By Sami Mokbel and Chris Wheeler for the Daily Mail

Published: 15:11 EDT, 14 September 2023 | Updated: 03:18 EDT, 15 September 2023

Mechanics, plumbers, electricians and carpenters often learn their trade on the job. But now a new profession is being added to the list of apprenticeship training schemes: doctor.

So how would you feel if the doctor treating you in hospital or at your GP surgery hadn’t undergone the traditional training of up to six years at medical school (plus another five years to be a GP, or longer for a hospital consultant)?

Are they second-class doctors — or actually better equipped to do the job, as some experts now suggest?

This new apprentice scheme is part of a raft of measures to address the shortage of NHS doctors and create a sustainable future workforce.

Currently, half of new doctors are recruited from abroad as the UK supply route has struggled to keep up with demand.

Meanwhile, the number of home-grown medical students a year is only around 7,500 in England, which has left the country lagging behind other developed countries in terms of doctors per head of population.

One proposal to get doctors into the NHS faster is to reduce medical degrees from five years to four.

Another approach is to employ more physician and anaesthesia ‘associates’. Unlike fully qualified doctors, physician associates do only two years of postgraduate training (generally after a bioscience degree) before they have direct contact with patients. (Anaesthesia associates also do a two-year postgraduate course.)

Physician associates, who are under the supervision of a doctor, generally work in GP surgeries or in A&E, and are permitted to do a range of tasks including diagnosing illnesses, analysing test results and, in some cases, they’re able to provide medication. Anaesthesia associates can give anaesthesia under consultants’ supervision.

The Government is planning greater use of physician associates — with 10,000 on the payroll by 2036/37, up from 3,000 now.

But concerns have been raised about this new medical role after actress Emily Chesterton, 30, died from a blood clot on the lung last October after a physician associate dismissed it as anxiety — Emily thought she had seen a GP.

Her symptoms — calf pain and shortness of breath — should have suggested a pulmonary embolism (a lung clot) and meant she was sent to A&E, a decision which a coroner ruled would probably have saved her life.

She’d been seen twice by the same physician associate at a GP practice in North London, who told her to take anti-anxiety pills which she’d previously been prescribed. 

Her father Brendan said after the inquest in July: ‘We are concerned patients are seeing physician associates and not realising they are not doctors, like Emily.’

Separately, yesterday it was reported that the Royal College of Anaesthetists is being pressed by doctors to halt its support of the anaesthesia associate scheme.

The Doctors’ Association UK, a campaigning group, is concerned titles such as physician associate ‘create misleading impressions for patients, potentially conflating the distinct professional roles of physician associates and doctors’.

It has also said it is ‘not safe’ for the Government to use ‘any alternative healthcare provider as replacements for fully trained doctors’. 

So will the Medical Doctor Apprenticeship scheme provide an acceptable solution to the workforce crisis? Under the scheme, the next generation of doctors will learn how to be a fully-qualified medic without going to university full-time.

They will need the same A-level grades in the same subjects as are needed to get a university place, but they will then study and ‘earn while they learn’; starting paid work on the wards or in GP practices immediately, and learning as they go along.

‘The main difference between the Medical Doctor Apprenticeship and a traditional medical degree is apprentices will work in healthcare from the beginning of their degree while also studying the academic subjects of the medical degree,’ says Elizabeth Hughes, medical director for Undergraduate Medicine at NHS England.

‘They’ll spend most of their time with their employer, which could be a hospital or in general practice. And they’ll work safely under supervision at an appropriate level that is suitable to their stage of training.’

Up to 2,000 prospective doctors a year will be able to train this way in England by 2031/32. The first 200 will begin their five-year apprenticeship programme as part of a pilot scheme next year. 

According to NHS England, it will allow the NHS to ‘draw on the widest pool of talent’ — attracting people traditionally put off medicine by the cost of going to medical school for five years.

This typically leaves them £50,000 to £90,000 in debt.

Apprentices’ tuition fees will be paid by the Government and they’ll also receive a salary from their employer.

‘The aim is to recruit students from varying backgrounds, who may have struggled to pursue a traditional medical degree education, so that future generations of health professionals more closely mirror the population they serve,’ NHS England said last year, when the idea was first suggested.

‘Apprenticeships may also appeal to people who might have gained experience in clinical roles and be ready to start training as a doctor at a later stage in their career.’

Encouraging people from different socio-economic backgrounds to become doctors is universally accepted as a good thing. ‘Medical schools have tried to be inclusive, and some are better at it than others,’ says Barry Paraskeva, a consultant surgeon at Imperial College NHS Trust in London, who helps design teaching for medical students.

