Review Body on Doctors' and Dentists' Remuneration (DDRB): written evidence - 2024-2025 pay round

Annex A: Education and Training

Postgraduate - Medical trainee recruitment

The recruitment of trainee doctors is predominantly undertaken on a UK-wide basis. There are separate UK-run recruitment processes for the various stages of training i.e. entry into (i) Foundation training, (ii) first year of specialty training (Core & ST1 level), and (iii) higher specialty training levels (ST3+).

Trainees apply for posts at Core or ST1 level (the first year of specialty training) after they have completed Foundation training. If they apply for a post in a run-through training programme they would typically advance from ST1 through to CCT (Certificate of Completion of Training) without having to reapply, assuming they achieve the necessary competencies required to progress. Core programmes are slightly different in that trainees must reapply for a higher specialty training (ST3+) post in their chosen specialty. For example, after completing three years of Core Psychiatry training (CT1-CT3), trainees would then apply for an ST4 post in General Adult Psychiatry, Forensic Psychiatry or another specialty of their choice. Where Core programmes only last for two years – in surgical training, for example - trainees would apply for an ST3 post after completing CT2.

All trainee doctors in Scotland are managed by NES (NHS Education for Scotland). The number of posts advertised by NES each year is determined by two factors: (i) the number of trainees who have completed training, obtained a CCT and whose posts are therefore vacant, and (ii) whether any additional posts have been created i.e. expansion posts (more detail below). Any unfilled vacancies at the end of the recruitment rounds are passed to Health Boards to fill through local action, either using locums or other solutions such as Clinical Development Fellowship (CDF) posts which have been growing in popularity recently as an alternative to progressing directly into specialty training after completing FY2.

Collective results from recruitment rounds 1 and 2 were published in July 2023. End-year results – which include the third and final recruitment round of the year - have not yet been published. All data quoted in this section is therefore accurate as of 25 July and does not necessarily reflect the end-year position. End-year data will be published by NHS England imminently following lengthy delays. Headline data is as follows:

• As of 25 July 2023, a total of 1,137 posts had been advertised in Scotland and 1,061 (or 93.31%) had been accepted. At the same stage in 2022, 964 posts had filled from 1,018 advertised (94.69% fill rate).
• Core & ST1 – 762 posts were advertised at Core/ST1 level and 750 (or 98.42%) filled. This includes recruitment into General Practice Specialty Training (GPST). At the equivalent stage of the 2022 recruitment year, 716 posts had been advertised and 708 (or 98.88%) had filled.
• Higher Specialty Training (ST3+) – 375 posts were advertised at ST3 level and above and 311 (or 82.93%) filled successfully. 302 posts had been advertised at the same stage in 2022 and 256 (or 84.76%) had filled.
• GPST - all 273 posts advertised in General Practice filled successfully. Additional posts were advertised in the last recruitment round of the year and results will be available within the coming weeks. At the same stage in 2022, 266 posts had filled from 268 advertised (99.25% fill rate). We have been increasing the number of GPST places to support the Scottish Government commitment to have 800 additional GPs in post by 2027. 100 extra places were created in 2016 and a further 35 places were added 2023. Another 35 expansion posts have also been approved for 2024 (more detail below).

Foundation Training

Medical graduates progress into the two-year UK Foundation training programme following graduation from medical school. They obtain provisional GMC registration upon graduation but cannot gain full GMC registration until completion of the first year of Foundation training (FY1). UK medical graduates must therefore complete Foundation training in order to progress into speciality training and become qualified GPs and consultants.

In line with a UK-wide agreement, each of the four nations have agreed to fund a core establishment of Foundation posts which is equivalent to anticipated output of medical graduates from that nation’s medical schools. In Scotland we currently have 954 established Foundation posts. The number of established Foundation posts corresponds broadly to medical school intake 5-6 years before with a small allowance for attrition. The numbers expected to graduate and enter Foundation are also checked annually with the medical schools by NES.

Ministers have been pursuing a policy of medical undergraduate expansion for a number of years in response to a series of political commitments made in the context of NHS workforce need. Between 2016 and 2023 the targeted medical undergraduate places increased from 898 to 1,417.

There are 954 established/permanent FY1 training places in Scotland. This has been the case since 2022. 33 additional posts were made available in 2023 in anticipation of the programme being oversubscribed. 987 FY1 posts were therefore advertised overall, and 918 (93%) were accepted. 968 posts filled in 2022 (95% fill rate) and 909 filled in 2021 (95% fill rate).

