Opinion: Should we offer to pay university fees for doctors who commit to NHS?

The dire need in the NHS for qualified high level medical staff could be given a much needed boost by offering medical students free university fees if they commit themselves to working solely for the NHS for a number of years after qualifying as a junior doctor.

Even as they progress through the NHS as junior doctors they are still being taught and trained in NHS hospitals by senior doctors, surgeons, anaesthetists and registrars. Some then go on to be the elite in the world of medicine, being in demand to do heart and liver transplants, neuro-surgery, plastic surgery etc – but far too many do so overseas where they earn massive money. They have learnt their skills in the NHS but NHS patients do not benefit when they leave the UK when they are at the top of their game.

Many people may not be aware but during the troubles in Northern Ireland, given the appalling bomb outrages, surgeons out of necessity developed new skills in repairing bone, rebuilding muscle tissue, skin graft and plastic surgery. Now I accept that they learnt these skills because of atrocious acts, and in circumstances none would have wanted, but  a lot of them are using these skills to earn large sums of money abroad. Not only have NHS patients lost their skills, but we’ve also lost the fact that they are not training anybody here to take over from them.

I want to see these skills retained in the UK for as long as possible and there are precedents for this approach both in the private and public sectors.

In the Armed Forces men or women who go on highly priced training courses sign a contract to commit to so many years service. If they leave before time they have to repay part or all the cost of the training. Examples include learning to fly helicopters and diving.  This seems to me perfectly reasonable.

Similarly, young footballers sign contracts with clubs. They are trained and coached to enhance their skills and as they progress through the system they become more valuable to the club. They are under contract and if another club wishes to buy them there is a transfer fee, often of millions of pounds depending on their skill level. So why should it be unreasonable for a private health hospital or clinic to pay a transfer fee for a doctor going to what is effectively a competing organisation.

The fees that come into the NHS in this way would be ring-fenced to pay for the university fees and on-going training of new medical students thus helping both the NHS finances and patients within the system.

I would very much appreciate any readers’ views, both for and against, this proposition. If you would like to contact me you can do so on either: [email protected] Facebook or Twitter.

* Douglas Nicol is a Liberal Democrat Councillor from Bath

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  • Only if it is cost neutral. Physicians are some of the most highly paid people within the UK, those that stay in the NHs also have a pension those in the private sector could only dream of. I disagree with fees full stop but as nurses and some paramedics also have degrees and much lower earning levels then why start with Doctors?

  • Eddie Sammon 22nd Jun '13 - 12:29pm

    We should keep things simple and just offer NHS doctors more money if we think the financial incentives aren’t high enough to work for the NHS.

  • Personally, I think lifelong education should be free to all UK citizens. I am old enough to remember the good old days before students had to run up debts to pay tuition fees and when benefits were available to people who were studying.

  • Simon McGrath 22nd Jun '13 - 1:27pm

    “Similarly, young footballers sign contracts with clubs. They are trained and coached to enhance their skills and as they progress through the system they become more valuable to the club. They are under contract and if another club wishes to buy them there is a transfer fee, often of millions of pounds depending on their skill level. ”

    Sounds like a good reason the change the law so that this exploitation can’t continue.

  • Jeremy Davis 22nd Jun '13 - 1:43pm

    I’m not sure that doctors’ pay being too low is what is wrong with the NHS. There are not many places abroad where their pay would be higher. And doctors are likely to find it a lot easier to pay off student loans than most graduates.

  • Stephen Donnelly 22nd Jun '13 - 4:05pm

    A little bit of research would have revealed that after graduation, on appointment, doctors receive a further two years basic training, and then between three and seven years specialist training. All of this is provided through the NHS free of charge. On appointments as a hospital consultant they can expect to earn a minimum of £76000. They also have the right to undertake private work while contracted to the NHS. Most GPs are not employed by the NHS, and after the Landsley reforms, are able to sit on clinical commissioning boards to award themselves large private contracts.

    This idea is a non-starter, but perhaps we should ask doctors being trained by the NHS to work exclusively for it for ten years, or pay back the cost of their training.

  • Simon McGrath 22nd Jun '13 - 5:27pm

    @Stephen – just to follw your logic you believe that GPs should have to pay back their training costs?

  • Richard Gadsden 22nd Jun '13 - 5:54pm

    I don’t want to stop doctors working in hospices (mostly charities outside the NHS) or volunteering for medicins sand frontieres or in emergency relief as in post-earthquake Haiti.

    Making them repay some fraction of.training if they go to the US or into private practice on Harley Street makes some sense, though initial training wouldn’t be my priority over specialist training into consultant status.

  • As indicated by Stephen Donnelly, the idea is largely a non-starter. “High level medical staff” are those with experience are typically 40 plus and not in their 20’s, Hence the problem isn’t so much those who receive their trained and go elsewhere, but why are so few staying within the NHS to become consultants.

    A question that needs answering is the extent to which changes (implemented in the 1990’s?) to the pass rate on some qualifications necessary for an application for a high level medical position. For many years the pass rate was determined by the number of vacancies within the NHS for that specialisation…

  • Stephen Donnelly 22nd Jun '13 - 11:32pm

    @Simon McGarth. Interesting point. Why should GPs get free training unless they are willing to make a commitment to the organisation providing the training ? Why should the NHS provide training if it does not get a return on the investment ?

