NHS Hot Topics for Medical School Interview
There are a multitude of NHS topics present at medical school interviews, both in panels and MMIs.
Below is a reference list of some of the most frequently discussed NHS hot topics at interviews that we have explored in detail on our website.
A&E Waiting times
A&E waiting times are a very hot topic in the media every year, as it is one of our most-cited tools for measuring staffing levels and efficiency. This, in turn, provides the general public with an idea of the performance of the NHS. The most important details to know on this topic are the ways the targets have changed and how that has impacted our ability to meet them, what changes have been proposed and what implications those have on the NHS and the public perception of our healthcare system.
NHS guidelines currently require that A&E departments see 95% of all their patients within four hours by either discharging them after a review or transferring the more serious cases to appropriate further care. Even though this target dropped by 3% since 2004, departments still struggle to meet the numbers and currently sit far below at 84.4%. The biggest contributing factors to our failure to meet these standards are lack of resources, understaffing and an overall high volume of patients visiting A&E.
Reforms have been suggested to improve the current situation whereby a stricter triage system is implemented, leading to non-life-threatening injuries waiting longer or being transferred to minor injury departments. Alternative solutions include a paid A&E service, which, however, has been opposed by many as going against core NHS principles. The implications feared by many, if A&E waiting times continue to trail behind, include compromised patient safety and decreased public trust in the medical profession.
Brexit & the NHS
Brexit and its effect on the NHS has been a hot topic since 2016, when a referendum decided that the UK will leave the EU after more than 45 years of membership. As the EU was first set up to allow citizens to move between EU countries easily for living and working purposes, you can imagine that this will be hard for the UK once Brexit is finalised. There have been plenty of speculations about the likely negative effects that this move would hold over the country, but the most important ones you need to be aware of for your interview are those directly impacting the NHS.
At the moment, hundreds of thousands of EU nationals work in the UK, a huge number of which as health and social care workers. Should free movement be restricted as anticipated after Brexit, the country will face a severe shortage in the health workforce, which will have a negative impact on patient care. The European health insurance card will also likely be rendered invalid, preventing EU nationals from receiving free emergency care and access to medications whilst in the UK.
Other consequences to the NHS would be a cut in the research funds for the country as well as a significant decrease in international research collaborations, leading to less opportunities for UK patients to enter clinical trials for novel treatments, significantly decreasing the level of healthcare they can receive. Lastly, relaxations of the working time directives, delays in shipments of medicines and medical equipment are other ways in which patient care may be compromised once the UK leaves the EU.
As with any ethical question you might have to answer at an interview, it is important to present a balanced argument, and as such, you should be able to consider potential positives resulting from this situation, as well. Such may be increased funds to this NHS from saving costs on EU membership, less competition for medical school spots, as well as increased opportunity for private practices within the country.
Euthanasia
Euthanasia has been a heated topic for many years and one which requires a little bit of background reading before your interview. Euthanasia is the act of deliberately terminating a sick person’s life in order to relieve suffering. This is different than assisted suicide, which is the act of deliberately assisting another person to kill themselves. Both are actions that could be carried out by relatives or medics, at the person’s request.
Euthanasia and assisted suicide are legal in countries like Switzerland, the Netherlands and some US states, but at the moment, both euthanasia and assisted suicide are illegal under UK law. Assisted suicide is punishable by imprisonment of up to 14 years, whereas euthanasia can lead to life imprisonment, as it is viewed as manslaughter or murder. There are two types of euthanasia you should be aware of - voluntary, where the sick person makes a conscious decision to request their life to be terminated and non-voluntary, where the person is unable to give consent and another person makes that decision, usually based on previously expressed wishes.
The ethical questions raised by euthanasia bring about a lot of arguments for and against the legalisation of such service. Can euthanasia ever be justifiable? Is it ever right to end someone’s life under any circumstances? Or are there any differences between killing someone and allowing them to die?
GP and Nurse Shortage
Scarcity of resources in the NHS are not anything new or unique to particular areas or specialties in the UK, but they are particularly severe in primary care and so it is important to be aware of the reasons behind it and proposed solutions to tackle these GP shortages.
The reasons for the severity of the problem are complex and multifold. The number of patients in primary care has steadily risen in recent years as the population is ageing. The types of conditions that are typically dealt with in the community, such as mental health, have also increased dramatically in prevalence. Furthermore, there has been an overwhelming demand for community nurses and more and more GPs working part-time, rendering their availability across practices insufficient.
