After years of undersupply, the UK is finally getting serious about training doctors – some 44 percent more students started training in 2022 than a decade ago.

Medicine has always been a popular choice of course to study: it’s a chance to do some good and have a well-remunerated career in the process. For this reason it has also been a hard course to get into.

You need very good science A level grades to start at medical school. You also need a good score in the Universities Clinical Aptitude Test (UCAT), and to apply via UCAS extra-early. The whole application process is complex and variable – interviews, statements, tests and prior attainment all play a part, and this varies by provider and year.

It helps in, other words, if you go to the kind of school that is used to getting people into medical school. According to a new Sutton Trust report, independent school pupils still have substantially better odds than their state school peers of receiving an offer.

It also helps if you are middle class. Some 75 per cent of entrants to medical school were from higher socio-economic backgrounds in 2021, with just 5 per cent from the lowest. Wonkhe readers will be aware that A levels, interviews, and personal statements with copious extra-curricular activity are mainly a measure of how middle class you are – so the well-known link between economic disadvantage and low prior attainment plays a huge part here.

There is evidence of good news from area based measures of deprivation. Perhaps because such measures are often used as an access target, applicants from the lowest index of multiple deprivation (IMD) quintile are more likely to get an offer than similar applicants, and more likely to enter medical school if they do get an offer.

You will have spotted a recent expansion of medical school provision – and might hope the newer medical schools would be more dynamic in appealing to undeserved groups. They are better – one in ten entrants to newer schools are from private school backgrounds, compared to one in four at more established providers. But there is still an issue – 7 per cent of entrants have come from the lowest socio economic group and 66 per cent from the highest. Likewise “gateway” courses designed to improve access – a foundation year for medicine, basically – attract just 11 per cent of their entrants from the lowest socioeconomic group.

If we want the best doctors, we can’t assume they all come from the kind of background that allows them to stand out in admissions processes in traditional ways. The Sutton Trust calls for a Fair Access Review for the whole sector, with a specific focus on medical school, and asks the government to prioritise expansion in medical schools that have shown they are good at fishing beyond the usual puddle. Information – including on admissions processes and requirements – needs to be clearly presented, ideally centrally.

Raising attainment in schools will help level the playing field a little, as potentially could medical apprenticeships (unless they are just seen as another route into the profession for the well off). And we can’t ignore the fact that a long course like medicine also presents student maintenance challenges – the report calls for parental contribution thresholds to be uprated with inflation, and for the reintroduction of grants. This would also need to follow through to later years, where maintenance is offered – at a lower rate – by the NHS.

But a large chunk of the recommendations focus on medical schools themselves. There’s calls for an increase in contextual offers, more participation by medical schools in WP programmes, a better basket of measures of deprivation, less weight placed on medical work experience (usually only available to very well connected applicants), and a review of UCAT.