BACKGROUND

  1.  The Science and Technology Select Committee expressed concerns about the position of clinical academics in its 1995 report Medical Research and the NHS Reforms. In response, the Committee of Vice Chancellors and Principals (CVCP) commissioned the Task Force on Clinical Academic Careers chaired by Sir Rex Richards. The Richards Report, which the CVCP published in July 1997, described the pressures on clinical academics and made recommendations on how these pressures might be alleviated.

  2.  The Select Committee interviewed Sir Rex Richards and members of his team in November 1997 and subsequently published a short report Clinical Academic Careers. In this report the Committee welcomed the initiative by the NHS Executive and the Higher Education Funding Council for England (HEFCE) to establish two joint Department of Health (DH)/HEFCE task groups. This initiative was a positive response to concerns about the outcome of the 1996 Research Assessment Exercise (RAE) in relation to clinical health services research and the interrelationship between research, teaching and patient care. The Committee also welcomed, and appended to the report, Sir Alan Langlands' letter of 24 November 1997 which summarised a number of other developments which had taken place since Sir Rex Richards began his inquiry. Further progress continues to be made as set out below.

INCREASING MEDICAL SCHOOL INTAKES

  3.  The Richards Report recommended that "any increase in the target numbers for medical student admissions must be accompanied by a corresponding increase in the numbers of clinical academic staff and the facilities to accommodate them". In July 1998, the Government accepted the recommendation of the third Report of the Medical Workforce Standing Advisory Committee (MWSAC) that the intake of students to medical schools in the United Kingdom should be increased by about 1,000 places per annum (about 20 per cent) to about 6,000. The need to accommodate a significant increase in the numbers of clinical academics nationally was one of the factors reflected in the planned phasing of the increase over the period 2005.

  4.  Most of the additional medical student places will be in England, and the HEFCE was advised in the allocation of places by a Joint Implementation Group (JIG) co-chaired by the Permanent Secretary of the Department of Health and the Chief Executive of the HEFCE. The increase in students in Wales was 35 in the only Welsh undergraduate medical institution—the University of Wales College of Medicine—and there may be more following consideration by the National Assembly for Wales. Northern Ireland and Scotland did not plan any significant increase. Scotland will continue to produce more doctors than its proportion of the UK population would indicate.

  5.  The JIG required all bidders to satisfy it on the availability of suitable clinical academic staff. The JIG bidding form, which was sent to all Universities and NHS Chief Executives in England on 8 January 1999, required all bidders to comment specifically on:

". . . the numbers of clinical academic staff, currently engaged, additional recruitment implied by the proposal, and anticipated ease of recruitment. . . ."

  6.  The need to ensure effective academic support was reflected in the linking of new centres of medical education to existing medical schools. Three have been announced so far:

—  Keele (Manchester).

—  Warwick (Leicester).

—  Durham, Stockton Campus (Newcastle).

PAY PARITY WITH NHS COLLEAGUES

  7.  The Richards Report referred to clinical academics' longstanding concern about pay parity with NHS colleagues; progress on this issue was reported in Sir Alan Langlands' letter of 24 November 1997.

  8.  Pay parity has been maintained between clinical academics and their NHS colleagues. In order to meet the terms of the new DfEE condition of grant in relation to clinical academic pay announced in November 1996, the HEFCE wrote on 14 March 1997 to all institutions which had received Council funding for teaching and/or research in clinical medical and dental subjects. The letter said that their recurrent grant payment for March 1997 would include an allocation to meet additional costs arising from the Government's award to clinicians following the Review Body recommendations, for the period April 1996 to July 1997. This took into account HEFCE's most recent estimates of clinical academic staff costs to the sector, and the differential between the clinical pay award over the period and that for other academic staff. Further funds were allocated for the academic years 1997-98 and 1998-99.

  9.  In Scotland, the SHEFC concluded that further resources were not required for 1997-98 because of an additional £15 million allocated to teaching this year and because the differential would be small enough to be easily absorbed by the institutes. Parity has thus been maintained for 1997-98. The then Scottish Office Education and Industry Department nevertheless advised that the SHEFC needs to consider extra funding for that part of the 1998-99 financial year which falls within the 1997-98 academic year and also to recognise the ongoing requirement for parity with clinical academics. For 1998-99 (and 1999-2000) a condition of grant was applied and the SHEFC has made a specific allocation to institutions to maintain parity. These will be reviewed and adjustments made as necessary from within the SHEFC's resources. The Scottish Executive welcomes the inclusion of clinical academics in the Review Body's consideration.

