Academic medicine has a key role in health systems, and the definition of the International Campaign to Revitalise Academic Medicine (ICRAM) captures the issues well.1 In the United Kingdom, the number of clinical academics continues to fall, particularly at the clinical lecturer grade (42% lower in 2004 than in 2000).2 At the same time, the numbers of students and young doctors are rising, creating an unstable situation. NHS staff already do most of the training for both postgraduates and undergraduates, and this is increasingly occurring outside university centres, including in primary care. The NHS funds some 40% …