Review Body on Doctors' and Dentists' Remuneration 2023 to 2024: Scottish evidence

G. Education and Training

Postgraduate

Medical trainee recruitment

169. The recruitment of medical trainees is predominantly undertaken on a UK-wide basis, some of which is by competitive entry with others based on progression where performance is satisfactory (known as run-through training). There are separate UK-run recruitment processes for the various stages of medical training i.e. entry into (i) Foundation-level training, (ii) first year of specialty training (Core & ST1 level) and (iii) higher specialty levels (ST3+). The start dates for most posts are spread from August to September of each year, with a subsequent recruitment round available later in the calendar year for a smaller number of posts starting the following February.

170. The 2022 recruitment cycle has now concluded and headline data is as follows.

171. A total of 1,155 posts were advertised throughout 2022, 1,072 of which filled successfully. This equates to a 93% fill rate. While this year's fill rate is slightly lower than it was in 2021 (94%), more posts have been advertised andfilled this year than any other year on record. This exceeds last year's record:

	Advertised	Filled	Fill Rate
2022	1,155	1,072	93%
2021	1,088	1,020	96%
2020	1,062	1,015	93%
2019	1,096	1,015	93%
2018	1,125	958	85%

172. Posts were advertised in 66 different specialties overall. Following the conclusion of all recruitment rounds, 39 specialties filled 100% of advertised posts. 9 specialties filled between 80-99% of posts, 11 filled between 50-79% of posts and 7 filled less than 50% of posts. Of the specialties that filled less than 50% of posts, 4 filled 0%. The number of posts advertised in those 4 specialties was very small, ranging from 1-3.

173. Foundation – 877 FY1 posts filled from 915 advertised (96% fill rate). 53 more FY1 posts have been filled this year than in 2021 (824 from 851 advertised, 97% fill rate). This increase follows the 2019 Workforce Plan commitment to increase the number of available places by 105 over two years.

174. Entry to Specialty Training: Core & ST1 (including GP) – 99% of the posts advertised this year at Core/ST1 level filled (773 from 782 advertised). A 99% fill rate was also achieved last year, however more posts have been advertised in 2022 (734 advertised in 2021). In 2022, 14 out of 17 specialties at Core/ST1 level achieved a 100% fill rate.

175. Higher Specialty Level (ST3+) – posts were advertised in 49 different specialties at ST3 or ST4 level. 373 posts were advertised and 299 filled successfully (80% fill rate). 25 specialties filled at 100%.

176. General Practice Specialty Training (GPST) – 326 GPST posts were advertised throughout 2022 at ST1 level, 319 of which filled (98% fill rate). This year's fill rate is down slightly on 2021 but still represents a very positive result. Recruitment in previous years is included below for comparision.

	Advertised	Filled	Fill Rate
2022	326	319	98%
2021	323	321	99%
2020	347	336	97%
2019	340	325	96%
2018	347	292	84%

177. We have been increasing the number of GPST places to contribute towards the Scottish Government commitment to have 800 additional GPs in post by 2027. 100 extra places were created in 2016, with a further 35 places being made available in 2023. Further increases are likely to be made in the coming years via the Scottish Shape of Training Transition Group (more detail below).

178. We also continue to offer £20,000 Targeted Enhanced Recruitment Scheme (TERS) bursaries to GP trainees who agree to take up post in locations which are historically 'hard-to-fill' and/or in remote and rural locations. The one-off, taxable payment is made to trainees as a lump sum upon taking up the post and in return they agree to complete the three year training programme in that location. Across the 2022 recruitment rounds, a total of 98 GPST posts were advertised with the bursary attached, 94 of which filled (96% fill rate). A full evaluation of the bursary and its impact is currently underway and is due to conclude in Spring 2023. This evaluation will inform future policy decisions in light of the fact that GP training places are now filling at close to 100%.

Expanding the medical trainee workforce

179. The Scottish Shape of Training Transition Group (SSoTTG) is responsible for making recommendations to Scottish Ministers regarding need to create additional training places for trainee doctors in order to support increased demand. These additional places are commonly known as expansion posts.

