Andrews School of Medicine were instead to use the resources, as the only nearby options for clinical training, we envisage a 25% reduction in training capacity for Dundee and as such this proposal would not deliver on either the medical training requirements of the country or the goals of the 2019 PfG. We would also point out that while Dundee has 85% Scots-domiciled students, a high percentage of those in St Andrews are from the rest of the UK, Canadian or students who go to Manchester as part of a joint initiative, and so increasing capacity in St Andrews at the expense of Dundee would run counter to Scottish Government's concerns about national retention.

It is also worth pointing out that the collaborative ScotGEM programme was largely borne out of the expertise of the University of Dundee. St Andrews had no experience of delivering a clinical programme as its biomedical teaching was largely traditional and lecture based. Innovative aspects of ScotGEM such as the Agents of Change model and Longitudinal Integrated clerkships, were developed using Dundee's expertise and outstanding reputation in teaching. In this context, St Andrews at no time indicated they were considering applying to develop their medical school capability and the current application to Scottish Government has been made without consulting Dundee. This may very well negatively impact the delivery of ScotGEM.

The proposal also allows St Andrews University the ability to award degrees in Midwifery and Dentistry which will be in direct competition to the University of Dundee (and other providers). Many of the same arguments raised about medicine also apply to these subjects.

Some additional points:

Further developing a medical school with degree awarding powers in St Andrews will materially affect the University of Dundee's very successful track record and question its viability.

Scottish Government proposes to expand medical training by developing a new medical school, a proposal that was not supported by the existing four medical schools in Scotland.

Scotland can be proud of having existing medical schools of outstanding international reputation that already graduate 50% more students per million of the population than medical schools in the rest of UK.

The School of Medicine in Dundee has directly addressed the needs of NHS Scotland by recruiting greater than 80% Scots-domiciled students, consistently meeting Widening Access targets, increasing the General Practice component of the curriculum to 25%, developing innovative approaches such as the longitudinal integrated clerkships in primary care, developing innovative partnership programmes such as ScotGEM that directly address the future needs of remote and communities, and by retaining nearly 90% of its graduates in Scotland for their Foundation years.

We believe there is a significant risk that unless Scottish Government take a coordinated, geographical approach to allocation of Health Boards to partner medical schools, a marked increase in student numbers across Scotland or the development of a new medical school will likely increase the complexity and burden of undergraduate teaching on a strained NHS workforce.

We have recognised that, irrespective of their socioeconomic background, Scottish medical graduates are more likely to remain in Scotland if they have been Scots-domiciled prior to their undergraduate training. The Dundee MBChB programme has consistently recruited at above Scottish Government target levels for Scots-domiciled students and for the 2019/20 intake had the highest percentage of Scots-domiciled students in the UK (86%).

The School of Medicine in Dundee is committed to promoting entrance to its programmes via non-traditional routes, to engage in work to attract and support disadvantaged students and to increase the proportion of entrants from Scottish postcode areas classified as deprived, recognising that by doing so we are ensuring the NHS in Scotland is better reflective and understanding of the broader needs of all of its patients in the future. The school has consistently met or exceeded its targets, which as a percentage of intake, are the highest in Scotland. Within the 2019/20 Gateway cohort 36% of students are from SIMD20 postcodes and 27% are young carers. Students with disability are also represented. Some 31% of ScotGEM entrants are SIMD20 or SIMD 40.