As Foundation training is a necessary step in allowing medical school graduates to become qualified doctors, the Scottish Government and NES have projected forward the number of additional Foundation places that are expected to be needed to the end of this Parliament to accommodate estimated graduate output.

Between 2024 and 2026 we have projected that we will need to increase our Foundation establishment by approximately 219 posts to accommodate expected graduate output. This includes 48 FY1 additional posts commencing in August 2024. It should be noted that further expansion will be required post 2026 to accommodate further graduates arising out of the sequential expansions at undergraduate level.

The new Foundation posts will provide an opportunity both to support fragile rotas and to innovate. As we increase Foundation numbers over the next few years there is an opportunity for the Scottish Foundation School to move at pace, and in collaboration with stakeholders, to:

• address healthcare inequalities;
• explore and resolve structural issues that detract from a good training experience;
• explore, pilot and evaluate innovative placements that value generalism and social care;
• draw on experience and evidence within and outwith Scotland to drive transformational change;
• co-produce a glide path for innovation in placement design and evaluation.

Targeted Enhanced Recruitment Scheme

We 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, where fill rates have been lower in the past. 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). 112 bursaries were accepted in 2023 across recruitment rounds 1 & 2. SG has committed to another £1m of funding in 2024/25 which will cover 50 bursaries, noting that fill rates are currently sitting at 100%. Priority will be given to posts in the most remote and rural parts of the country.

Expanding Scotland’s trainee doctor workforce

The Scottish Shape of Training Transition Group (SSoTTG) is responsible for making recommendations to Scottish Ministers regarding the need to create additional training places for trainee doctors in response to increased demand and evolving working patterns. These additional places are commonly known as expansion posts. SSoTTG membership includes SG, NES, BMA Scotland, the Scottish Academy of Medical Royal Colleges and various NHS Scotland Health Board representatives including Directors of Medical Education, Medical Directors and regional workforce planners. The group is chaired by Dr. John Colvin, Senior Medical Advisor to SG.

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. These assumptions are currently being reviewed to ensure they remain fit for purpose.

These assumptions, coupled with an annual consultation exercise to make any required deviations from default modelling assumptions, have 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. 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.

Scottish Ministers have created 878 expansion posts since 2014 across a wide range of medical specialties – see breakdown below. 153 of those were approved in November 2023 and will be recruited to from 2024 onwards. This will be the largest annual expansion to date, supported by £42m of SG funding over the next four years. A full breakdown of the 153 is also included below.

* Includes 100 additional GP training places

Medical trainee progression

The ARCP (Annual Review of Competence Progression) process is an opportunity for trainee doctors to demonstrate that they have gained the competencies required to progress to the next stage of their training pathway. The ARCP outcomes which are awarded to trainees (i) reflect the progress they have made in that training year, (ii) identify where there have been issues relating to progression, (iii) specify the reasons behind delayed progression, including where Covid-19 has been a contributory factor, and (iv) confirm whether additional training time is required in order to progress. The definitions attached to each outcome are included in the following table –

Description of each ARCP outcome.

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.

A total of 6,999 outcomes were recorded for the 2022-23 training year. There were 495 instances where a review had not taken place (7.07% of all outcomes). Of the 6,504 outcomes which were recorded following a review:

• The majority (55.87% or 3,910) signalled satisfactory progress and the development of competences at the expected rate.
• 24.87% (1,741) showed that trainees had gained all the required competencies and were recommended for completion of training.
• 3.51% of trainees (246) were pursuing OOP (Out of Programme) opportunities e.g. career break, research etc.
• 2.61% (183) required additional training time due to insufficient progress.
• 2.16% (151) required development of specific competencies, however, no additional training time was required.
• 1.70% (119) were LATs (Locum Appointed to Training) who were either making satisfactory progress or had completed their time in post.
• 1.03% (72) received a holding response due to incomplete evidence.
• 0.19% (13) were released from their training programme, with or without specified competencies.
• 0.16% (11) were LATs who needed to develop specific competencies but did not require an extension to their training.
• 0.16% (11) were LATs who had made inadequate progress.
• 0.11% (8) were LATs who received a holding response due to incomplete evidence.
• The 2022-23 ARCP results show that that Covid-related disruption to training continues to reduce. 0.56% of all outcomes awarded in 2022-23 reflect the impact of Covid-19, down from 2.6% in 2021-22, 4.7% in 2020-21 and 14% in 2019-20.

The following table provides an overview of all ARCP outcomes recorded from 2019/20 - 2022/23. These are broken down into the same categories as above. Please note that the number of outcomes recorded for the 2022/23 training year is lower than previous reporting periods due to previous reports including all outcome 5s, whereas it was decided this year to only report outcome 5s which were outstanding at the end of the training year.