180. Scottish Ministers have created 725 expansion posts since 2014 across a wide range of medical specialties. 152 of those were agreed to recently and will be recruited to in 2023. This represents the most significant annual expansion to date (13 posts above the 139 created in 2022) and will be supported by £37m of Scottish Government funding over the next four years. An annual breakdown is included below.

Year	Number of posts created
2014	58
2015	15
2016	117*
2017	21
2018	26
2019	53
2020	70
2021	74
2022	139
2023	152
Total:	725

* includes 100 additional GP training places

181. Setting annual training intakes involves forecasting the supply of trained doctors required to maintain the future trained doctor workforce by specialty, using default modelling assumptions initially agreed during the 'Medical Reshaping' work, 2010-2013. These assumptions are: retiral age of 60-61; participation reduction factor of 1.4 to reflect increased Less Than Full Time (LTFT) working and a default consultant establishment growth factor of 1% pa. The SSoTTG will work with NHS Scotland Health Boards and other stakeholders to review these modelling assumptions and ensure they are still fit for purpose.

182. This, coupled with an annual consultation exercise to make any required deviations from default modelling assumptions, has been used since 2014 to make adjustments to the medical specialty training intakes which are implemented via annual UK national recruitment. All vacancies which arise during the annual recruitment cycle are fed back into national recruitment for replacement.

183. The SSoTTG consultation exercise involves assessing medical trainee establishment data, the factors influencing recruitment and requests from specialty training boards, Medical Royal Colleges and other relevant parties to increase the established number of core or specialty training posts in any given medical specialty in response to demand, attrition and Ministerial priorities. This process aligns with medical workforce modelling and is intended to achieve a planned and sustainable medical workforce.

184. The fundamental principle that trainee numbers and training establishments are determined by the need for future consultant output - not by need to cover 'service gaps' in rotas - remains central to these modelling assumptions and decisions on training numbers.

Foundation training

185. After graduating from medical school, new trainee doctors must complete two years of Foundation training (FY1 – FY2) before progressing onto the next stage of their training. Medical school graduates are granted provisional registration by the GMC after graduating from medical school with full registration being granted after successful completion of FY1.

186. Scottish Ministers have been increasing the number of available Foundation training places in line with the Workforce Plan commitment made in 2019. 51 additional places were created in 2021 and a further 54 have been created and recruited to this year (an increase of 105 places over two years). Further increases are likely to be made in the coming years to accommodate increased graduate output resulting from expansion at undergraduate level (more detail below).

187. Despite these additional places, however, oversubscription to the Foundation training programme still occurs on an annual basis as a result of there being more applicants than available places. Many of these applicants either originate from other UK nations or from overseas. Additional places are therefore created and funded every year by the Scottish Government and the other UK nations where necessary to ensure that a sufficient number of FY1 places are available. Scottish Ministers took a proactive approach in 2022 by creating 51 additional places upfront (in addition to the planned increase of 54 places referred to above). The four UK nations are considering policy options for oversubscription in the light of recent changes to the shortage occupation list; increasing overseas campuses of English Medical Schools; and, increasing private medical schools in England, each of which will cause further oversubscription to the UK Foundation programme.

188. The Scottish Government has directed NES to ensure that, wherever possible, any additional Foundation training places receive increased exposure to Psychiatry and General Practice in an attempt to increase the likelihood of these trainees pursuing a career in either field after completing FY2. A target has been set to ensure that 1/3 of all trainees gain exposure to Psychiatry and General Practice.

Medical trainee progression

189. The ARCP (Annual Review of Competence Progression) process is used to demonstrate where trainees have gained the necessary competencies required to progress through their training pathway. The ARCP outcomes which are awarded to trainees (a) reflect the progress they have made, (b) identify where there have been issues relating to progression, and (c) highlight the reasons behind delayed progression, including where Covid-19 has been a contributory factor.