  10.  In Wales as in England it was agreed that pay parity between clinical academics and their NHS colleagues should be maintained. The Secretary of State's letter of 15 December 1998 to the HEFCW stated that it was a continuing condition of grant funding of the HEFCW that the Council enables institutions to meet any additional costs for medical schools from the Government's award to clinicians following the Doctors' and Dentists' Review Body recommendations.

ACCESS TO DISTINCTION AWARDS

  11.  The Richards Report recommended that the recognition of academic distinction in the award of discretionary points be kept under annual review. The report also expressed concern about the absence of an equivalent mechanism for rewarding academic GPs. As part of the consultant contract negotiations between the UK Health Departments and the BMA, a review of the discretionary points and distinction awards schemes is being undertaken.

HIGHER SPECIALIST TRAINING

  12.  As the Select Committee is aware, in response to concerns over the implementation of the Calman reforms to higher specialist training and their effects on clinical academic medicine, the Department of Health (on behalf of the four UK Health Departments) issued an Academic and Research Medicine supplement to the Guide to Specialist Registrar Training to explain the flexibilities and opportunities which exist under the new training arrangements. This was incorporated into the revised version of the Guide which was published in February 1988.

ACADEMIC AND RESEARCH SUB-GROUP OF THE ADVISORY GROUP ON MEDICAL EDUCATION TRAINING AND STAFFING (AGMETS)

  13.  The Academic and Research sub-group of AGMETS, which was pivotal in producing the supplement to the Guide to Specialist Registrar Training, continues to provide a forum for the academic and research community to discuss matters of mutual concern with senior DH officials. The sub-group meets approximately twice-yearly under the chairmanship of Professor John Temple. The current work programme includes a joint JCC/DH Symposium on Careers in Academic Medicine which is being held in Birmingham on 5 October 1999. The symposium aims to publicise the action which has been taken to address the disincentives to academic careers, to disseminate examples of good practice and to identify solutions for outstanding problems. Health Department representatives for Wales, Scotland and Northern Ireland will also be involved.

DENTAL EDUCATION

  14.  Following the request from the Council of Deans of Dental Schools (CDDS) and the CVCP and some discussion at meetings of the Steering Group on Undergraduate Medical and Dental Education and Research (SGUMDER), the Dental Schools and Dental Hospitals Priorities Group was set up in June 1998 under the chairmanship of the Chief Dental Officer for England. The membership is representative of those bodies with an interest in Dental Schools and Dental Hospitals in England. The Group's remit is to consider the implications for undergraduate and postgraduate education and training of England's current and future need for dentists, to determine the priorities for dental schools and dental hospitals in meeting that need, and to make recommendations to appropriate bodies. The Group is expected to report its findings to SGUMDER and other appropriate fora in autumn 1999. A separate group is considering the position in Scotland.

RESEARCH ASSESSMENT EXERCISE

  15.  The Richards Report drew attention to the impact of the 1996 RAE. In England, the first of the two joint DH/HEFCE task groups, which were announced by Sir Alan Langlands and Sir Brian Fender in their letter of 26 June 1997, was asked to consider how health-related research should be handled in the next RAE. The Task Group was jointly chaired by DH and HEFCE officials and the membership included representatives of NHS R&D and academic advisers to the HEFCE. The Group has considered the units of assessment to be used in the RAE, the criteria for assessment, assessment panel membership and whether special initiatives might be taken to encourage investment in developing areas such as health services research and primary care.

  16.  The Task Group issued a consultation document in August 1998 and in the light of the response made a number of specific proposals on how the RAE might best deal with DH and NHS strategic issues in respect of health services research. For the next RAE in 2001: sub-panels will cover strategic interest areas; and ratings for subject areas agreed by each of the sub-panels will be published.

  17.  The final report from Task Group I has been submitted to HEFCE and DH.

  18.  A current issue for the employment of clinical academics is the pressure on universities to substitute research academic posts for clinical academic posts to reduce their costs and to benefit their RAE position. The potential consequences for teaching and clincial care are recognised as an issue in the Richards' Report and for DH/HEFCE Task Group II. In Scotland this has led to the funding of clinical lectureships through the Scottish Council for Postgraduate Medical and Dental Education in order to ensure that there is a sufficient input of medically qualified clinical experience into the teaching process.