The solutions that have been considered by the government include recruitment of extra GPs both from the UK and abroad, assigning bigger responsibilities to nurses and healthcare assistants in order to alleviate the workload of GPs; train GPs in further specialty areas to improve continuity of care and alter the length of appointments to suit patient needs better. All of this is an effort to improve conditions for both healthcare workers and patients, who currently experience a lot of distrust in the profession with long waiting times and lack of continuity of care.
Irish Abortion Referendum
On 25 May 2018, a referendum was held that successfully passed the proposal to repeal the abortion ban of Ireland that has been the law since 1983. Under this law, which aimed to provide equal right of life to both the unborn and the mother, abortion was prohibited in all circumstances where the life of the mother was not considered at risk and both patients seeking and medical professionals assisting in the administration of the procedure faced 14 years in prison.
Most European countries at present allow abortion up to 12 weeks of pregnancy, with a handful more, amongst which the UK, which extend this to up to 24 weeks upon request. Further extensions may also be considered where the mother’s life, physical or mental health are considered endangered. Following the example set by the majority of Europe, thus, Ireland’s successful repeal of the abortion ban introduced a new amendment, under which abortion is allowed for any reason up to 12 weeks, or beyond in extenuating circumstances.
The implications of this referendum will be incredibly significant for the country, where hundreds of thousands of women have travelled abroad or engaged in self-medication with pills ordered online in order to access abortion, potentially further endangering their health from unknown risks and side effects. With Ireland successfully passing the amendment allowing women to seek abortions, Malta now remains the only European country where abortion is still considered illegal.
Lifestyle diseases
A lifestyle disease is a common umbrella term for a group of non-communicable diseases that are associated with various lifestyle choices, such as alcohol consumption, smoking, unhealthy eating and lack of exercise. As these conditions make up the vast majority of the burden on the NHS, they are a frequent topic of discussion in the medical community.
It is important to be aware of some of the major lifestyle diseases and the pathophysiology that can lead to their development, as well as the impact they have not only on our healthcare system, but on our economy, as well. Obesity is one of the biggest contributors to these statistics, with up to 25% of adults and 20% of children falling into this category. The fact that obesity does not occur in isolation, but is associated with other serious health conditions, such as cardiovascular disease, diabetes and mental health problems, it is easy to see just under what amount of pressure our health system is put, having to cater through a multitude of specialties and intervention to resolve and monitor such comorbidities for up to a quarter of the country’s population. If we also take into account the disability these conditions can lead to, we can also appreciate the economic instability this may cause when the workforce begins to suffer as a result.
Consider the factors that lead to the development of lifestyle diseases too - people from a lower socioeconomic status are particularly susceptible due to the easy access and affordability of fatty foods and the amount of education around health.
The reason why it is important to be aware of lifestyle conditions is twofold - what their implications are to you as a future doctor and what solutions have we implemented to tackle this national problem. As an individual, you need to be aware of the importance of taking a good history and how crucial asking about a patient’s social history is. On a national level, being aware of the government’s attempts to curb the rise in prevalence of such conditions through higher taxes and educational programmes, as well as NHS’s efforts to monitor susceptible individuals are important elements to your understanding of this topic.
Medicinal cannabis
Medical cannabis is a very broad term that is used to describe any cannabis-based medicine that is used to relieve symptoms. In England very few people can receive a prescription for medical cannabis, and that includes people with very severe and rare forms of epilepsy, people experiencing vomiting and nausea as a side effect from chemotherapy and people affected by MS. Even then, medical cannabis would only be considered in cases where nothing else has helped.
However advertised as medical cannabis, products bought online or from health stores are not approved for medical use or proven health benefits and do remain illegal and potentially dangerous. It is important to be aware of the safety aspect of medical cannabis. Cannabis products containing THC have the risk of psychosis if used regularly as well as dependency, though that is low when controlled. If a product has no THC, such as the cannabis used to help epilepsy, no such risks exist.
Cannabis is categorised as a Class B drug in the UK and there is currently no intention of legalising the use for cannabis for non-medical use. If in possession without prescription, one could face up to five years in prison.
NHS structure
The structure of the NHS is an important topic of knowledge for medical school applicants, as the majority of graduates will spend most of their lives working in it and as such, they will be expected to have an understanding of their workplace and its history. Most importantly you need to be aware of the historical context around the decision to set up a National Health Service - after the war, it was felt that there was a need to socialise healthcare and make it free and accessible for all, which made it a unique system for its time.