But some may see an apprenticeship as the easier option, he says. ‘The training to be a doctor is rigorous. It requires high A-level grades, pre-medical school tests, sometimes a pre-medical degree and a structured interview.

‘Why would you do all that if you can go on the medical apprenticeship scheme?’

Dr Martin Scurr, a retired GP and Good Health columnist, agrees: ‘Is this a way of opening a backdoor for people who academically didn’t get the right grades and can be brought in on the grounds that they will be trained as apprentices?

‘Medicine is a huge course — none of it is very difficult but it is like doing 45 O-levels all at once.

‘In other words, there is an awful lot of it to be crammed into five years, even on the traditional medical school course, never mind working at the same time.’

Concerns are also being raised about how the doctor apprenticeship scheme will work in practice.

Despite being officially announced by NHS England last July, details of the scheme still remain sketchy and the start date for the pilot scheme has already been put back a year, from this month to 2024. 

It is also not clear what kind of work they will do, how much they will be paid and who will monitor them.

Nor do we know what proportion of their time will be spent working compared with studying. And how does ‘study’ work if you’re on the wards? And who will train and supervise these students? Another unanswered question.

Queen Mary University of London is one of the medical schools known to be taking part in the scheme. But when Good Health contacted it for more details, we were told: ‘It’s still not something we can speak about at this time.’

What we do know is that at the end of the scheme apprentices will have to take the same exams as other medical students to join the medical register, run by the General Medical Council.

Clare Owen, assistant director of the Medical Schools Council, which represents the 46 medical schools in the UK, says: ‘The knowledge and outcomes needed will be exactly the same as for someone going through a traditional medical degree. How that balances out in practice between lecture-based and practical-based learning will be down to individual medical schools.’

Mr Paraskeva believes on-the-job experience is vital for training doctors. ‘When I was training, medical students were part of the team: we were on call, carried a bleep, took blood and saw patients. It was like an apprenticeship,’ he says.

‘Medical students now seem to be on the wards less than they were and that means they sometimes don’t want or feel comfortable putting themselves in situations where they are doing clinical work like taking blood.

‘If an apprenticeship reintroduces a more hands-on approach, it would be a good thing for doctors and patients. I would challenge medical schools to say why this is not happening anyway for students going down the more traditional route.’

Separately, will apprentices who graduate have the same career opportunities as their medical school peers?

Mr Paraskeva has his doubts: ‘If you want to be a surgeon or oncologist, would the apprentices be as equipped academically as someone who has gone down the traditional medical school route?

‘Or would they be disadvantaged because they don’t have the academic background?’

Dr Scurr fears the scheme could create a ‘second-class cadre of doctors’. ‘By definition, they will be the students who didn’t get into medical school. There will be positives but it’s going to be like the curate’s egg — it’s going to be good in parts — and that is a worry for the NHS and patients.’

Man United’s Erik ten Hag says Jadon Sancho was dropped due to ‘training performance’ – before the winger blasts ‘completely UNTRUE’ comments and claims he is a scapegoat

By Michael Rudling For Mailonline

Updated: 16:00 EDT, 3 September 2023

Medical degrees are set to be slashed from five years to four in a drive to put tens of thousands of extra doctors on hospital wards.

Ministers plan to take advantage of Brexit to change rules on training, which were previously imposed by the EU.

The move forms part of a package of measures aimed at slashing waiting lists by boosting the NHS workforce, with 60,000 more doctors and an extra 170,000 nurses by 2036/37.

Bosses also expect to have an additional 71,000 allied health professionals such as physiotherapists, midwives and pharmacists.

The ambitious proposals are detailed in the first NHS Long-Term Workforce Plan, which is published today and supported by £2.4billion of Government funding.

The blueprint warns that staffing shortages within the health service could more than triple over the next 15 years – from 112,000 to 360,000 – as a result of a growing and ageing population, coupled with new treatments. 

The NHS says it will seek to embrace more homegrown talent and reduce its reliance on overseas employees as competition for healthcare workers is rising around the world.

A record recruitment drive will also allow it to become less dependent on expensive agency staff, cutting the bill for taxpayers by around £10billion between 2030 and 2037.

Amanda Pritchard, chief executive of NHS England, described it as a ‘once-in-a-generation opportunity to put staffing on a sustainable footing and improve patient care’.

