Following the Long-Term Workforce Plan commitment to develop a four-year undergraduate medical degree, the University of Buckingham was commissioned by NHS England to develop a four-year prototype curriculum. It is concerning that the NHS in England is moving swiftly towards the development of a truncated degree programme, particularly as this is apparently being developed by the NHS without input from appropriate representatives of the medical profession.

Four-year courses for graduate students already exist. Entrants will have demonstrated they have what it takes to complete an accelerated course. These current graduate courses are considered to be even more demanding than the five / six-year course – they are not suitable for everyone. But if new four-year courses are intended primarily to increase the number of medical graduates annually, then the potential of expanding the numbers on the existing four-year courses (with concomitant increased provision of medical academic input) would seem a more responsible approach, especially as we know that there are insufficient graduate-entry places for the numbers applying.  These applicants then take up places on standard degree courses. 

In the wake of the pandemic and massive waiting lists, consultants are facing increased pressure in their job plans and are not being provided with the time to deliver good quality teaching with current undergraduate courses, let alone proposed accelerated ones. There is also already insufficient capacity in the provision of academic components in general practice. 
Implementing a new accelerated four-year course will take years of planning – itself a further drain on a seriously overstretched system. It will have to be designed from scratch to ensure all learning outcomes can be met. This cannot be achieved in the recently announced timeline for entrants to start these courses in 2026. We have significant concerns that any further modification to an already demanding undergraduate course would negatively impact the welfare of these students and result in doctors who may not be adequately prepared for medical practice, do not have the skillset to teach future generations of healthcare practitioners, or the necessary exposure to cement the UK’s future as a global centre for research excellence. It is crucial that the BMA and the relevant royal colleges are involved to reconsider these plans before they are developed, let alone piloted.

Furthermore, a compressed teaching programme will require additional academic staff to provide the teaching outside of the standard format. However, many universities currently looking to make academic staff redundant; the opposite of what is needed to deliver this compressed teaching.

Any proposals must be accompanied by an equalities impact assessment, a clear explanation of the rationale for the changes, an assessment of the impact on patients and the doctors themselves of having younger qualified medics, and clear consideration of how the change will impact the rest of the system, for example in placement posts, foundation school capacity, and access to specialty training. 

An assessment of whether it is the most effective, and cost-effective, way of widening participation is also required. Those from a widening participation background may be less prepared for the requirements of such a challenging course as medicine and widening participation successes have often added time and support to those taking a course rather than reducing it.