190. A total of 8,075 ARCP outcomes were recorded for the 2021-22 training year. There were 529 instances where a review had not taken place. Of the 7,546 outcomes which were recorded following a review, 77% were satisfactory, 19% were neutral and 4% were developmental. 6.3% (478) of all outcomes awarded in 2021-22 noted a requirement for trainees to gain additional competencies. Of those 478, 64% did not require any extension to their training. The remaining 36% did require an extension in order to demonstrate that they had gained the necessary competencies.

191. The 2021-22 ARCP results suggest that Covid-related disruption to training continues to reduce. 2.6% of all outcomes awarded in 2021-22 reflect the impact of Covid-19, down from 4.7% in 2020-21 and 14% in 2019-20.

192. The 7,546 outcomes referred to above were recorded in the following categories:

Outcome	Description
1	Satisfactory progress - achieving progress and the development of competences at the expected rate.
2	Development of specific competences required – additional training time not required. Not applicable for Foundation doctors.
3	Inadequate progress by the doctor – additional training time required.
4	Released from training programme - with or without specified competences.
5	Neutral outcome / holding response - panel cannot issue an outcome because evidence is incomplete.
6	Recommendation for completion of training - gained all required competences.
7.1	Locum Appointment for Training (LAT) Satisfactory progress in or completion of the post.
7.2	LAT) Development of specific competences required – additional training time not required.
7.3	(LAT) Inadequate progress by the doctor.
7.4	(LAT) Neutral outcome / holding response - panel cannot issue an outcome because evidence is incomplete.
8	Out of programme for clinical experience, research or a career break.
Outcomes which reflect the impact of Covid-19
10.1	Any additional training time necessary to achieve competences/capabilities can reviewed at the next ARCP: Trainee is not at a critical progression point in their programme and it facilitates the trainee to progress to the next stage of their training; Trainee is at a critical progression point in their programme where there has been a GMC-agreed curriculum derogation such that that the competences/capabilities can be acquired at the next stage of training.
10.2	Additional training time is required before the trainee can progress to the next stage in their training Trainee is at a critical progression point in their programme and where there had been no derogation to normal curriculum progression requirements (e.g. specific professional examination); Trainee was approaching CCT.

193. The following table provides a breakdown of the ARCP outcomes recorded from 2019/20 – 2021/22 in the various categories as set out above.

194. The ARCP outcomes recorded between 2019-20 and 2021-22 have all been somewhat impacted by Covid-19 i.e. outcomes 10.1 and 10.2 did not exist prior to the 2019-20 reporting period. The following table therefore summarises the ARCP outcomes recorded in the 2018-19 training year (prior to the onset of Covid-19).

2022 GMC National Training Survey

195. The 2022 GMC National Training Survey results were published in July 2022. Over 67,000 doctors in training and trainers completed this years' survey across the UK. 76% of all trainees responded, and 34% of all trainers. In Scotland, 81% of trainees completed the survey, and 29% of trainers. The 2022 survey focused on four key areas; high-level findings are included below.

Quality of training and support for trainers

196. Overall, most trainees continue to be satisfied with the quality of their training. Positive responses to questions about supervision, teaching and overall experience are consistent across all four UK nations.

• 74% of all trainees rated the quality of teaching as either good or very good.
• Almost nine out of ten trainees (87%) in general practice posts described the quality of teaching as good or very good. The results were less positive in medicine (66%) surgery (64%) and obstetrics and gynaecology posts (65%).
• Trainees were very positive about the quality of their clinical supervision, with 87% of all trainees rating it as good or very good.
• When asked about the quality of experience in their post, 83% of all trainees said it was good or very good.
• Trainers from all regions and specialties continue to be very positive about their role, with nine out of ten doctors (90%) saying they enjoy their role as a trainer. But, when asked if they were always able to use the time allocated to them specifically for that purpose, less than half of all trainers (45%) said that they were.
• 90% of trainers said they enjoyed the role, although less than half (45%) said they were always able to use the time allocated for that purpose.