Measures in the plan, which comes ahead of the NHS’s 75th anniversary on Wednesday, include:

• Doubling medical school training places to 15,000 by 2031, with new schools and more places in areas with the greatest shortages;

• Increasing GP training places by half to 6,000 by 2031;

• Almost doubling the number of adult nurse training places, with 24,000 more nurse and midwife training places a year by 2031;

• Allowing staff to ‘earn while they learn’, with apprenticeships that lead to a full degree but more-on-the-job training;

• Greater reliance on ‘associate’ roles that can help with less demanding tasks, freeing up senior colleagues for complex cases;

• Expanding training for clinical psychology and child and adolescent psychotherapy, with places rising by more than a quarter to 1,300 by 2031;

• A renewed focus on retention with better opportunities for career development, improved flexible working and pension reforms to keep 130,000 staff working in the NHS for longer.

The NHS and Government will consult with the medical regulator and universities on introducing four-year medical degrees. Graduates would still need to follow their degrees with a further two years of foundation training in a hospital, as is currently the case.

Prior to exiting the EU, UK training was governed by the Mutual Recognition of Professional Qualifications directive (MRPQ), which stipulates 5,500 training hours and at least five years to become a doctor. 

The Department of Health and Social Care says that now the UK is no longer bound by the directive it can consider options on how to shorten training periods.

The General Medical Council would need to be assured of no risk to patient safety but last night appeared to back the move, saying there is ‘a strong case for innovation in medical education’.

Over the next five years alone, medical places may increase by almost a third, nursing degrees will increase by more than a third and GP training places will jump by a quarter. 

Meanwhile, 16 per cent of all training places for clinical staff will be offered through apprenticeships by 2028 – including more than 850 medical students. 

Mrs Pritchard said: ‘The publication of our first-ever NHS Long-Term Workforce Plan now gives us a once–in–a–generation opportunity to put staffing on sustainable footing for the years to come.

‘As we look to adapt to new and rising demand for health services globally, this long-term blueprint is the first step in a major and much-needed expansion of our workforce to ensure we have the staff we need to deliver for patients.’

Louise Ansari, chief executive of Healthwatch England, said patients will ‘really welcome the news’ that the NHS will train more doctors and nurses.

But Dr Latifa Patel, workforce lead at the British Medical Association, said: ‘Accelerated undergraduate degrees and apprenticeships are untested, and must not mean a two-tiered system of doctors.’

Rishi Sunak said: ‘On the 75th anniversary of our health service, this Government is making the largest single expansion in NHS education and training in its history. This is a plan for investment and a plan for reform.’

Chancellor Jeremy Hunt said: ‘Our plan will end the reliance on expensive agency staff, while cutting waiting lists in the coming years and building an NHS which can match up to the scale of tomorrow’s challenges.’

Professor Sir Chris Whitty, chief medical officer for England, also backed the proposed reforms to training and staff retention, saying they will ‘create opportunities for more people to study and train in parts of the country that have historically struggled to recruit’.

The Health Secretary said the plan was about getting ‘care to patients quicker’ as he pledged to boost domestic training and improve job opportunities for staff already working in the service.

Steve Barclay told Sky News: ‘It is a hugely important day for the NHS. It is something that many in the NHS have been asking for, for a long time, to have a long-term workforce plan.

‘It is the biggest ever expansion in workforce training in the NHS’ history. It is backed up by £2.4billion of additional funding over the next five years.

‘And what it will do is train more staff, more doctors, more nurses, more midwives, but also give more opportunities to the staff within the NHS in terms of apprenticeships, developing more skills, their continual professional development.

‘And it will also look at how we reform some of our training, making that more efficient so that we can get care to patients quicker.

‘We recognise from the pandemic that there are big waiting lists, we’ve got a plan to clear those but in terms of the longer-term position of the NHS, we also need to boost our domestic training, and that is what the plan today sets out, that long-term vision for the NHS.’

Latest NHS performance data shows that the waiting list for routine operations soared to another record high.

More than 7.42million patients in England — or one in eight people — are now in the queue for ops like hip replacements. This includes 370,000 people stuck in limbo for at least a year, often in pain.

Experts have warned the backlog won’t start to shrink until the huge staffing crisis engulfing the ailing health service starts to ease. 

But strikes by up to 34,000 NHS consultants over two days next month, is likely to lead to the cancellation of more than 300,000 appointments, hampering efforts to clear record waiting lists.

It is estimated that more than 650,000 routine operations and appointments have been put off since December due to industrial action. 

Shadow health secretary Wes Streeting told Times Radio he had been calling on the Government to adopt Labour’s plan for the biggest expansion of of the NHS workforce in history.

He added: ‘To be fair to the Government, it looks like they’re about to adopt our plan, and that’s important because having had an understaffed NHS for more than a decade.

‘Knowing how long it takes to train new doctors, new nurses, new midwives, it’s really important that we get our skates on as a country. And if the Government have swallowed their pride and adopted our plan, why wouldn’t I welcome that?’

