We support robust mechanisms to assess the quality and impact of research within HEIs, as this is about maximising the use of taxpayer, charity and commercial funding and investment. 

In the 2014 REF report, women and certain other groups were under-represented in HEI submissions compared with the pool of all academic research staff. As a result, the 2015 Stern report made recommendations which were adopted for REF 2021.

Of particular significance were the requirement to submit all eligible academic researchers with ‘significant responsibility for research’ who were ‘independent researchers’, and the decoupling of staff from outputs. This was intended to take pressure off individual academics and prevent the disproportionate exclusion of academics with protected characteristics.

However, the very high-stakes nature of REF means that HEIs have competing pressures and priorities, the power of which should not be underestimated. Clinical academics employed by universities, but also with responsibilities in the NHS, are potentially at particular risk of exclusion from REF, because of the dual nature of their work.

Their substantive contract in an HEI and their honorary NHS contract means that, compared to other academics, it is relatively easy to change their status for the purposes of REF.

The relative ease with which clinical academics can be excluded from submission by either moving contracts from university (with honorary NHS contract) to NHS (with honorary academic sessions) or even losing their academic sessions completely has an impact on job security for all clinical academics, but those from protected groups may be at most risk of being affected. 

This could exacerbate the existing under-representation of doctors with protected characteristics in clinical academia and comes on top of the wider pressure to move from a research-focused to a teaching-focused role and thus no longer be REF-returnable.

In addition, REF shapes the type of research that is encouraged. For example, applied research serving NHS Employers and the UK health policy agenda may not achieve a 3* ‘internationally excellent’ rating, being deemed ‘UK-focused’, with the risk that clinical researchers may avoid this type of work, despite its importance to UK health services and patients.

The BMA Women in Academic Medicine group and Medical Academic Staff Committee surveyed the BMA’s clinical academic members to capture their experiences of REF. 73 responded, with 70 confirming that during the 2014-2021 REF cycle they were employed by a UK HEI with a substantive (not honorary) contract of at least 0.2 full time equivalent which involved carrying out research.

This is equivalent to 7% of BMA members contacted who are consultant clinical academics or senior academic GPs employed by universities (the main groups affected by REF). 34% of respondents were female and 12% declared a minority ethnic background.

While the survey cannot claim to be representative, given that those with strong opinions on REF might be more likely to participate, it captured concerning responses.

10% reported pressure to change contracts because of REF: two-thirds of these were women. All those who reported being pressured to move to teaching roles were women.

Two respondents were pressed to retire or threatened with redundancy; the latter (ethnic minority) respondent had sought BMA support. Another stated that they had observed other staff being pressed to transfer from research contracts and one stated they had left their HEI as a result of REF (ethnic minority respondent).

56% of respondents reported that their HEI stipulated a minimum star rating for an output to be submitted to REF; in 83% of these cases the minimum star rating for submission was 3* even though REF guidance suggested that outputs of 1* and above could be submitted.

89% of respondents felt under pressure to produce outputs for REF. Of these, 79% said this led them to work longer hours, to the detriment of work-life balance, and for 44% it led to a high degree of stress or mental ill-health. 37% of men, 64% of women and 66% of ethnic minority respondents had feared for their job. One third said REF distracted them from clinical work and caused the, to devote less attention to clinical duties. One respondent considered they had been subject to ‘covert bullying’ over REF, driving them to seek BMA advice.

Comments made about REF were not all negative. Some of the comments made were positive and included:

• Positive impact on career; part of REF team overseeing submission and impact statements for our school
• Has influenced some decisions about which projects to pursue but they have not been bad decisions
• It was a positive, motivating experience, unusually.

However, the overwhelming majority of comments were negative and raised concerning themes. Below is a small sample of those, concerning the pressures respondents experienced:

• I had to get the BMA involved to stop bullying behaviour … it has, however, shaken my confidence in the university and I am considering a switch to just clinical work
• I left for another university where my outputs were valued
• When my children were very young, my rate of publication dropped … I was told that unless my publications picked up again … I would be required to explain myself to senior university academic management and that disciplinary action 'could not be ruled out' … similar review meetings continued to be called at intervals, and feeling under pressure, I opted to change to a teaching-focused academic contract
• Just getting the feeling I am getting 'too old' and they want me out – in particular because I am not British
• It has narrowed the perceptions … of what a 'good academic' is. And so altered the career pathways, opportunities etc for individuals – and paradoxically altered our capacity to impact ... work that is potentially changing practice (eg, hits KE 'targets') may not hit REF targets and so is devalued … we are making ourselves obsolete and lacking in value to the stakeholders we seek to work with.

These findings are concerning. One aim of the Stern report was to reduce what was seen as unacceptable pressure on academics. REF has made extensive efforts to introduce protections for staff following that review, which have been recognised and welcomed by the research community.

Nonetheless REF remains a high-risk exercise for individual researchers. Our data indicate the persistence of activities characterised as ‘extremely harmful’ in the Research England-commissioned report ‘Understanding perceptions of the Research Excellence Framework among UK researchers’, which may affect up to 10% of clinical academics.

Much of what is measured by REF is known to be biased against academics with protected characteristics: for example, women and ethnic minority researchers are less likely to win grants or to have their work published in prestigious journals.

The danger is therefore that these well-recognised existing disparities may be amplified. Our data (acknowledging the limitations) appear to bear this out. Any exacerbation of the existing under-representation of doctors with protected characteristics in clinical academia would be to the further detriment of diversity, with potential long-term adverse impacts on UK medical research.

COVID-19 brought the crucial role of clinical academics into sharp relief and serves as a timely reminder of the importance of nurturing this workforce and all its potential talent.

David Strain is BMA board of science chair

Angharad Davies is former deputy chair of the Women In Academic Medicine group