Doctors' wellbeing at work and their workload

197. Two fifths of trainees who responded (39%) said that they feel burnt out to a high or very high degree because of their work. Over half (51%) said they felt that their work was emotionally exhausting to a high or very high degree and two thirds (66%) said they always or often feel worn out at the end of the working day.

198. Trainees in emergency medicine gave the most negative responses to all seven questions relating to burnout. For example, over a third (35%) said that every working hour is always or often tiring for them. Trainees in medicine, surgery and obstetrics and gynaecology posts also reported more overall negative responses than average to most of the questions. Half (49%) of trainees in medicine posts said that they are always or often exhausted in the morning at the thought of another working day, and over two fifths (42%) of surgery trainees said that their work frustrates them to a high or very high degree.

199. GP and secondary care trainers also gave more negative responses to these questions than in previous years. When asked if they felt burnt out because of their work, 27% of secondary care trainers and 25% of GP trainers said to a very high or high degree.

200. Since 2021 the proportion of trainees and trainers at high risk of burnout has increased to 19% of all trainees and 12% of all trainers. Over half of the trainers (52%) and 63% of the trainees who responded to the questions relating to burnout were at either moderate or high risk of burnout: the highest levels since the GMC introduced these questions. One out of three (32%) trainees in emergency medicine fall into this category, an eleven percentage point increase since 2021.

201. 77% of trainees in emergency medicine rated the intensity of work as heavy or very heavy compared to 41% of those in GP and 18% in anaesthetics.

202. Before the pandemic, the proportion of trainees reporting these conditions had been decreasing steadily since 2015 to 39%. This trend is reversed in 2022, with 45% of all trainee doctors saying that the intensity of their work, by day, is either very heavy or heavy. Emergency medicine, obstetrics and gynaecology, medicine and surgery had the largest proportions of trainees in post rating the intensity of their work as very heavy or heavy. These are the same post specialties that recorded the largest proportions of doctors at a high risk of burnout.

203. 10% of all trainees said that they worked beyond their rostered hours daily. This figure rose to 16% of trainees in GP posts, although over a fifth (22%) said they never worked beyond their rostered hours.

Supportive training environments

204. 79% of all trainees agreed that their working environment is a fully supportive one. This is consistent across the four countries of the UK.

205. A greater proportion of doctors in surgery (11%) and obstetrics and gynaecology posts (11%) disagreed with this statement.

206. 67% of all trainees agreed or strongly agreed that staff are always treated fairly but 15% disagreed. 76% of all trainees said that staff always treat each other with respect. Trainees in GP posts were even more positive, with 90% agreeing or strongly agreeing that this was the case.

207. 88% of trainees agreed or strongly agreed that their workplace provides a supportive environment for everyone regardless of background, beliefs, or identity. This still means that 12% do not agree.

208. 98% of GP trainers agreed that their practice provides a supportive environment for everyone regardless of background, beliefs, or identity. However, like last year, trainers in secondary care were less positive, with 79% agreeing with this statement. Overall, nearly two in ten (18%) trainers (GP and secondary care combined) don't agree there is a supportive environment for everyone.

209. A smaller proportion of secondary care trainers than GP trainers said that staff are always treated fairly by their employer. 13% of trainers from secondary care disagreed or strongly disagreed that this was the case, compared to 1% of GP trainers.

Covid-19 training recovery

210. New questions were introduced in 2021 to help track the impact of Covid-19 on training, and to explore whether new processes were effective.

• 47% of trainees agreed that they have been able to compensate for any loss of training opportunities through transferable skills gained from other aspects of their training.
• 72% of trainees agreed that virtual learning environments are being used effectively to support their training. There were however large variations between specialties i.e. more than eight out of ten trainees on psychiatry (88%), occupational medicine (87%) pathology (84%) and GP programmes (82%) responded positively to this statement, compared to just over half of those on surgery programmes (55%).
• 70% of trainees agreed that they were on course to gain enough experience in the operative/practical procedures needed to progress onto the next stage of their training.
• A larger proportion of doctors in 2022 (61%) agreed that they've had, or expect to have had, enough training opportunities to adequately prepare them for their next professional exams. 85% of trainees felt they are on course to meet their curriculum competencies/outcomes for this stage of their training.
• 21% of trainees who completed the survey said they didn't need any additional opportunities to backfill what had been lost due to the pandemic. Of those who did, 40% agreed they'd been provided enough training opportunities, although it is a concern that 30% felt this was not the case.

