Scotland's GP crisis forces 'discrimination' against medical students from rest of UK

The government accepts the policy will “indirectly disadvantage” students from the rest of the UK (rUK), but argues the “positive gain” in the Scottish workforce justifies the move.

It also accepts there has been opposition from Scottish universities - who can charge £9,000 a year in fees to rUK students.

The plan is part of a drive to reduce a chronic shortage of GPs across the country. According to the Royal College of General Practitioners Scotland, there will be a shortfall of 856 whole-time equivalent GPs by 2021.

Part of the problem is that universities in Scotland train a smaller proportion of Scottish medical students than other parts of the UK and therefore more of the doctors trained here leave after the completion of their studies.

The Scottish Government has already increased the number of available medical school places by 190 compared to levels in 2016, but a report on the issue states: “In addition to growing the workforce ... it’s clear we need to retain more of those whom we train.

It adds: “Evidence shows that Scotland-domiciled graduates from Scottish medical schools are retained at almost twice the rate of graduates from the rest of the UK.

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“Consequently, despite recent significant investment, evidence confirms that if we do not take action to improve the retention of medical undergraduates then this investment will not translate into the medical workforce that we need.”

The report says replacing 100 rUK medical students with 100 Scots on a phased basis over the next three years would help to retain medical school graduates in Scotland in the long term - with estimates suggesting an increase of 36 a year.

On the issue of discrimination the report states: “It is expected that those of Scottish national origin will generally benefit from the policy proposal ... English, Northern Irish and Welsh nationals are likely to be indirectly disadvantaged.

“Our rationale for this policy, however, is the positive gain in terms of workforce, estimated at 36 doctors a year once the policy is fully implemented, justifies any indirect disadvantage.

“In all of the circumstances, it is considered that protecting medical school places at Scottish universities for Scotland-domiciled .. students is a legitimate aim and is a fair exercise of the Scottish Government’s devolved powers.

“On balance, the means of achieving the aim is appropriate and necessary and could not be achieved by less discriminatory means.”

Alastair Sim, director of Universities Scotland, said it was “unfortunate” that students from the rest of the UK would be disadvantaged.

He said: “We welcome the opportunity for more Scottish students to study medicine, especially given that there is such a high demand for the course.

“We understand the rationale behind this policy. Evidence shows Scottish domiciled graduates are twice as likely to take up work in Scotland than graduates from the rest of the UK.

“However, the overall medical student headcount remains the same, which means students from the rest of the UK will, unfortunately, lose out.”

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A spokeswoman for the British Medical Association also raised concerns about losing talented medics from other parts of the UK.

She said: “Recruitment and retention of valuable, skilled doctors is a pressing issue here in Scotland and it is a fact that we need more doctors to cope with the ever-increasing demands of a growing and ageing population on our NHS.

"However, we must be very careful that we are not turning away the highest quality students simply because we may lose them to another part of the UK or overseas.

“Scotland’s NHS has an excellent workforce and perhaps we should be focusing on how we can make it a more attractive place to work for graduates and encourage them that this is a great place to live and build their careers.”

Dr Carey Lunan, chair of the Royal College of GPs Scotland, added: "Scotland urgently needs to increase its GP workforce if it is to continue to meet the increasingly complex healthcare needs of patients.

"There are currently not enough GPs working in Scotland, with many GPs opting to leave the profession altogether and not enough GPs being recruited into the profession to plug this gap."

Liz Smith, education spokeswoman for the Scottish Conservative Party, said the decision would lead to many highly-qualified students losing out.

She said: "There can be no surprise that this policy is causing concern amongst our universities, most especially that the direct cost of increasing places for Scots ... would be placed on students from elsewhere in the UK.

"This is yet more evidence of the deeply damaging discrimination inherent within SNP higher education policy."

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A Scottish Funding Council spokesman said: “Analysis of medical students’ destinations shows that Scots domiciled graduates are more likely to stay and work in Scotland.

"By increasing the number of places for those already resident in Scotland, the needs of NHS Scotland are being recognised with a view to ensuring that Scotland has the number of doctors it needs to support communities across the country."

The government said it was more cost effective to replace 100 rUK places with Scottish-domiciled students rather than creating a further 100 new undergraduate places.

This is because the Scottish Government currently funds the the clinical training of both Scottish and rUK students, which costs £10,000 a year per student.

Over a five year degree course the cost of replacing 100 rUK students with 100 Scottish students after five years would be £9 million, compared to £32m for the creation of 100 new undergraduate places for Scotland-domiciled students.

Currently students from the European Union (EU) will also be able to apply for the new Scottish-funded places under EU rules, although this may change after Brexit.