For hundreds of years, doctors in the UK have been trained in almost exactly the same way. Indeed, the origins of the University of Oxford¡¯s medical science curriculum . But, later this year, a new entry point into a medical career will open up when the first degree apprenticeships in medicine begin.?While undertaking degree-level study, the apprentices will also immediately begin working in healthcare settings. And rather than racking up large university debts, they will be paid for their services.

Sceptics ¨C including the British Medical Association ¨C have said that it will be a ¡°complex challenge¡± to ensure an apprentice¡¯s individual needs are met while adhering to the NHS¡¯s necessarily high standards. What¡¯s more, the BMA says, the existence of such a scheme does not in itself guarantee a more diverse workforce, while the 200 apprentices who will make up the initial cohort will barely make a dent in the 46,000-strong doctor shortage the UK is experiencing.

Yet, in many ways, medicine ¨C long one of the most competitive and heavily gatekept fields in higher education ¨C represents the final frontier in the quiet revolution that has seen degree apprenticeships transform the offering of many UK universities in just a handful of years, potentially opening up the higher levels of medical careers to a whole new demographic.

In 2022-23, 42,060 people began higher-level apprenticeships in the UK in a wide variety of fields, from policing and social work to sales and retail. That number is still dwarfed by the 560,000 applicants accepted on to full-time traditional undergraduate courses. But the current universities and skills minister Robert Halfon ¨C who is fond of claiming that ¡°degree¡± and ¡°apprentice¡± are his two favourite words ¨C has suggested that degree apprentices could make up half of all university-enrolled learners in the future. And, in a sign of the increasing mainstreaming of degree apprenticeships, admissions service Ucas will display them alongside degree options from next year.

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Currently, about 100 UK universities offer degree apprenticeships, around two-thirds of the entire sector. But ¡°I know the minister would like to see all universities delivering degree apprenticeships and we would encourage all institutions to consider their value,¡± says Greg Wade, policy manager for Universities UK.?The sector body recently launched a 10-point action plan to build on the ¡°impressive growth¡± in degree apprenticeships seen since 2017, when the apprenticeship levy ¨C a 0.5 per cent tax on large employers¡¯ payroll that is then used to fund placements ¨C came into force.

¡°Degree apprenticeships are in a good place,¡± Wade says. ¡°More universities are engaging, we¡¯ve seen more employer demand and increased recognition of their value among policymakers. We see this as an opportunity to assess the barriers, ask what would encourage institutions to deliver apprenticeships and then reflect that back to ministers.¡±

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But as the world watches with interest ¨C with several countries looking likely to follow the UK¡¯s path ¨C many observers, as well as apprentices themselves, have voiced concerns that degree apprenticeships are not the perfect blend of academic and practical training they are often lauded as. Regular gripes include a?lack of employer engagement, opportunities being subject to a ¡°middle-class landgrab¡± and a sometimes poor quality of education.

It is rarely acknowledged how difficult it is to deliver degree apprenticeships to a high standard, says Tom Richmond, a former adviser to Conservative education ministers and founder of EDSK, the education and skills thinktank, whose , No Train, No Gain, shone a light on poor quality in the sector when it was published last year.

¡°For a degree apprentice to have a really good experience, with an employer and a training provider jointly delivering a great training programme, is extremely challenging and requires a huge amount of time and effort, resources, planning and dialogue between the three main actors,¡± Richmond says.

So if degree apprenticeships really are the future for higher education in the UK and the world, what will ensure that this challenge is always met?

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One question is whether degree apprenticeships truly create opportunities for hard-to-reach communities. Social mobility charity the found last December that just 5 per cent of degree apprentices were eligible for free school meals.

However, examples of where they have been life-changing for individuals are not hard to find.?Rajindu De Silva and Justin Jones have both worked for tech giant Microsoft for more than five years after being recruited as apprentices, De Silva in the public healthcare team and Jones specialising in cloud computing.?De Silva was previously working in retail and says he did not want to go to university. None of Jones¡¯ family had a degree and it was always made clear to him that whatever post-18 route he took, ¡°You¡¯re going to be the one paying for it so make sure it is really what you want to do.¡±?Both were attracted to the debt-free apprenticeship route into the technology industry, and both are enthusiastic about the benefits. ¡°We¡¯ve managed to have a whole degree paid for, get on-the-job experience, meet and network with a huge amount of people in the industry, and come out pretty much geared up for the whole of our careers,¡± says De Silva.

As a wealthy tech firm, Microsoft has a lot of resource to dedicate to such programmes, and universities have typically found that working with big companies leads to the most successful degree apprenticeships. For instance, Zahir Irani, deputy vice-chancellor of the University of Bradford, says his institution¡¯s most successful scheme is with supermarket chain Morrisons, with which a pre-existing relationship morphed into a degree apprenticeship offer for staff in areas including retail, operations and logistics.