Improving the medical trainee experience

Less Than Full Time (LTFT) Working

211. Working LTFT is becoming increasingly popular because of the flexibility it offers trainees, regardless of their grade or specialty. Basing training establishments on WTE (Whole time Equivalent) data rather than headcount is therefore imperative, especially in specialties with a high proportion of trainees working LTFT such as GP, and work continues towards achieving this in all specialties. Good progress has been made in this space, particularly in specialties such as Paediatrics, and further transition to WTE for other specialties is being supported by the annual expansion of training numbers via the SSoTTG.

212. We also continue to work with NES to streamline selection and recruitment processes, improve flexibilities within medical training to assist movement into and through specialties, and offer Out of Programme opportunities so that trainees can undertake clinical training/experience, research or take a career break.

Wellbeing, Conditions and Rota Evaluation (WeCaRE) Framework

213. WeCaRE is a user-friendly quality improvement framework designed to improve the working environment and experience of doctors in training. It has been co-created through detailed learning from the user experience of the Professional Compliance Analysis Tool (PCAT), which was signed off by the previous Cabinet Secretary for implementation in all Boards.

214. The WeCaRE framework acknowledges that the trainee experience is more than rota design and working pattern compliance. The process addresses this in the context of wellbeing, psychological support, professional development and much more. During the WeCaRE cycle trainees are listened to, valued and empowered to make positive changes. The data from the process gives trainees a vehicle to drive structured improvement to the working environment in partnership with their senior/managerial colleagues.

215. WeCaRE is currently being utilised in four health boards (Lothian, Greater Glasgow and Clyde, Lanarkshire and Grampian). Three further health boards (Tayside, Forth Valley and Fife) are in the process of initiating the first cycles, and discussions are underway with Ayrshire & Arran and Dumfries & Galloway. The first health board to implement WeCaRE was NHS Lothian, who piloted it early in 2021, with the first complete cycle in August 2021. NHS Lothian have therefore embedded this practice and have significant learning to share.

Softer Landing, Safer Care

216. Softer Landing, Safer Care is a programme designed to better support International Medical Graduates. These doctors are more likely to encounter challenges early in their career than their colleagues who graduated from within the UK. Recent changes to the Shortage Occupation List are likely to mean an increase in IMGs coming to work in Scotland and it is important that we ensure that they are appropriately supported to be able to flourish. Doctors who receive appropriate support will be able to provide better patient care.

217. Softer Landing, Safer Care involves a period of enhanced induction, and an opportunity to shadow current trainees so that they can better understand things such as:

• the interface between primary, secondary and social care
• the use of common acronyms
• roles and responsibilities e.g. prescribing
• how to make referrals
• NHS Scotland cultures e.g. patient-centred care, multi-disciplinary team working, child protection etc.
• the most appropriate methods of communicating with both patients and colleagues

Enhanced Monitoring

218. The GMC is responsible for ensuring the quality of medical education and training in the UK and approves both the educational content of training programmes as well as where training can be delivered. It uses Enhanced Monitoring (EM) to support medical training organisations where there are concerns about the quality and safety of training.

219. Issues that lead to the introduction of EM are those that the GMC believe could adversely affect patient safety, the safety of trainees, trainee progression or the quality of the training environment. Local quality management processes alone being insufficient to address issues would also warrant escalation. Staff can raise concerns directly with NES if they are unsatisfied with the training environment or the quality of training. Trainees may also identify a potential need for EM through their responses to the GMC National Training Survey and/or the NES Scottish Training Survey.

