Graduates wanting to study medicine as a career change from 2012 are facing a possible sevenfold increase in the upfront tuition fees required, prompting warnings of course closures.

According to a document seen by Times Higher Education, the government is "unlikely" to be able to continue funding a scheme under which the NHS covers the majority of tuition fees for medical students on accelerated graduate courses. Funding for the later years of undergraduate programmes may also come under threat.

Currently, about 10 per cent of medicine students are on four-year graduate-entry courses, which are run at 16 of the UK's 31 medical schools. The courses are intended to widen access to the profession.

The students, who are not entitled to state-financed fee loans, must pay for the first year of their tuition - ?3,375 in 2011-12. The Department of Health pays for the following years through the NHS Bursary Scheme.

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However, with fees increasing to about ?9,000 from 2012-13, there is now uncertainty about whether the government will be willing to cover the extra cost.

A briefing note prepared for a cross-departmental strategy group on health and education, seen by THE, estimates that the additional cost of higher fees for all medical degrees, including undergraduates, would be about ?60 million a year.

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It states that this represents a threefold increase in NHS funding for medicine and dentistry courses, and warns that the Department of Health "cannot afford to take this increased pressure without serious implications to other parts of the education and training budget".

If students have to meet the shortfall - almost ?6,000 for years two to four in addition to the ?9,000 year one cost - it would equate to a graduate-entry course costing about ?26,000 upfront.

Will Seligman, a University of Oxford medicine undergraduate who chairs a committee on student finance at the British Medical Association, said there was real risk that graduate-entry courses would have to close.

"The graduate route will cease to exist if nothing is done about it," he said, adding that BMA research indicated that graduate-entry courses had a higher proportion of students from lower socio-economic groups compared with undergraduate courses.

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He said he understood that the Department of Health and the Department for Business, Innovation and Skills were in talks on the issue, but said a decision was now urgent as prospective students had only a few months before the application deadline for 2012 courses.

Meanwhile, there are concerns that undergraduates studying medicine for up to six years would also be hit as, at present, their fees are paid by the NHS after the fourth year. A Department of Health spokesman said it was considering whether the NHS Bursary Scheme remained "fit for purpose".

simon.baker@tsleducation.com.