A healthy education - British Medical Association (BMA)

Co-Chair of the BMA's Medical Academic Staff Committee Professor Michael Rees makes the case for the continued support and investment in the UK's clinical academics…

As a recent glowing Elsevier report for the Business, Innovation and Skills Department stated: 'Relative to the world average, the UK has generally a well-rounded portfolio, with a strong and increasing emphasis in clinical sciences, health and medical sciences' with a 'high and increasing share of world articles published in' these subject areas.¹ It also highlighted how the UK has become a global leader in areas such as cognitive neuroscience. The British Medical Association (BMA) has, therefore, welcomed the positive news for science and research arising from the Comprehensive Spending Review and the government's commitment to the establishment of a Health Research Authority. But this has been offset by concerns that the changes made to the funding of higher education and the reduction in the government's commitment to funding teaching in higher education could have an impact on the UK's current and future research capacity.

For the BMA, the key group of higher education employees are the medical academics. These are doctors employed by universities, or at least working in higher education, undertaking at least two of the following functions:

• Research;
• Medical education;
• NHS clinical work;
• The management of one or more of these functions.

It is this straddling of the worlds of higher education and healthcare that makes them such a unique and valuable resource to both sectors and to the UK as a whole.

Given the contribution of medical academic activities to the quality of life of our fellow citizens and to the health of the UK economy, we believe that particular support should be given to the academics and doctors that undertake this work. The economic value of medical research has been demonstrated through an increasing number of reports from across the world. A particularly striking study was that published by the University of Chicago in 2003, which estimated that life expectancy gains alone added $2.6trillion per year to the national wealth of the United States between 1970 and 1998.²

The BMA understands the need for efficiencies and savings across the public sector in this age of austerity, but would suggest that medium and long-term future success demands that the UK continues to invest in medical research and education despite the current short-term financial considerations. In terms of the source of that investment, some good suggestions have been made, such as the efforts made by Lord Browne to diversify the funding base for higher education and proposals from the government to encourage charitable funding. We agree with the Academy of Medical Sciences that charities would not be able to take up the slack and that government funding for medical research leverages rather than displaces investment by industry and charities. We are also deeply concerned about the potentially damaging effect that increased tuition fees could have on the attractiveness of a medical degree and on the diversity of applicants. The BMA believes that medicine should endeavour to reflect the society that it serves and would argue that this diversity enhances the range of research that can be successfully undertaken by the NHS.

Given the importance of medical research and of teaching the future doctors the UK needs, it is vital that we continue to emphasise the importance of retaining and supporting the medical academics that undertake these tasks. Unfortunately, the early years of the 21st Century saw a significant decline in the number of medical academics. This has only recently been stabilised, with the last couple of years seeing a small increase in numbers. However, the concern in the medium term is how the sector will cope with the imminent retirement of a large number of senior clinical academics. The higher education sector has also increasingly relied on NHS doctors to take on teaching responsibilities in particular. With the pressures on NHS time and resources this may become less and less possible.

Another key principle underpinning the maintenance of a cadre of doctors in academia is parity of pay and other terms and conditions with the NHS. Both sets of employers share a commitment to this principle, even though in practice it is not quite achieved. To put this right properly there is a twin track of policies that need to be implemented. First, we need a targeted allocation from Higher Education Funding Authority for England to universities employing clinical academics to cover the additional costs that may arise. We must ensure that it is used for its intended purpose and, in the long term, expanded and extended to support the employment of the additional trainee clinical academics that are needed to replace and add to the existing cohort of clinical academics.

And alongside this, we need to ensure a right of access to the NHS Clinical Excellence Awards Scheme for consultant clinical academics and senior academic GPs. This has the double advantage of helping to achieve parity with the NHS, but also of retaining and attracting the best medical researchers and clinicians in the world.

The breadth of the activities of clinical academics means that their individual roles must be managed and appraised in the round with the research, teaching and clinical components given equal weight. The BMA's concern is that, particularly with the first round of the new Research Excellence Framework due, universities expect clinical academics to perform at the same level as their full-time academic colleagues, and that they undervalue the teaching and clinical work that they do. A singular focus on the REF has the effect of distorting research away from the NHS and it is a concern that NHS-based research has not been as fully promoted and understood as it could be.

We are now in a situation whereby it is unusual rather than the norm for doctors based in the NHS to perform research. In the long term this will result in the UK losing its place in world rankings; this prospect supports the arguments for a significant expansion in the roles and numbers into the NHS. In terms of the general policy environment or medical research we have argued that more needs to be done to reduce the bureaucracy impeding medical research, and put evidence to that effect to the review undertaken by the Academy of Medical Sciences.

We also support enhanced collaboration with industry, and have put that in practice ourselves by bringing together the representative structures for medical academics and pharmaceutical physicians. More could be done to encourage and support medical academics to patent their work and to assist in the development of new patterns and forms of teaching, and we have offered to assist with any initiatives that the department might have in these areas of work.

The BMA has expressed concerns about the government's proposals to focus funding on excellent research in key centres and target resources at what are regarded as timely key issues. Colleagues in the pharmaceutical industry advised that it had followed a similar course over the last 10-15 years and had come to the conclusion that the optimum way to support innovation was to encourage a broad base of research. In other words, academics should be guided so that they can choose the best route for themselves, rather than be straight-jacketed into specific target areas. A key role for senior clinical academics is to provide the necessary guidance and mentoring to enable their more junior colleagues to take well-informed decisions about their future work.

Finally, we would reiterate our plea that the government continues to support medical and scientific research (and those that undertake it) at the current rate.


¹ International Comparative Performance of the UK Research Base – 2011
² 'The Economic Value of Medical Research', Measuring the Gains from Medical Research, An Economic Approach. University of Chicago Press. Ch.2, 2003


This article originally appeared on Publicservice.co.uk: A healthy education