220. After being escalated to EM, Health Boards must supply NES with frequent progress updates. NES then share these updates with the GMC which allows them to consider whether any additional support might be required. An action plan is also provided by the Board which sets out in detail what is being done to address concerns and make progress against requirements set by NES and the GMC. Sites subject to EM processes are also subject to quality management/ assurance visits which are undertaken by NES and the GMC. These visits are used to closely monitor progress and identify any emerging, persisting or worsening problems.

221. EM is typically seen as the catalyst for change where there are serious issues that need to be addressed. There are instances however where progress either isn't evident or is being made at too slow a pace. If NES and/or the GMC is concerned about the rate at which progress is being made, or if challenges continue to persist or even worsen, then the GMC may consider imposing formal conditions on a site.

222. These conditions are designed to clarify responsibilities and the actions that need to be taken within Boards and/or specific training sites. They are intended to facilitate organisations working together in a transparent way, and provide clear evidence that concerns are being addressed. If progress isn't made even after the introduction of formal conditions then the GMC may withdraw its approval for training to be delivered at a certain training site, which would see the removal of trainees. This is considered to be a very last resort and would have serious implications for service delivery. This has never happened in Scotland.

Trainee gender composition

223. The following table shows the gender composition of medical trainees in Scotland. These figures are accurate as of October 2022.

	Female	Male	No response	Total
Core	377	341	188	906
Foundation 1	565	389	44	998
Foundation 2	536	328	59	923
General Practice	730	401	107	1238
Specialty Training	1126	887	636	2649
Grand Total	3334	2346	1034	6714

Undergraduate

Scotland's medical undergraduate intake

224. The Scottish Government's Health Workforce Directorate convenes the Medical Undergraduate Group (the MUG) to consider Scotland's annual medical undergraduate intake. The Group's primary purpose is to ensure an appropriate supply of high quality trained doctors to meet the needs of NHS Scotland's medical workforce whilst avoiding, or minimising, the possibility of medical unemployment.

225. For 2022-23, Scottish Ministers approved a medical undergraduate intake of 1,317. This represents a 55% increase compared to the 2015-16 intake of 848. At the time of writing, the 2023-24 intake has yet to be formally agreed. The MUG will meet in early-2023 and the Scottish Government will send the guidance letter on the 2023-24 undergraduate intake to the Scottish Funding Council thereafter.

226. The Scottish Government remains focused on increasing the number of places at medical schools to grow our workforce to meet the future demands of NHS Scotland. It is necessary to properly plan medical undergraduate numbers in order to ensure there are sufficient educational and training places of appropriate quality in NHS Scotland for our undergraduates and trainee doctors. This is why the 2021-22 Programme for Government committed to increasing medical school places by 500 over the lifetime of the Parliament, while also doubling the number of available widening access places.

• The first 100 of this commitment was delivered in 21/22, with a further 100 students being added in AY 2022-23. When the commitment reaches full implementation this will result in 500 additional medical school places per year, creating a robust pipeline to supply NHS Scotland with the doctors it needs to meet the demands of the population.
• The Graduate Entry Medical programme (ScotGEM) places introduced in 2018, initially 40 places with another 15 added as part of the 100 additional undergraduate places the Scottish Ministers committed to under Part 1 of the National Health and Social Care Workforce Plan. The number of ScotGEM places increased to 70 per cohort in AY 2022-23.
• From AY 2022-23 there are: 30 HCP-Med places, 90 WA places and 85 GP Track places (55 at Aberdeen, 30 at Glasgow – more detail below).

Scotland's Graduate Entry Medical Programme (ScotGEM)

227. ScotGEM is a four-year graduate entry medical degree which commenced in 2018 and is delivered collaboratively by the Universities of Dundee and St. Andrews. The programme is delivered in partnership with NHS Fife, NHS Tayside, NHS Highland, NHS Dumfries and Galloway and the University of the Highlands and Islands with first and second years being led by the University of St Andrews and third and fourth year led by the University of Dundee.

