The way postgraduate medical education and training is funded in England is changing. Those changes, and the impact they will have on junior doctors, is explained in detail below.
The tariff and updated study budget system
The complex system for funding medical postgraduate education and training in England has seen a number of changes over the past few years, with the most recent being to the study budget system.
The tariff system for funding medical education and training in England came into effect on 1 April 2014.
The tariff system was established to create a more transparent funding mechanism, and mirrored systems already in place for non-medical and medical undergraduate education and training.
In April 2018, this was updated in terms of the way in which study budgets are managed and distributed to junior doctors.The new study budget arrangements are designed to improve transparency and equity for junior doctors across England.
However if you notice a change in your access to training opportunities, any other part of your training or any aspect of patient care, especially if you think it could be due to the new funding arrangements, let us know as soon as possible. Send as much detail as you can to [email protected]
Why have changes been made to the study budget system?
This originated in the "Enhancing Junior Doctors Working Lives" group – a tripartite committee between the BMA, Health Education England (HEE) and NHS Employers, where study budgets were raised as an issue. Junior doctors had told us that there were serious problems with the way the study budgets were administered, so we lobbied HEE for a change and increased transparency.
Many trainees were paying for costs associated with their training out of their own pockets, simply in order to progress. Budgets differed across the country and by specialty.
There was a lack of transparency regarding what happened to any unspent money. Funds couldn't be carried over between years. Study budgets were being top-sliced to pay for training, which sometimes could be of questionable benefit or quality.
What will the changes be?
There was a commitment made by HEE to try and fix these issues, and therefore from April 2018, they will oversee administration of study budgets from a local office.
The funds will be pooled, allowing greater flexibility of distributing this money, to benefit trainees. Trainees will continue to apply for and be reimbursed in the same way.
The intention is that this will result in a more transparent system, with all funds guaranteed to be used for the education and training of junior doctors.
If you see a negative impact on what you are able to claim for, please get in touch with us. We can help you raise this or appeal it.
Who will fund courses that my Trust say are mandatory?
HEE has agreed with NHS Trusts that the trusts will cover costs of all mandatory training required to fulfil the trainee’s clinical role e.g. life support courses, safeguarding training.
If your trust refuses to pay for your mandatory training courses, and you are a BMA member, make sure to get in touch with our BMA Employment advisors on 0300 123 1233 or by email
What about courses that aren't technically linked to my curriculum, but will benefit me as an individual, or the NHS more generally?
This will need to be approved by your Head of School or Training Programme Director one, but it is intended that this will also be funded.
How the tariff works
Funding is provided as a lump sum payment to Local Education Providers (LEPs) to cover the direct costs of delivering education and training for each placement for one year. A LEP is an organisation, such as a hospital or trust that delivers postgraduate medical education and training (i.e. the trainee's employer).
There are two components to the tariff:
- Salary support - HEE makes a salary contribution for each trainee, payable to the LEP. It is approximately 50% of the basic salary costs for the post across all grades (including "on-costs", such as pension and national insurance contributions, and London weighting where applicable). Exact figures are outlined in the tariff published by the DHSC. The remainder of the salary costs have to be met by the LEP.
- Placement fee - The placement fee funds all the "direct costs" involved in delivering the education and training needs for an individual trainee. The fee for 2017-18 is £12,152 (multiplied by the Market Forces Factor).
Pre-April 2014, funding for training placements came from a single pot known as the Multi Professional Education and Training (MPET) levy.
Salary replacement was agreed nationally and varied depending on the type of post while funding for additional costs (e.g. study budgets) were agreed locally and were determined by the number of doctors training within a deanery plus an additional sum based on local need and historical precedent.
Which placements does the tariff apply to?
The tariff is applicable to placements in any organisation (LEP) whether they are NHS funded or not, unless specifically excluded.
The placement must:
- be a recognised part of the education or training curriculum for the course;
- be approved by the higher education institute and the relevant regulatory body;
- meet set quality standards and be quality assured;
- be direct clinical training (including clinical exams) with an agreed programme being a minimum of one week; and
- have appropriate clinical and mentoring support.
What does the tariff not apply to?
This tariff does not apply to:
- dental trainees
- placements in GP practices (the tariff does apply to hospital placements for GP specialist registrars)
- placements in hospices
- placements in public health
- National Institute of Health Research (NIHR) trainees
- Less than Full Time (LTFT) trainees
- Trust funded posts
- Nationally introduced one-cycle posts (such as any remaining Hewitt and Johnson posts), which remain out of tariff until the end of the individual's training cycle
- Out of Programme experiences
- Doctors in Difficulty
These posts are funded on national pre-April 2014 arrangements or by local arrangement.
What are the 'direct costs' that the placement fee covers?
The placement fee should cover all direct costs of providing education and training including (this list is not exhaustive):
- Course fees and expenses (where required as part of the training)
- Direct staff teaching time
- Teaching facilities, access to library services and trainee accommodation costs
- Administration and infrastructure costs
- Education supervisors
- Pastoral and supervisory support
- Health and well-being (excluding occupational health assessments funded separately)
What costs are excluded?
The tariff does not cover relocation or exceptional travel costs, tuition costs, or items funded separately in the LETB budget.
This includes but is not limited to:
- resources required to support ARCPs
- management of placements
- administering rotations
- Foundation Programme Directors
- Foundation Programme administration support staff
- Heads of Schools
- Training Programme Directors
How the BMA can help you
If there is a change in your study budget, library facilities, any other aspect of your training or any aspect of patient care, especially if you think it could be due to the change in funding, you MUST let us know. Send us as much detail as you can to [email protected]
The Junior Doctors Committee (JDC) is a leading voice of trainees to Health Education England and we can help influence spending in the future.
If you have any questions about the new education and training tariff or postgraduate medical education and training more broadly, please contact us at [email protected]
What do people think about the changes?
Patrick Williams, Specialist registrar Trauma and Orthopaedics, Northern deanery
'Orthopaedic courses are expensive. We are fortunate that a lot of our courses are subsidised by industry but, even so, a cadaveric course can cost well over the £600 of my study budget. These courses are almost essential for my training as they allow me to hone skills in a safe environment. Unfortunately, I have had to almost completely stop going on them due to cost.
I am now coming towards the second half of my training and looking to sit the FRCS. This exam, which I am required to pass to complete training, costs over £1800 before doing any revision courses. Whilst this does incentivise you to pass the exam first time it also prohibits me from doing any other courses that help further my training.
Increasing the study budget available will have a huge benefit.'
Simon Fleming, ATDG Vice Chair & BOTA Past President
Vimal Gokani, ATDG Vice Chair & ASiT Past President
'The costs of mandatory courses should not be borne by trainees.
The costs (including travel and accommodation) of courses which are required to progress through training, achieve a Certificate of Completion of Training (CCT), or which are felt to be of significant educational value by training program directors, should be provided by the bodies with educational responsibility, just as courses which are mandatory to work within a Trust should be provided, without charge, by the employer.
Time to undertake these courses should also be allowed by the rotas, without penalty.
Any changes which facilitate this, widen access to medicine as a career. They reduce cost of training as a barrier to being a successful doctor, and work to improve morale within the already overstretched career and are welcomed wholeheartedly by surgical trainees.'
Tell us what you think about the changes
How do you see forsee the changes to study budgets and their impact on you?
Feel free to leave your comments, suggestions or questions at the end of Sarah Hallett's blog