The Medical Doctor Degree Apprentice standard was approved for delivery by the Institute for Apprenticeships and Technical Education on 19th July 2022. Funding for the first 200 apprentices was confirmed in 2023, and in 2024 the first programme describing itself as a Medical Degree Doctor Apprenticeship (MDDA) commenced as part of a collaboration between Anglia Ruskin University and East Suffolk and North Essex NHS Foundation Trust (ESNEFT).
In many ways, the Anglia Ruskin / ESNEFT programme does not resemble an apprenticeship as commonly understood. In this programme, the MDDAs carry out exactly the same medical degree course alongside the other medical students at Anglia Ruskin, and the course runs over the same length of time. They will also take the Medical Licensing Assessment (MLA), which all medical students need to pass as part of their degree to join the medical register. Unlike traditional apprenticeships, there is no on-the-job learning. Instead, the MDDAs will work in a range of non-clinical hospital roles out-of-term-time, which will not contribute directly to their qualification.
With no university fees to pay and a salary paid throughout, we estimate that at the end of the degree programme, the average MDDA will be around £160,000 better off than the other medical students at Anglia Ruskin.
The vast majority of medical students remain subject to university fees while training alongside students on apprenticeship programmes who not only do not pay fees but are paid while they learn. Access to MDDAs is not reserved for those with the greatest financial need.
Further MDDA programmes are scheduled to begin in England in 2025, although it has been reported that funding for future programmes is now in doubt. While it is possible that any future schemes would follow a similar model to Anglia Ruskin / ESNEFT, they are permitted to take different approaches.
The BMA fully supports the development of carefully considered and fully planned innovations in medical education and the workforce, when properly piloted, however, our members have raised significant concerns about the rollout of MDDAs and their potential future development. We are therefore clarifying the BMA’s position as follows:
- A medical degree must be obtained by a traditional route of at least 5 academic years medical training or 4 years by graduate entry medicine (3 years for qualified dentists).
- No programme should be introduced that creates a two-tier medical education system by watering down the medical degree.
- No programmes should be introduced that risk the overseas validity of a UK medical degree.
- While we welcome innovative approaches to education and training, there must be no illusions about the limited impact MDDAs will have in solving the dire NHS workforce crisis. A dramatic increase in traditional medical school places to meet the projected future demand on the health service is urgently needed, along with investment in the academic staff required to provide high-quality medical education.
- Whilst we support initiatives to improve medical workforce numbers in under-doctored areas, we remain to be convinced that MDDAs will have the desired effect. This should be among the metrics against which the scheme is judged.
- No MDDA graduates should be required to work locally after graduation.
- It is not clear that the MDDA programme offers good value for money or an effective way of solving the workforce crisis, when compared to expanding the number of standard-entry medical school places.
- As MDDA programmes seek to draw applicants from existing NHS staff groups, there is a risk that any significant expansion of the programme could have a destabilising impact on those staff groups and NHS service provision and risks giving the impression that other staff groups are under-valued. It will be important to ensure that MDDA programmes do not create or exacerbate shortage areas.
- Any introduction of an MDDA programme, and the accompanying increase in student numbers, must be engineered to ensure there is no negative effect on learning for the medical school’s standard entry medical students. Increases in undergraduate training places must be matched with commensurate increases in capacity in foundation and specialty training with additional clinical academic staff employed as required.
- Beyond apprenticeships, there must be a greater concerted effort to address the educational and financial hurdles faced by school leavers and graduate entrants from underrepresented backgrounds, which themselves act as significant barriers to widening participation in medicine.