What you don’t know about… doctor apprenticeships

In the first of a new series looking at policies, funding pots and new initiatives that may have slipped your notice, Dr Ammad Butt looks at doctor apprenticeships and what they could mean for the future of general practice

What is a doctor apprenticeship?

The past year has seen reports of GPs being out of work – something that was unthinkable beforehand. This is because of a funding crisis. But the nation as a whole is still not producing enough GPs to provide the care needed. 

The medical doctor apprenticeship is an alternative route for aspiring doctors in the UK, offering a degree apprenticeship funded by the apprenticeship levy. Apprentices will study at medical school throughout the academic year, attending lectures and being examined in the traditional way to meet the GMC-required competencies. But they will also be employed by an NHS trust, working across primary and secondary care over the five years. HEE has secured confirmed funding for 200 apprentices, and is engaging with four universities.

The scheme’s lack of clarity has been met with valid criticisms from the medical community. However, if implemented properly, it could be a good way of training future doctors and beneficial for general practice in the long term. 

Why don’t I know about doctor apprenticeships?

There have been rumblings of the idea of a ‘doctors apprenticeship’ throughout the press for the last four years, but was largely shunned off by the medical community as it was deemed impossible. How can a doctor be trained without going through the rigorous academic route of a medical degree? Since then, more information has been released before the programme was officially confirmed and while reflecting on my experiences (and struggles) throughout medical school, medical education has long required a reform and the apprenticeship starts to do that.

What are the benefits of a doctor apprenticeship?

The main driver behind the announcement has been a push for an increase in diversity and access to medicine for those from disadvantaged backgrounds. Medicine remains a course primarily favouring those from highly educated and wealthy backgrounds, with 61% of the country’s top doctors having gone to private school. Statistics show that apprenticeships can be powerful in improving social mobility, and removing the sizable debt medical school brings. Simultaneously, adding a salary on top of that improves access to medicine like never before. 

The second advantage of medical apprenticeships is integrating young doctors into their environment in a more holistic way. All of us who have graduated medical school remember the anxiety of being on a ward for the first time with responsibility. Despite the arduous process of a medicine course, the feeling of being ill-prepared for practice is common. But apprentices will have a greater chance of eradicating that feeling, because they will have already been employed by the NHS for five years. 

The apprenticeship at East Suffolk and North Essex NHS Foundation Trust suggests working in non-clinical roles including discharge planning and note summarising; admin skills which take time to learn as a beginner doctor, and can be quite frustrating to get to grips with. If the programme also added light clinical roles (eg phlebotomy) this could create foundation level doctors who are better equipped for the day-to-day tasks which take up significant time.

Beyond the benefit to the individual doctor apprentice, there should also be consideration for the collective benefits of the scheme on the wider profession. As already stated, general practice has rapidly swung from a recruitment crisis to an employment one at all levels: more than 80% of locums are unable to find work; newly qualified GPs will struggle to find jobs according to the director of NHS England; and over half of job-seeking GPs are ‘struggling’ to find roles. The crisis is pronounced for doctors of all stages, so once again: why would we want to produce more GPs? 

The answer to this should (hopefully) be obvious. We should not discourage people from pursuing medicine, nor blame them for the state of general practice. In a country with an ageing population, with patients suffering from more complex, long-term and comorbid conditions, more doctors are and will be a necessity. The issue is that there are not enough positions for these doctors to fill; that is a systemic and institutional failure – not one that should be heaped upon hopeful young medics.

What are the problems with doctor apprenticeships?

Medical school is already intense and medical students have higher rates of anxiety and depression compared to their non-medical counterparts. Adding a job on top could lead to burnout before even starting as an FY1.

And, while apprenticeships can be beneficial in helping those from disadvantaged backgrounds, the right access framework has to be in place to make this work. Research shows apprenticeships do improve attraction to a qualification – but the intake does not always reflect this, with many still being from privileged backgrounds.

A further increase in student numbers without hospital space or training capacity compounded with specialty training places still not being increased at an adequate rate is disappointing. There will be 2,000 apprentices by the 2030s, and a double in the number of medical students to over 15,000 during this time according to the NHS workforce plan, yet speciality training has no confirmed increases in numbers aside from general practice which will increase by 6,000 places in the same period. The competition ratio for general practice was 2.67 last year, and is expected to go up further this year. The lack of foresight centrally will have long-term consequences on doctors’ employment unless properly addressed. 

How could doctor apprenticeships affect general practice?

NHS Employers have recommended the apprenticeship to primary care, and it is expected GPs could be training apprentices soon, given how GP practices are often the first clinical attachment medical students have. This could benefit practices with additional workers helping with administrative tasks for GPs, and using the apprenticeship levy is a cost-effective way to expand staff. It could work as an alternative to the ARRS scheme, with the long-term benefit of attracting apprentices into becoming fully qualified GPs, which does not happen with ARRS staff. The ARRS scheme has been widely criticised as detrimental to general practice, stifling practices’ ability to hire GPs and contributing hugely to the employment crisis. Although obviously not definite at this early point in the scheme, it is worth considering then whether having doctor apprentices might stymie the ‘substitution’ of doctors in general practice. 

Apprentices will likely have increased exposure to patients and staff compared to current medical students, which will help develop communication skills in the ‘hidden curriculum’ needed to work in general practice and a greater understanding of the healthcare system as a whole. Behaviours, norms and dynamics between staff are not explored in medical school and are only learnt through working. Likewise the variety of presentations of often vulnerable and complex patients in primary care requires problem solving gained from experience of general practice. 

It could also help address the GP workforce crisis. Though a national issue, it is particularly prevalent in Essex, where one of the first apprenticeships is being carried out. Essex has fewer than 50 GPs per 100,000 patients which the programme, aimed toward homegrown students, could help resolve with local students being more likely to stay within the region. Students from state schools have historically made up a greater proportion of GP trainees, likely increasing numbers further. 

What can I take away from this?

Medical apprentices will be in training from September this year, and the number of apprentices available will therefore increase over the coming years. To get involved with training apprentices, GP practices will have to partner with NHS trusts and universities in hiring and creating a programme of work suitable for the apprentices. To find out how to do this, practices should contact their local medical schools and trusts who are taking part in the scheme.

The medical apprenticeship has been controversial from its inception, but it has potential. If the drawbacks are managed, it is a revolutionary change for medical education. While the employment crisis in general practice is still pronounced – with the BMA council chair declaring it is time to bring ‘the full force’ of the trade union behind the profession – we still cannot turn away those who want to pursue a career in medicine. And even more so, we should welcome initiatives that allow for a wider scope of people to enter the field. I believe doctors like myself should be championing the change to increase inclusivity and a new way of training doctors.

Dr Ammad Butt is a foundation doctor and freelance writer working in Birmingham. He has an interest in general practice and health policy. You can find him on X (formerly known as Twitter) @ammadbutt_

Have you got an idea for this series? Something that might have flown beneath everyone else’s notice that you think would be interesting and helpful to share? If so, we want to know! Email mayadhillon@cogora.com with your idea.