Today, the NHS structure is founded on general practices which are independent businesses that treat the majority of health conditions and refer more complex cases to secondary or tertiary care in the form of hospitals and specialist national or regional centres, respectively. This way resources can be centralised, saving costs on the NHS. Recent history and political involvement in the NHS is also of importance to be aware of, so remind yourself of the current Secretary of State for Health Matt Hancock who is in charge of running the NHS and its budget that is then distributed to CCGs according to their population level and demographic needs.
Lastly, having an understanding of the current challenges our healthcare system is facing is imperial for success at your interview, so consider hot topics such as Brexit and its impact on doctor shortage, the ageing population and related comorbidities translating to increased demand, as well as funding constraints and privatisation threats, amongst others.
Organ donation
The opt-out system for organ donation, which already existed in Wales, has been implemented this year in England, too, after government approval. Under this proposition, also known as Max’s Law, as an adult of over 18 years of age, you are presumed to be an organ donor unless otherwise specified. This is expected to save hundreds of lives a year.
For your interview, you would need to know the specifics surrounding this decision and what this means for the population at large. For example, the ability of families to influence decisions and override presumed organ donation where they strongly feel this is not what their relative would have wanted, thus avoiding situations in which the deceased may not have been aware of the opt-out system. It is also important to consider the public opinion of such a large deviation from our current system. Many believe that without explicit consent, the rate of relatives denying organ donation will substantially increase. Others base their opinions on the model already set by Wales, and expect that similarly in England, the consent rate would jump instead.
Robotics in healthcare
Robots’ use in healthcare is a controversial topic that is supported by many but equally feared by others, so having a good understanding of the level of involvement they currently have and what the plans for the future are is important to be able to form an objective opinion.
We’ve come a long way since robots’ first introduction to healthcare in the 60s, where they were mainly utilised behind the scenes for automation of manufacturing on healthcare products. Today robots are much more involved in clinical practice and to various degrees - some are active, which can carry out partial procedures completely autonomously, semi-active, where they are supervised by a surgeon or passive, where they are involved in other aspects of care and not directly in the operation. The most famous robot in medicine which you might have heard of is the Da Vinci Surgical System, which has been around for about 20 years, but there are many others involved in nursing and minor procedure tasks, which are being trialled around the world.
To form a good argument at your interview, you need a good understanding of the advantages and disadvantages of such advances. On one hand, we have a steep increase in productivity and better precision, which means more efficient hospital services and better patient outcomes - a win-win situation. On the other hand, however, is the increased cost of acquisition and upkeep of such technology, additional training time and reduced job availability.
The Alfie Evans case
The Alfie Evans case outlines the case of an infant boy from Liverpool with undiagnosed neurodegenerative disorder. At 6 months he was admitted to hospital with temperature, jerking and epileptic spasms and his functional level was found to be that of a 2-month-old. As the parents wanted to seek treatment in Italy, a disagreement between them and the medical team caring for Alfie ensued, which was followed by a legal battle.
According to the doctors, administering ventilation, which was offered in Italy, would be inhumane and unkind against Alfie’s best interest which the parents disagreed with, who felt it should be up to them to decide their child’s care. A question of deprivation of liberty was raised. The hospital applied to the High Court to withdraw parental rights and despite multiple appeals, life support was discontinued shortly before Alfie’s second birthday.
Similarly to the Charlie Gard case, the Alfie Evans case displayed the power of social media, when an online campaign group “Alfie’s Army” was established in support of Alfie and his parents. Prominent figures like Pope Francis supported the case and Alfie was even granted Italian citizenship to facilitate his transfer. Furthermore, threatening conduct and acts of intimidation by the crowds protesting on behalf of Alfie and his parents were observed towards hospital staff, raising the question of the importance of public reaction towards healthcare in cases like this.
The Charlie Gard case
The Charlie Gard case is a case from 2017 that has received a lot of media attention and has raised important questions regarding patients’ best interests and autonomy of decisions, which are still very relevant today. Charlie was born with a rare genetic condition that required full support measures to sustain life. After having been kept on such measures, the doctors caring for Charlie at the Great Ormond Street Hospital in London felt that continuing to provide this type of care only prolonged his suffering and palliative care was in his best interests and further opposed the parents’ wishes to allow Charlie to fly to the USA for an experimental treatment.