2023 GMC National Training Survey

The GMC National Training Survey (NTS) is the largest annual survey of doctors across the UK. It focuses on five central themes: learning environments and culture; educational governance and leadership; supporting learners; supporting educators and developing and implementing curricula and assessments. This year for the first time, the survey included questions on discrimination, covering topics such as unfair treatment, stereotyping and confidence in reporting discriminatory or unprofessional behaviours. More than 67,000 doctors completed the survey in 2022 and that number has increased this year to over 70,000, with 74% of all trainees and 38% of all trainers responding. Published in July, the 2023 NTS results can be found online.

Though most doctors in training say they work in supportive environments, more than a quarter (27%) said they have experienced micro-aggressions, negative comments, or oppressive body language from colleagues. Poor behaviours are more prevalent in some specialties, with instances rising to a third for those working in obstetrics and gynaecology, emergency medicine, and surgery. More than a quarter (28%) of trainees said they had heard insults, stereotyping or jokes relating to their or another person’s protected characteristics in their post. This number rose to 38% for foundation trainees

Despite these experiences, eight out of ten (83%) trainees said they had a good or very good experience in their post. Over three quarters (77%) said that staff, including fellow doctors-in training, always treat each other with respect. Training also remains to be of a high quality, with almost three quarters (74%) of all trainees rating the quality of their teaching as either good or very good, this is consistent with 2022 results and previous years.

This report focused on UK-wide trends in postgraduate medical education and summarises initial findings in three key areas:

• the quality of training and support for trainers;
• supportive environments and discrimination in the workplace;
• doctors’ wellbeing at work and workload.

The GMC will be completing further analysis of the national training survey data by personal characteristics, this will inform their work with organisations across the system and support action to eliminate discrimination, disadvantage and unfairness in undergraduate and postgraduate medical education.

Key findings are as follows

Doctors in training

• Wellbeing – Nearly a quarter (23%) of trainees are now measured to be at high risk of burnout, an increase of four percentage points since 2022, with all seven of our burnout questions receiving a higher proportion of negative responses.
• Discriminatory behaviours – There was a higher proportion of negative responses from doctors in their early stages of training to our new questions. There’s also a wide variation between specialties, with surgery, obstetrics and gynaecology and emergency medicine responding more negatively.
• Developing leadership skills – There’s a decrease since 2022 in the proportion of positive responses across all training levels and most specialties when asked about opportunities to develop leadership skills.
• Rota design – A quarter (26%) of all trainees think that their training is adversely affected because rota gaps aren’t dealt with appropriately. The same proportion (25%) do not think that rota design optimises their education and development.
• Impact of changes due to the Covid-19 pandemic – Innovations introduced during the pandemic are viewed increasingly positively, with an increase of twenty-one percentage points in the proportion of trainees agreeing that simulation facilities and/or simulation exercises are being used effectively to support their training.
• Quality of training – Despite the continued pressures on the health services, the quality of training remains high: 86% of trainees were positive about their clinical supervision and 83% said the quality of their experience was good or very good.

Trainers

• Wellbeing – 52% of trainers are measured to be at high or moderate risk of burnout, the same level as 2022. A third (32%) said their work frustrates them to a high/very high degree.
• Rota design – A third (33%) of secondary care trainers said that their trainee(s) education and training is adversely affected because rota gaps aren’t always dealt with appropriately. This increased to two fifths of trainers in surgery (41%), medicine (40%) and obstetrics and gynaecology (47%).
• Time for training – Less than a half of all trainers (46%) told us that they were always able to use the time allocated to them in their role as trainer, specifically for that purpose.
• Development – Over a fifth (23%) of all trainers said they didn’t have an appraisal to review their responsibilities as a trainer within the last twelve months.

Scotland-specific data

• Scotland are number one in overall satisfaction rankings in the 4 nations.
• Out of 18 deaneries NHS Education for Scotland (NES) are ranked 7th for overall satisfaction.
• NES has 31 programmes ranked number 1 in the UK for overall satisfaction.
• We have increased the number of sites on the high performers list (top 2%) across the UK based on post, to 21 this year compared to 17 sites last year.
• We reduced the number of sites on the priorities list (bottom 2%) based on post to 12 compared to last year’s figures of 21 and we are already engaged with ongoing quality activities with each of the 12 sites.
• Overall satisfaction for each of the regions has also improved this year.

