Undergraduate medical education: recommendations

Appendix C: Medical ACT Primary Care Re view: Draft Recommendations

NES' Medical ACT Governance Group triggered a review of the costs of delivering undergraduate medical teaching in primary care with the aim of describing the following areas:

1. An understanding of the provision of undergraduate medical teaching in GP-Primary Care for each of Scotland's medical programmes, including ScotGEM, to create a baseline snapshot of what is being provided currently.

2. An understanding of the costs associated with delivering undergraduate medical teaching in GP-Primary Care for each programme, including ScotGEM.

3. An analysis of whether the existing approach to measurement and reimbursement from Medical ACT funding of the costs of undergraduate teaching in secondary care using the Measurement of Teaching (MoT) Tool could be adapted to support, prospectively, the measurement and reimbursement of the costs of undergraduate teaching in GP - Primary Care.

The NES review describes the current vital and varied contributions of GPs and the wider Primary Care team to undergraduate medical curriculum delivery for all Scotland's Undergraduate Medical Programmes. The group has had input from a number of stakeholders including representatives from all Scottish Medical Programmes and from Prof John Gillies, Chair of the Scottish Government/ Board for Academic Medicine Primary Care Review Group. Outputs from all NES review meetings have been shared with the SG/BfAM group as will the final report on completion of the NES review.

The following draft recommendations have been made based on discussions at the final NES Medical ACT Primary Care Review meeting in February 2019 and following feedback from the SG/BfAM Increasing Undergraduate Education in Primary Care Group.

Measurement of Teaching Activity and Accountability Reporting

• It is clear there is considerable heterogeneity around the detail within the annual accountability reports for undergraduate teaching delivered in primary care that is supported through Medical ACT funding.
• Consistency of information provided from all Boards, including clear headings for all categories relevant to primary and secondary care is required.
• For GP-Primary Care costs, information should provide explicit detail of all GP-related teaching activities including placements, lectures/tutorials, support costs and information on costs associated with student travel and subsistence for all programmes.
• The contribution made by GPs and Primary Care teams to the delivery of SSCs, electives, and other non-core activities for some programmes is not ACT funded and therefore not currently captured within the MoT exercise or annual Medical ACT Accountability process.
• It is apparent that some educational activities within the GP-Primary Care curriculum are being provided pro bono. It would be important to understand how changes to student numbers and percentage of curriculum devoted to Primary Care teaching influence that amount
• The current funding models and accountability processes do not reflect the heterogeneity around which healthcare professionals contribute to the delivery of medical education and training in GP-Primary care. In reality, this is likely to be difficult to quantify on an ongoing basis.

Recommendation 1

Revision of the processes of accounting for ACT funding received and reporting of activities funded by ACT must be implemented to ensure a consistent and comprehensive understanding of the contributions to undergraduate medical education and training by GPs and other healthcare professionals in Primary Care, across all undergraduate Medical Programmes.

Recommendation 2

All Medical Programmes should have an understanding of the costs associated with Primary Care teaching, including any elements that are not funded via Medical ACT and those which are currently being provided pro bono.

Recommendation 3

The current ACT allocation model is based on use of retrospective data. While the merits or otherwise of this approach were not considered by this review, there is some appetite for exploring whether there may be benefit in moving to a prospective model in the future. The recommendation is therefore to engage with all relevant stakeholders to consider jointly the risks and benefits of adopting a prospective versus retrospective allocation model.

Quality Assurance of UG Teaching in Primary Care

• The approach to quality assurance of UG GP teaching is also heterogeneous across the programmes
• All programmes invite student feedback at least annually and are involved in an annual national Undergraduate Quality Review Panel which includes representation from the NES Quality team.

Recommendation 4

If the amount of undergraduate medical education and teaching increases as seems likely, resulting in an increase to the associated costs - the activities provided must continue to be subject to quality management by the Medical Schools responsible for the curricula. This process should adhere to common principles and have a consistent approach.

Revision of the tariff for GP remuneration (Category A teaching)

• the current rate of remuneration of £40 per placement session for medical undergraduate teaching in GP-Primary Care has been in operation since 2010 and has not altered with inflation over that time
• The group recognizes why the payment rate needs to be increased and the potentially deleterious effects that have occurred already and are likely to persist if action is not taken. However, any upward revision of the tariff needs to take into account the knock-on effects for funding to Health Boards for undergraduate teaching in secondary care, within the overall Medical ACT funding arrangement.

Recommendation 5

This will be made to Scottish Government based on modelling an uplift to the tariff for clinical placement (Category A) teaching and the amount of GP/Primary Care teaching delivered in line with SG/SFC advice.

If the Medical ACT budget remains the same and the current provision of undergraduate medical education and training in GP and primary care remains the same - we will model the impact of changing the tariff for remuneration, on the distribution of the medical ACT budget across primary and secondary care.

Thereafter if required, we will also assess the impact of any increase to the proportion of undergraduate medical curricula devoted to GP and primary care teaching as advised by SG and SFC - by modelling the impact of that change on the distribution of the Medical ACT budget across primary and secondary care.

Revision of the tariff for GP remuneration (Category B teaching)

Category B teaching refers to formal teaching or other teaching-related activity which occurs outwith clinical placements. This can be delivered on campus and within other settings including in a General Practice setting, by staff employed by a variety of contracts. The review identified significant variation between the type of activity and rates of remuneration provided by each of the medical programmes. As such it was not possible to make meaningful comparisons between programmes or to make recommendations for any changes to the current rate of Category B payments. Further work will be required to investigate the feasibility of doing so.

Recommendation 6

Following feedback received from stakeholders as part of the Scottish Government/Board for Academic Medicine (SG/BfAM) Primary Care review process, the NES Medical ACT team will lead further work on the feasibility of revising Category B payments in collaboration with relevant stakeholders. The remit will be to attempt to streamline the existing diverse range of Category B tariffs in Primary Care ACT, with an aim of agreeing a simplified range of tariffs that are applicable to all medical programmes.