IMPROVING NHS/UNIVERSITY LIAISON: JMAC REPORT GOOD PRACTICE IN NHS/ACADEMIC LINKS

  19.  Sir Alan Langlands' letter of 24 November 1997 informed the Select Committee of a joint initiative with HEFCE to identify and disseminate examples of good NHS/university partnership at local level. In 1998, the HEFC's Joint Medical Advisory Committee (JMAC) commissioned the University of Manchester's Health Services Management Unit to undertake a study of good practice in NHS/university relations. The study was concerned with the ways in which the NHS and universities are dealing with:

—  competing pressures on staff time for teaching, research and patient care;

—  curriculum change and changes in the pattern of clinical placements; and

—  issues arising from the implementation of the Culyer Report on supporting research and development in the NHS.

  20.  The study focused on the development of good practice in five study sites (Aberdeen, Cardiff, King's College London, Liverpool and Sheffield) but also gathered examples from other locations.

  21.  The report Good practice in NHS/academic links was published in March 1999 and has been distributed to heads of UK higher education institutions, heads of UK medical and dental schools and chief executives of NHS trusts, health authorities and health boards.

IMPROVING NHS/UNIVERSITY LIAISON: NUFFIELD TRUST WORK ON PUTTING SGUMDER'S TEN KEY PRINCIPLES INTO PRACTICE

  22.  The Richards Report recommended that "more work should be done to explore the concept of the University Hospital NHS Trust". Following some discussion of the Richards Report at SGUMDER and other fora, Sir Alan Langlands met the Chairman of CVCP's Medical Committee and the Chairman of the Council of Heads of Medical Schools to discuss their concerns about relationships between medical schools and NHS trusts and to explore how these might best be taken forward.

  23.  It was agreed that new structures and radical solutions should be avoided but that there would be benefit in improving collaboration and joint management processes in line with SGUMDER's Ten Key Principles. It was agreed to invite the Nuffield Trust to organise and host a small seminar of key players to discuss the development of ground rules to operationalise the Ten Key Principles at local level. The Nuffield seminar was held in November 1998. To inform the discussion, the Nuffield Trust carried out a survey of medical school deans and teaching hospital chief executives on the interface between medical schools and NHS trusts. The survey results, which were circulated with the JMAC report on Good Practice in NHS/academic links, confirmed that there is scope for improvement in many parts of the country but also identified some positive initiatives.

  24.  The November 1998 Nuffield seminar brought together a number of chief executives of university teaching hospitals, heads of medical schools, and other key players including the chief executives of the NHS Executive and of the HEFCE, to address the results of the survey and address the interface between the NHS and university sectors. It was agreed to form a smaller working group with the aim of considering a joint strategic appoach and producing guidance for its translation into local relationships. The November 1998 group will reconvene in October 1999 to consider the working group's report.

 IMPROVING NHS/UNIVERSITY LINKS: DH/HEFCE TASK GROUP II

  25.  The second of the two DH/HEFCE task groups was set up, under the chairmanship of Professor Alasdair Breckenridge, to examine how best to take account of the interdependency between research, teaching and patient care in the funding of university medical schools in England. In particular, the Group's terms of reference are to:

—  suggest what practical arrangements might be put in place by the HEFCE and the DH to anticipate and consider the potential impact of their funding decisions on university medical and dental schools and NHS service providers; and

—  consider what practical steps universities and NHS employers might agree locally to help reconcile the competing pressures on clinical academics in delivering research, education and patient care.

  26.  The Task Group's report was submitted to Sir Alan Langlands and Sir Brian Fender in September 1999.

CONCLUSION

  27.  The Government recognise the importance of academic and research medicine and has taken note of the findings of the Richards Report. A considerable programme of work is underway to strengthen the partnership between the NHS and the higher education sector and address many of the issues which were highlighted in the Report. The Government are committed to an approach which takes full account of the key role of universities and of academic medicine in delivering the NHS of the future, and will continue to work with all the stakeholders to ensure that further progress is made in removing disincentives to a clinical academic career.

October 1999