¡°It works well because we have a relationship with one company,¡± Irani says. ¡°That two-way conversation is relatively easy to have. They can forecast the number of students they are going to send to you in advance as they¡¯ve got a stable business model. And we can be adaptive to their needs.¡± For instance, the university can leave the apprentices alone in the busy pre-Christmas period for retailers, knowing that ¡°a 3,000-word assignment due on 15 December is not going to land very well.¡±

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By contrast, coordination is harder regarding the university¡¯s open programmes, which are delivered in collaboration with multiple smaller employers. Working with more small and medium-sized enterprises (SMEs) is a key aim for the sector, but, Irani says, ¡°they all require different contractual relationships. There are big overheads¡­and you are trying to organise through many different contact points. With Morrisons, you are dealing with an HR department containing many people. Small businesses maybe have half a person dedicated to this.¡±

Daniel Lally, director of business engagement, skills and employability at Sheffield Hallam University ¨C one of the institutions that has moved into apprenticeships in a big way ¨C agrees.

¡°Commercially, it would be far easier for us to go for a very small number of selected high-profile employers that give us massive numbers,¡± he says. ¡°But in Sheffield we have a local economy where the vast majority of businesses are SMEs. We can¡¯t be a university for the region and not meet the demands of that market, but working with SMEs is more expensive and there is often no recognition of that for a provider. Ministers have focused on how SMEs can be incentivised to take on apprentices, but I think there needs to be more thought given to how to incentivise providers to work in that space as well.¡±

For Lally, apprenticeships can only work for institutions if they are done at volume. ¡°That doesn¡¯t mean do a lot of a lot [of programmes]. You could do a lot of a small number, but you can¡¯t dip your toe in the water,¡± he says.

Irani agrees. ¡°There¡¯s a myth that an apprenticeship degree is just a condensed normal degree. It¡¯s not,¡± he says. ¡°The scaffolding, the assessments, the delivery are fundamentally different. It comes with its own operating model and cost infrastructure and that¡¯s the same whether you have one student or 50.¡±

But even large employers can¡¯t always be relied on to deliver on their side of the bargain. For instance, a partnership between Bradford and an NHS trust to upskill existing staff did not get the take-up expected. ¡°We were promised x number of students,¡± Irani says. ¡°In good faith, we designed a programme.¡± But when it came to the crunch, recruitment issues within the health service conspired against the programme.

¡°The trust often can¡¯t release the staff, or the staff themselves don¡¯t feel they can commit because of the pressures of the workplace,¡± Irani explains. ¡°You as a provider want to do good, the employer wants to do good, but there are tensions there. Engagement has been relatively limited, and you can see that by the numbers going through. They are way below what we and the trust expected.¡±

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Disconnect between employers and education providers is often the source of frustration for apprentices themselves, too. Dexter Hutchings, a former digital marketing apprentice and co-founder of the group Apprentice Voice, says he felt his course content bore little relation to what he was doing in his job, which nearly led to him dropping out.

¡°The major issue was that the programme felt almost two to three years out of date,¡± he says.

At their best, degree apprenticeships promise classroom-based learning that complements on-the-job experiences, but, for Hutchings, ¡°the industry moves at such a pace¡­it almost felt like everyone in the classroom knew more than the lecturers.¡±

Niamh Mulhall, another co-founder of the group, had a different experience but ultimately came to the same conclusions.?She began a level 3 (post-16) apprenticeship in NHS business administration after dropping out of sixth form and college, before moving on to a degree apprenticeship with the education publishing and assessment group Pearson.?The company, which has its own higher education college in London, handles much of the education side of the degree apprenticeship in-house, but Mulhall says there was still a lack of understanding on both sides.?

¡°We¡¯d have a day off work each week and they would assign you research projects you were expected to do with your employer, but, actually, in the workspace there was no time or space for that,¡± she says. ¡°My manager had no idea. There was still quite a big disconnect even though you would think they would speak to each other.¡±

A spokeswoman for Pearson said the company was ¡°proud to have offered employee apprenticeship programmes for over 20 years, and we always welcome feedback for improvement. Since 2017, more than 110 colleagues have successfully completed a degree apprenticeship, with a 76 per cent distinction rate. All apprentice managers receive specific training and support to ensure they understand their role and responsibilities, which is essential to apprentices' successful completion.¡±??