Covid-19 training recovery

• The responses to questions exploring the ongoing impact of the pandemic on training suggest trainees are increasingly positive about developments and innovations introduced to support training recovery, with 55% of trainees agreeing or strongly agreeing that simulation facilities and/or simulation exercises are being used effectively to support their training. An increase was seen across all specialties except occupational medicine which was slightly lower than presented in 2022.
• While 35% of trainees on surgery programmes were positive about the use of simulation exercises, 42% disagreed that they were being used effectively.
• 64% of trainees agreed that they have had enough training opportunities to adequately prepare them for their next relevant professional exam, though as in 2022, one fifth (20%) of trainees on obstetrics and gynaecology programmes said this was not the case. And three quarters of trainees (74%) said that they were on course to gain enough operative/practical procedures needed for their stage of training.
• In 2022, 39% of obstetrics and gynaecology trainees and 31% of surgery trainees disagreed with this statement, but these proportions have now decreased to 23% and 18% respectively for these specialty programmes.
• A third of trainees said they didn’t need any opportunities to backfill what had been lost because of the pandemic. Of those who did, 62% agreed they’d been provided enough replacement training opportunities, with just 14% disagreeing.

Less Than Full Time (LTFT) Working

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.

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.

18.89% of all trainee doctors current work LTFT (3% of Foundation doctors, 13% of Core/ACCS (Acute Care Common Stem) trainees and 28% of higher specialty trainees). Please note that this figures remains subject to ongoing movement.

Wellbeing, Conditions and Rota Evaluation (WeCaRE) Framework

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).

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.

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 cycle completed in August 2021. NHS Lothian have embedded this practice and have good examples of best practice to share.

This is now being extended to new departments within NHS Lothian including oncology, paediatrics and respiratory care. NHS Tayside have also been in touch with NHS Lothian to see how WeCaRE could benefit them.

Softer Landing, Safer Care

Softer Landing, Safer Care is a programme designed to better support International Medical Graduates (IMGs). 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.

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

Directors of Medical Education received prior notice in June of how many IMGs would be coming to their Board, allowing them to put local arrangements in place to. NES also ran an orientation event for IMGs and pre-start webinar. All of these initiatives are designed to better support IMGs when take up post.

Enhanced Monitoring

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.

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.

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.

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.

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.

Last year, NES adopted a new process which was designed to better support Health Boards with sites under EM. This involved providing more support to Directors of Medical Education, considering how examples of best practice could be shared more swiftly with other Boards/sites facing similar challenges, and providing additional support for sites which have long-term issues which often lead to them being re-escalated as a result of concerns not being fully addressed.

There are currently 5 hospital training sites under enhanced monitoring in Scotland, spread across 5 Health Boards. Dr Gray’s Hospital, NHS Grampian (General Surgery & Anaesthetics) is the only site which remains subject to GMC conditions. More information can be found on the GMC’s website.

1.6 Trainee gender composition

The following table shows the gender composition of medical trainees in Scotland. These figures are accurate as of October 2023.

Scotland’s medical undergraduate intake

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.

For 2023-24, Scottish Ministers approved a medical undergraduate intake of 1,417. This represents a 67% increase compared to the 2015-16 intake of 848. At the time of writing, the 2024-25 intake has yet to be formally agreed. The MUG will meet in early 2024 and the Scottish Government will send the guidance letter on the 2024-25 undergraduate intake to the Scottish Funding Council thereafter.

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 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 places of this commitment were delivered in AY2021-22, with a further 100 students being added in both AY 2022-23 and AY 2023-24. 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 places available on the Scottish Graduate Entry Medicine programme (ScotGEM) remain at 70 places per cohort in AY 2023-24.
• From AY 2023-24 there are: 35 HCP-Med places, 115 WA places and 85 GP Track places (55 at Aberdeen, 30 at Glasgow – more detail below).

Scotland’s Graduate Entry Medical Programme (ScotGEM)

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.

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.

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.

The ScotGEM graduate entry medical programme has proved popular so far, with the first cohort of 52 students graduating in June 2022 increasing to 59 students in June 2023. For academic year 2023/24 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)

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.

The course commenced in AY 2020-21 with 25 places per cohort. A further 5 places were added in AY 2022-23 and AY 2023-24 bringing the total number of places per cohort to 35.

GP track courses

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.

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

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). For AY 2023-24 there are 40 funded places on the GAP and 30 on the G2M programme (70 places in total).

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.

Widening Access

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).

As part of the 2021 Programme for Government the Scottish Government committed to double the WA places available at Scotland’s medical schools. Raising the total number of available places from 60 places in available in AY 2020-2021 to 115 in AY 2023-24.