  • Doctors are paid extremely well, far and above many other graduate jobs never mind the national average wage. We should be supporting young people accessing further education, paid internships and increasing the numbers of apprenticeships and looking to give credibility to students,parents and employers to other avenues of post-16 education and training as a route to economic prosperity and personal fulfillment. Paying for middle class students to access highly paid careers is not what we should be concentrating on. If the NHS have problems of retainment they need to address that themselves as an organisation.

  • Peter Watson 23rd Jun '13 - 11:30pm

    Why would helping to pay any student’s fees make a difference?
    I regularly read on this site that the high fee loan repayments system is so much fairer and affordable for students than the low fee one it replaced, students won’t pay back their loans anyway, higher fees have led to an increase in the numbers of students from poorer families, yadda yadda yadda, Surely no student needs extra financial help now that Lib Dems have delivered such a brilliant and fair scheme.

  • A Social Liberal 24th Jun '13 - 1:28pm

    Personally I think that is should be mandatory to complete a certain number of years in the NHS after training, and should be the same for any in the medical profession

  • Peter Watson 24th Jun '13 - 1:54pm

    When I was at university (the 80s) I knew medical students who already degrees in dentistry but in order to specialise as oral surgeons needed to study medicine as well. I also knew medical students who took a “break” after their second year to complete a BSc followed by a three year “break” to complete a PhD before returning to the third year of their medicine degree in order to prepare for a career in medical research. Does our tuition fees system support the training and development of the next generation of such important people?

  • Matthew Huntbach 24th Jun '13 - 11:36pm

    Douglas Nicol

    The dire need in the NHS for qualified high level medical staff could be given a much needed boost by offering medical students free university fees if they commit themselves to working solely for the NHS for a number of years after qualifying as a junior doctor.

    There is no shortage of people wanting to take degrees in Medicine. Places on these degrees are hugely over-subscribed to the point where most university Medical departments can turn down applicants with three A-levels at grade A and still fill their places. Meanwhile, Engineering departments in the same universities are often struggling to keep going, having to drop their entrance requirements to C grades, having to take applicants with unsuitable A-level subjects and try to give them the maths and science education they missed at school, or getting closed down because even after this they cannot fill their places. There is a huge shortage of people with good Engineering and Technology degrees. Medicine is part of the problem here – British snobbery means Medicine is supposed to be the only really acceptable subject that someone who is good at science at school should go for, it is starving other science and engineering subjects of the most able applicants. We don’t need yet more incentive to push able students into Medicine. We need it to be the other way round.

  • @Matthew: “There is a huge shortage of people with good Engineering and Technology degrees. ”

    This (the shortage) will only get worse as more companies look to bring production back onshore for various reasons that include the reduction in the cost competitiveness of using China et al and the flexibility that onshore production lends particularly when dealing with small production runs.

  • Matthew

    I am not sure why students would want to work in the engineering or science areas in the UK. In my field, chemsitry (although I do have engineers working for me) the rewards are paltry unless you work in oil/gas.-

    The pharmaceutical industry has moved offshore and the scientific disciplines are not rewarded in the workplace, when those same people have the numerate and logic skills that are desirable in other, better paid areas of the economy.

    I would not recommend any child of mine to study science but if they did then not to stay in the sectior to work as the prospects and respect are low. Seeing someone who fixes a boiler is referred to as an engineer in the UK….and the starting salary for a PhD scientist is often less than that of a process operator.

    Other countries value science and engineering nmuch more than the UK does – don’t ask me why but I think it is still that we like to have the idea of the generalist and amateur – I would like to see the level of the science education of the cabinet, how many A Levels are there between them ?

    Scientists are seen as nerds, geeks and boffins – although everyone seems to become an expert whenever we discuss environmental, chemical or medical issues

    Cable seems to understand this – not so sure about the rest

    I am not saying scientists are encessarily worth more – the market decides – but stop bemoaning the fact that not enough people want it as a career when the prospects are so poor

  • Matthew Huntbach 25th Jun '13 - 1:10pm


    In software development, the shift to outsourcing has now been reversed. “Agile” development technologies are now dominant, and they involve close interaction with the customer, you can’t push your coding to some cheap-cost team in another country. Apart from this, I know from personal experience that the coding skills in the countries which we were once told would take all the development jobs are WAY out of date. Outsource if you want buggy, unreliable, insecure software that doesn’t do what you want, on the other hand, …

    Well, try this one:


    OK, it’s from Australia, but you’ll find recruiters for software development work here in the UK, and in the USA as well, are saying much the same. It doesn’t help that schools in this country still think that Computer Science is more of what they call “ICT”, and regard as a subject you put the duffers into.

  • @Matthew
    I’m aware like you of the software industry trends – having been responsible for the off-shoring, on-shoring and right-shoring of various projects!

    I was thinking more along the lines of more traditional engineering and technology skills – the sorts of skills and businesses that Dyson, JCB et al campaign about.

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