Some dissatisfaction among apprentices studying at a higher level is reflected in the government¡¯s own reporting. An released last year found that only 3 per cent of those at degree-apprenticeship level (level 6) and above failed to complete their programmes in 2020-21, compared with nearly half (46 per cent) of level 3 apprentices, while overall satisfaction, at 91 per cent, was higher than in any other category. But one in five (20 per cent) of degree apprentices was not happy with the quality of their learning, worse than the 15 per cent average for apprenticeships overall. And while many of the degree apprentices EDSK¡¯s Richmond spoke to for his report are grateful for the opportunities that were opened up to them, ¡°if you scratch the surface, you start to see what their actual experience was like, and some very concerning things came up.¡±

Richmond describes degree apprentices being unaware that their course was fully online until after they had started their apprenticeship. Moreover, in lieu of any direct training, they were often told to simply watch recorded lectures. Any time spent writing assignments also counts as part of degree apprenticeship ¡°training¡±, meaning that an apprentice could spend hours, if not days, interacting with nobody, he says. Support from tutors was described as ¡°almost non-existent¡± in some instances, with apprentices having to request feedback on assignments.

¡°The drive for a low-cost/high-volume delivery model, which we see in other parts of the apprenticeship system, is clearly playing out with some degree apprenticeships as well,¡± Richmond says. ¡°Many providers are doing an excellent job, maybe using a blended approach that offers flexibility, with high-quality teaching and learning. Regrettably, though, there are others who appear to be walking away from their responsibilities to offer a high-quality training course.¡±

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Much of the problem, he says, stems from a lack of external oversight of the training curricula, which education providers are free to set themselves and that apprentices sometimes know little about ahead of beginning their studies. ¡°Think about signing up for a degree course where there is no information available about what you are going to cover on that course. That would be seen as completely unacceptable, yet it is openly tolerated for apprenticeships,¡± Richmond says.

Ofsted ¨C the regulator that inspects universities¡¯ provision in this area ¨C can struggle to catch such poor practice, he adds. Besides, there is nothing in the funding rules that prevents it, even over an apprenticeship that can last six years.?¡°This is one of our biggest complaints. With such little attention being paid to the quality of degree apprenticeships, many future apprentices are likely to end up disappointed with their programme, and that¡¯s a shame ¨C not least because it is an entirely avoidable problem.¡±

The opposite argument ¨C that providers are subject to too much regulation ¨C is often heard, too. And Ofsted has been prepared to bare its teeth since it started inspecting universities.?Sheffield Hallam fell afoul of the regulator in 2019, when it was rated as ¡°requires improvement¡± across the board, from the quality of its teaching to outcomes for learners. Too few apprentices were completing courses in some areas, inspectors found, while careers information and guidance was often patchy.

The report ¡°sent shockwaves¡± around the university, according to Lally. ¡°But I said to colleagues that it might not feel like it, but it could be the best thing to happen right now. There was a slight concern ¨C and I think this happened elsewhere ¨C that you scrape through an Ofsted and everybody assumes what you are doing is good, whereas actually you just got lucky at the inspection. That doesn¡¯t drive activity in the way it did for us.¡±

Lally says the university questioned whether to carry on with degree apprenticeships but ultimately decided to conduct a complete root-and-branch review.

The result is that in its latest inspection, Sheffield Hallam received a ¡°good¡± rating, and it has grown its offer by 30-35 per cent year-on-year since 2019. It now has one of the broadest portfolios of any university, with 2,500 apprentices across 35 ¡°¡± (skills areas), working for 600 employers.

¡°Apprenticeships are one of the only provisions that cross the whole spectrum of what a university does,¡± Lally says. ¡°Everything else can be quite localised. If you have an issue with your nursing programmes, it is within that department. But we have 13 departments delivering apprenticeships. You have to make sure they are built, managed and governed in a similar way. The characteristics of an apprenticeship at an institution should be identifiable across the board.¡±

As such, Sheffield Hallam's embrace of degree apprenticeships?is starting to influence ¡°every corner of the university¡±. Academics are embarking on research into apprenticeships. Applicants for professorial-level positions are referencing work in this space. And innovations that started in apprenticeship courses are impacting on core curriculum design in undergraduate programmes.

¡°We said four or five years ago that when this starts happening, that¡¯s the point we know we are having an impact in the academic community,¡± Lally says.

So could this happen at every university? Oxford¡¯s chancellor and Conservative Party grandee?Lord Patten of Barnes does not appear to think so. In his for Oxford¡¯s new vice-chancellor, Irene Tracey, earlier this year he said the top-ranked institution ¡°is hardly in the best position to award apprenticeships. That would not be playing to our strengths, and other universities already do the job very well.¡±

But Universities UK¡¯s Wade says that while it was natural that the more vocationally orientated universities had been the first to move into degree apprenticeships, provision was picking up among the research-intensive institutions as well.?¡°That¡¯s not surprising,¡± he says. ¡°They deliver engineering, medicine and health. We have this bizarre notion that there is a really harsh dividing line between technical and academic but that isn¡¯t the case.¡±

Raheel Nawaz, a founding head of the Apprenticeships Research Unit at Manchester Metropolitan University, who now works as Staffordshire University¡¯s pro vice-chancellor for digital transformation, believes that while some elite institutions will continue to resist degree apprenticeships, others have started to engage, sometimes because of ministerial pressure or a feeling they should be ¡°on the bandwagon¡±.

