Anja Weidmann, Manchester

Plans to charge medical students up to the full cost of their university courses could be disastrous for the NHS recruitment drive, warned the BMA this month.

Details of future funding are expected in the government's white paper on education. But the government announced this week that the publication of the paper is to be delayed for a third time, until January 2003. Currently, student fees in publicly funded institutions are capped at a maximum of £1100 per year ($1738; a1723), payable on a means tested basis.

Tony Blair has confirmed that the government will uphold its manifesto pledge not to increase fees during this parliament. It seems likely that this will change in the future, and, although government funding remains undecided, universities are considering their stance on the introduction of top up fees.

Little consensus was reached regarding future charges at a recent meeting of the Russell Group of Universities, which is made up of the 19 top universities, all of which have attached medical schools. Many are in favour of increasing student fees; Imperial College is considering charging students the entire cost of their course--£10 500 per year.

Proposals to introduce higher fees are not new. Universities have repeatedly told the government that they are struggling financially with many operating at an annual loss and finding it difficult to retain, let alone recruit, top staff. The president of Universities UK, Professor Roderick Floud, says that universities need an extra £9.94 bn by 2006 if they are to meet government recruitment targets.

Despite recent concerns about budgeting for academic medical departments, the BMA Medical Students Committee is adamant that charging students extra fees is not the solution. Deputy chairwoman for finance, and final year medical student, Liz Kingston, is concerned that the prospect of top up fees would deter many young people from applying to medicine. Particular fears are that increasing fees would hinder attempts to recruit students from a wider range of backgrounds, especially from backgrounds that are currently under-represented.

She said, "The impression given is that medicine is an easy target for tuition fee increases and assumes that the students solely come from high income brackets. This attitude is unacceptable and contrary to the government's requirements for higher education. It would be folly for the higher education white paper to contain such a proposal."

Her views were echoed by principal of the University of Edinburgh, Tom O'Shea, who is also worried that the introduction of fees would work against widening participation in higher education. Glasgow and Edinburgh universities, the only Scottish members of the Russell Group, were completely opposed to idea of additional fees.