A legal battle ensued between the hospital and Charlie’s parents that reached all the way to the European Court of Human Rights, where arguments were made for the autonomy of Charlie’s parents to make decisions about their child’s best interests and his liberty to opt in to life-sustaining treatment that had been denied. Charlie passed away shortly after the courts had ruled that the medical team’s actions had been lawful and protective of his interests.
One of the main takeaway points that this case has raised is to try and determine who is the best equipped person to judge what is in the patient’s best interest. Was this decision solely on Charlie’s doctors to make or would his parents have known better? Other important factors to consider that this case brought to life are the impact of the media on such medico-ethical issues, but also the impact of such high profile cases on the medical profession itself. Did the media report all nuances of this case correctly and did any misinterpretations aid in incorrectly swaying public opinion one way or the other? What would the effect of the consequential backlash towards medical professionals have been on future care and performance at the workplace?
The junior doctor contract
The junior doctor contract has been a hot topic of debate since 2013, when negotiations between the government and BMA for it first began. From the government’s perspective, too much was being spent on workforce during unsociable hours, so a suggestion to reduce the premium pay for such shifts was made. Junior doctors, on the other hand, found these changes to be highly unfair in comparison to their previous standard schedule, essentially now getting paid the same rate for longer hours.
Another big proposal of the junior doctor contract was to offer pay increases not based on years working for the NHS, as it had been before, but proportionally as progressing through training stages instead. Many specialties, however, take considerably longer than others in terms of training, so this would negatively affect a large number of both trainee and part-time doctors, receiving less for just the same amount of work in the NHS.
As the BMA didn’t feel that the needs of doctors were met with these new proposals, a series of strikes began at the start of 2016, which led to many doctors walking out of A&E departments across the UK. Regardless, the contract was imposed in late summer of 2016, even with 58% of BMA members opposing its terms. This development has had a significant impact on the NHS and the public perception of junior doctors, which are commonly asked topics for medical school interviews. Junior doctors, despite initially largely supported by the public, faced harsh criticism once they engaged in an all-out strike and were accused of not following the ethical principles of healthcare. Another consequence of the imposition of the junior doctor contract was the devaluement and attack many in healthcare felt, causing them to leave the profession and further exacerbating the challenges that the NHS already faces.
The medical licensing assessment
The Medical Licensing Assessment (MLA) is a new exam that will be introduced to UK medical schools from the academic year of 2024. This new assessment format replaced final medical exams and is a requirement for both UK and international medical graduates willing to pursue foundation training in the country.
The MLA is a two-part exam, which is made up of an applied knowledge test (AKT) and a clinical and professional skills assessment (CPSA). The first part of the exam is a multiple choice question assessment that tests your medical knowledge and ability to apply it in medical situations. The second part of the exam is a practical section that assesses your clinical and communication skills, much like current OSCEs. In fact, the content assessed on this exam will not be much different from current final exams, with a theoretical and a practical component each. So why the need to sit the MLA?
The MLA is the GMC’s initiative to ensure that all medical professionals joining the NHS have comparable knowledge and skills and can meet a common threshold for safe practice. This ensures that as a patient, the level of care and competence will not differ across health trusts or between doctors assigned to you.
Winter pressures
NHS winter pressures is a hot topic that springs to life every year with the approach of the harshest season. The reasons for it that lead to an imbalance between supply and demand of services are many - a spike in flu cases and other infections, increased risk of traumas and falls in the frail and elderly, as well as a rise in mental health problems. As a result, more beds, resources and staff than hospitals have available to offer are required, leading to massive challenges to keep up with the standards of care expected by the public.
It is important to be able to appreciate the consequences of such imbalance - for the NHS this means saturating capacity quickly and inability to admit new patients. It also means bed blocking, canceling scheduled procedures and delaying transfer of care to appropriate teams. Lastly, it means redirecting patients back to GP, who in turn become overwhelmed. Such pressure can translate to burn out and in turn - to mistakes, compromising patient care and safety. Saturating hospitals with sick patients also means higher rates of infections and longer times for treatment and discharge.
How do we begin to solve these issues? Proposals have been made for care provision to be delivered in patients’ homes for any services that do not require admission. Other solutions have been devised to prevent the need to seek medical help altogether, such as the annual flu vaccination programme. Lastly, social issues are suggested to be tackled by incorporating more occupational health services and mental health services in order to reduce A&E visits.