¡°I think there is a growing feeling that degree apprenticeships are bringing other benefits as well,¡± he says. ¡°They allow you to work more closely with employers; your Teaching Excellence Framework rankings get better. I think the direction of travel will remain the same: more and more towards degree apprenticeships.?I think the only thing that would potentially change it is if the levy system is revised radically.¡±

As more Ofsted inspections take place, Lally says it is likely that some universities will exit the market, having struggled to deliver a critical mass, ¡°especially in the current economic climate, where investment priorities are having to be made¡±.

The early adopters may also face stiff competition from private providers, Nawaz adds, which often have lower overheads and offer employers year-round teaching, instead of instruction being confined to university terms. ¡°We are already being slightly muscled out in that regard, although most employers appreciate the value of working with universities,¡± he says.

Nawaz has also advised other countries interested in developing their own degree apprenticeship programmes.?A pilot was recently concluded in New Zealand, influenced by the British model, and the results are expected imminently. Nawaz believes the government there is ¡°very likely to continue¡± to extend provision. In Canada, meanwhile, the first cohort enrolled on what is being called ¡°work-integrated learning degrees¡± will begin in autumn 2023. And in Spain, master¡¯s-level degree apprenticeships started a couple of years ago and seem to be growing steadily. Nawaz says he has also had conversations with figures in Pakistan and Australia.

But Universities UK's Wade cautions that the ¡°gamer-changer¡± in the UK has been the apprenticeship levy and ¡°it will be a significant challenge for other countries to introduce degree apprenticeships without something similar¡±. Sure enough, despite warm words about the concept, Australia has struggled to get degree apprenticeships off the ground. Last year, BAE Systems Australia and employer association Australian Industry Group (Ai Group) the nation¡¯s first-degree apprenticeship programme, to be delivered by Victoria University. But asked by Times Higher Education for a progress report, a spokesperson said Victoria was no longer involved.

Speaking broadly about why the concept is still in its infancy in Australia, Peter Hurley, director of the Mitchell Institute for Education and Health Policy at Victoria, says another big problem is regulation around industrial relations. ¡°It¡¯s not just a matter of offering a separate course. They¡¯ve tried to do that and work around it, but it is quite complicated. All those regulations sit at a state territory level, so it is hard.¡±

Employers also see little incentive to get involved, according to Hurley, when they can ¡°sit there and catch graduates at the end of their course, not having to pay for their education¡±.

Mish Eastman, deputy vice-chancellor at RMIT University, says?her institution is working to build its own portfolio of higher apprenticeships. It has received A$19 million (?10.4 million) of Victorian government funding to design and deliver training for the social care sector, she says, and has partnered with the federal government to deliver a higher apprenticeship in advanced manufacturing.

Such models, according to Eastman, require ¡°investment and commitment from institutions and government to deliver at scale¡±.

When such commitment is in place, is it possible that degree apprenticeships might even replace traditional undergraduate programmes in the long term? Wade is sceptical. Higher education is ¡°not just about jobs, and it is not just about specific jobs. An awful lot of graduate roles don¡¯t require a particular subject.¡± There is still therefore a lot of room for the teaching of transferable skills that academic institutions have always focused on, and many students will prefer to study broader, less job-focused courses, he believes.

But Bradford¡¯s Irani is less sure that traditional degree programmes will be unaffected by the rise of degree apprenticeships. He says the introduction of more work-focused T levels in England, Wales and Northern Ireland as an alternative to A levels will soon translate into more students placing a heavier focus on their careers, making them more likely to pursue the apprenticeship route ¨C a development he describes as ¡°bittersweet¡±.

¡°On the one hand, I think degree apprenticeships are a really strong alternative to traditional degrees, but, on the other, they will redefine what a university education looks like in the long term,¡± he says, warning that it would be a mistake to lose focus on the teaching of transferable skills and the broader, non-vocational aspects of higher education.

Sheffield Hallam¡¯s Lally goes further, suggesting that the move into apprenticeships is just the first stage in what will eventually be a complete transformation of what universities do.

¡°I think this is a big turning point for institutions,¡± he says. ¡°It is a chance to start thinking about ¨C at scale ¨C diversification and offering different products in different ways. That is a conversation that has begun with apprenticeships. But it doesn¡¯t finish there.¡±

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tom.williams@timeshighereducation.com