228. As Scotland's first graduate entry, undergraduate medical programme, ScotGEM is not directly comparable to a traditional medical degree. Instead, it offers a unique four-year programme tailored to meet the current and future needs of NHS Scotland with a focus on rural medicine, healthcare improvement and developing interest in General Practice.

229. Due to the unique arrangements of ScotGEM, and to encourage graduates into the programme, the Scottish Government (a) funds the tuition fees of those who secure a place, and (b) offers a £4,000 bursary to students per year of study. In return, students who accept the bursary agree to provide one year of service within NHS Scotland. If the bursary is accepted in all 4 years of study, students would receive £16,000 over the course of their degree and in return they would work for NHS Scotland for 4 years following graduation.

230. The ScotGEM graduate entry medical programme has proved popular so far, with the first cohort of 52 students graduating in June 2022. From academic year 2022/23 onwards there will be 70 ScotGEM places per cohort. This represents an increase of 15 places compared to the 2021/22 intake.

Healthcare Professionals Programme (HCP-Med)

231. HCP-Med is an innovative course delivered by Edinburgh University which allows experienced healthcare professionals to enter medicine and combine part time study with their existing job, with large parts of the course delivered online. It is designed to target high calibre candidates who are more likely to be retained in NHS Scotland.

232. The course commenced in AY 2020-21 with 25 places per cohort. A further 5 places were added in AY 2022-23, bringing the total number of places per cohort to 30.

GP track courses

233. New courses commenced in AY 2019-20 at the universities of Aberdeen and Glasgow which focus primarily on General Practice. Students who secure a place on Aberdeen's GP track course undertake an enhanced GP programme, with a set minimum of teaching time in Primary Care. All students who secure a place on Glasgow's course gain enhanced exposure in Primary Care settings and can opt for intensive experience in rural and deprived areas on the new COMET (Community Orientated Medical Experience Track) course.

234. When these courses were first established there were 30 places on each (60 in total). There are now 55 places at Aberdeen and 30 at Glasgow (85 in total).

Pre-medical entry courses

235. The Scottish Government funds the pre-medical entry courses which are delivered by the universities of Glasgow (Glasgow Access Programme (GAP)) and Aberdeen (Gateway 2 Medicine (G2M)). When both courses commenced in 2017 there were 20 places on each. The number of places per cohort then increased to 25 in 2018 (50 places in total). From AY 2022-23 there are 40 funded places on the GAP and 30 on the G2M programme (70 places in total).

236. The pre-medical entry courses are designed to target high calibre students who are from disadvantaged backgrounds, allowing them to gain the qualifications required to progress onto the standard medical degree. 93% of the students who have undertaken the GAP have progressed into first year of the main undergraduate medical degree, and more than 95% of students on the G2M programme have progressed onto the MBChB degree at Aberdeen.

Widening Access

237. Widening Access (WA) to medicine is one of the Scottish Government's key policy priorities. We therefore fund a number of places every year which are reserved for students who meeting the criteria for WA., targeting those from the lowest quintile of multiple deprivation (SIMD 20).

238. 50 WA places were created in 2016 which were distributed evenly between Scotland's five medical schools. A further 10 places were added in AY 2021-22 (12 per medical school), and another 30 places were added in AY 2022-23 (18 per medical school, 90 in total).

Recruitment Policy

239. We worked in collaboration with the Employability and Apprenticeship Network to develop a piece of work which will provide a more holistic picture of the diversity of applicants and recruits the NHS attracts. From this it is viewed it will develop accountability and governance around the monitoring and progression of equality, diversity and inclusion work.

240. The initial stage of this work reviewed NHS Scotland's equal opportunities monitoring form (used during initial recruitment process) considering any applicable changes to government regulations. By updating this form with the proposed changes, it will provide richer data and intersectional analysis to inform strategic direction for improving diversity and inclusion within the NHS workforce.

241. NHS Scotland is required to use this data to better perform its equality duty. We will undertake further work to ensure data is fed through relevant systems, ensuring the best use is made of the NHS Scotland equality and diversity recruitment data. This will enable an evidence-based approach to widening access policy at a national level in Scotland.