Expert advice

James Buchan: Compulsory service ends freedom to roam

Wales has retained the bursary for new nursing students but planned compulsory service agreements mean there are strings attached, says workforce expert James Buchan.
Compulsory_service_tile_Getty.jpg

Wales has retained the bursary for new nursing students but planned compulsory service agreements mean there are strings attached, says workforce expert James Buchan

At the end of last year, it was announced that bursaries will continue to be available to new nursing students in Wales in 2017-18, but with a sting in the tail.

Under the proposals, nurses who train in Wales will be required to spend the first two years of their careers in the country. This follows the suggestion that doctors trained in England will have to give back four years of service after qualifying, or buy themselves out of this commitment.

This is a new approach in the UK, but it has been used in other countries, including

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Wales has retained the bursary for new nursing students but planned compulsory service agreements mean there are strings attached, says workforce expert James Buchan 


While compulsory service is used widely in the health sector, evidence of its
effectiveness is scarce, says James Buchan. Picture: Getty

At the end of last year, it was announced that bursaries will continue to be available to new nursing students in Wales in 2017-18, but with a sting in the tail. 

Under the proposals, nurses who train in Wales will be required to spend the first two years of their careers in the country. This follows the suggestion that doctors trained in England will have to ‘give back’ four years of service after qualifying, or buy themselves out of this commitment.

This is a new approach in the UK, but it has been used in other countries, including Australia and the US, to try and get some return on the public funding invested in training health professionals. In some cases it is used specifically to allocate staff to relatively under-served communities, often in remote geographical areas.  

Delayed freedom

While compulsory service is used widely in the health sector, evidence of its effectiveness is scarce. Much depends on how well-managed the scheme is, how transparent the criteria are, and how costly it is for individual staff who want to ‘buy out’ of their commitment, if such an option exists. 

At present, we only have sketchy details of the scheme for nurses in Wales and for doctors in England. What is clear is that they challenge the implicit contract that has long existed between the student health professional and the public sector in the UK – that once qualified, the health professional is free to choose where and when to work. 

An NHS qualification has always been regarded as a passport to roam. In future, for some UK health professionals at least, that freedom may have to be delayed for a while.


About the author 

James Buchan

 

 

 

James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh

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