Asked if he would stick to the plan if Labour won the next general election, Mr Streeting said he would be speaking further to Steve Barclay, adding: ‘It is important that we do long term planning and I think one of the reasons the NHS is in the state that it’s in today is because for 13 years now, we have not had a consistent plan.’

He added that the ‘lesson from the last Labour Government is that it’s investment that matters but also reform and where we would go further than the biggest expansion of NHS staff in history, which we’d already committed to, is a reform agenda that seeks to modernise the NHS and make sure it’s fit to meet the challenges of 2048 rather than 1948 when it was created.

He said care needed to be shifted into the community and the NHS needed to switch ‘from an analogue NHS to a digital NHS’, adding: ‘We’ve also got to shift the focus so that we’re not just the national sickness service, but one that focuses on promoting good health – prevention is really crucial.’

He said the NHS ‘is a service not a shrine’ and ‘we’ve got to stop kind of just thinking of it as a national religion and make sure that it is an institution and a system that delivers the best outcomes and it’s got the potential to do that, but it does need reform.’

Inter Milan supporters give their players a hero’s welcome back from training as some rowdy fans sneak into their Istanbul hotel to greet them ahead of Champions League final

• Inter fans are building an atmosphere ahead of the Champions League final
• Raucous supporters welcomed the team back from training on Friday afternoon
• Some even got into the team hotel as they waited for players and staff to return 

By Ryan Walker For Mailonline

Published: 20:04 EDT, 9 June 2023 | Updated: 20:38 EDT, 9 June 2023

What do inflatable slides, fire extinguishers and heavy doors have in common?

They are all features of flight attendant training school, as highlighted by a fleet of TikTokers. 

Cabin crew from across the globe have shared behind the scenes clips from their grueling training camps, with some airline courses lasting up to six weeks.   

Kirsten Carriere from Toronto took to social media to share one of the most difficult parts of her session, which involved closing the very heavy cabin door.

In her video – which has been viewed more than 7.5 million times – she can be seen using all of her body weight to tug the door shut. But her efforts have little impact.  

In a bid to quash any viewer concerns, she highlights in an accompanying caption that this ‘isn’t something I struggle with anymore if you were wondering.’

The now qualified flight attendant for Sunwing Airlines goes on to explain in the comment section that the ‘gust lock was on… this was our first time trying the doors and we weren’t told about it, hence the struggle!

‘Also regardless, these doors are not easy to open especially for the first time. They’re heavy and there’s a technique. You have to learn!’

In another clip, a montage captures some of the other tasks she was required to carry out including giving safety briefings, whizzing down an inflatable emergency slide and operating a fire extinguisher. 

Many viewers asked her if the flight attendant training was hard, to which she responded: ‘It was! It was hard but it was manageable. 

‘You get out what you put in, and you really have to engage to get a hold of everything. But worth it!’ 

Like Kirsten, TikToker @grracebaeb said closing the main cabin door was the hardest part of her training with American Airlines. 

She also shared a video of her struggling to pull it forward and into place.

In an overlaid caption, Grace revealed that she finally managed to complete the task around five minutes later.

Many fellow flight attendants sympathized with her struggles. 

One commenter wrote: ‘I also struggled a lot with that door on the B737, but we make it through. You got this!’

Another added: ‘They are actually so much harder than they look! The first time I opened one I was shocked!’

TikToker @millatheangel, who also trained as a flight attendant for American Airlines, shared a video montage showing what her training involved. 

She revealed in an overlaid caption that the training took six weeks in total. 

Some of the more intense moments shown in her clip see her with fellow trainees inside a life raft during a swimming pool drill and later putting out a blaze armed with a fire extinguisher and wearing a protective piece of headgear. 

Milla captioned her video – which has been watched more than 620,000 times – ‘best decision of my life!’ in a bid to encourage others to pursue their ‘wings.’ 

Giving further insight into what cabin crew training entails, @Nicks.Travels reveals what he needed to pack for his four week course with an unnamed airline in Florida. 

He tells viewers: ‘We have to be in like business casual apparel… we’re allowed to wear kind of like khaki chinos and black or khaki colors for our pants no jeans.. and then for our shirts we can wear anything that’s like a full button down in black or white or two button polos.

‘Since my training is in Florida I got mostly short sleeves.’

On the footwear side of things, he invested in some comfortable, simple black dress shoes. 

Then for daily training, Nick explains that ‘it’s like class, like we’re going back to school and I have to have a binder and a notebook and a whole bunch of new pens and everything.’ 

In a follow up video he explains that the flight attendant program includes a rigorous test process that many people aren’t aware of. 

He says: ‘It’s so so stressful, but so rewarding at the same time.’ 

The keen traveler is still awaiting his results and is set to update his followers on TikTok in due course.