A controversial shake up in the way clinical training is funded in England has been postponed for at least a year.
The Department of Health had proposed to introduce a new system this month which would have redistributed some funding away from medical training posts.
A review has recommended that the current Multi Professional Education and Training levy (MPET) should be replaced with a tariff based system where the funding follows the student or the trainee.
It proposed cutting the money paid to trusts for the provision of undergraduate medical education. It also recommended that the funding for the salaries of junior doctors should be reallocated so that only the education and training element of posts is reimbursed and not the service contribution.
Under the new system trusts would no longer receive 100% funding from the DoH for the salaries of foundation doctors and the proportion of funding for specialist training posts would also be cut. Savings from these changes were intended to free up money for training nurses, midwives and other healthcare professionals.
Following concerns raised during the consultation the DoH has now agreed to proceed more cautiously.
The BMA had warned that the proposed changes were being introduced too quickly and that the funding cutbacks could result in trusts shedding medical academic posts.
The DoH has now announced that no changes will be made this year. Instead placement rates and a range of options for funding postgraduate medical salaries will be piloted by strategic health authorities. The aim is to test the impact any changes will have on individual trusts.
A spokeswoman said more detail on the pilots would be published after the election.
Gill Bellord, director for core membership services at NHS Employers, said: “NHS Employers want a system that fairly recognises the overall costs of training and provides sufficient quality training to meet future healthcare needs. We will look forward to seeing what the pilots reveal.”
NHS Employers is in favour of scrapping the model of 100% salary support for all trainees because it says it would effectively make trainees supernumerary.
It argues that trainees are employees of trusts and provide a variable level of service contribution and that funding for their posts should reflect what trainees actually do. This would make funding of their posts consistent with payment by results funding.
Dr Tom Dolphin, junior doctors’ committee vice chair, said: “How commissioners of medical education choose to distribute their discretionary funding for posts should be on the basis of the quality of the training available. It’s almost always a good idea to pilot something before deciding whether to implement it fully and any pilots have to be run in a transparent way that makes it clear how the funding flows and why.
“Unintended consequences of reform have the potential to disrupt service provision if funding changes are too abrupt, and at the undergraduate level care must be taken to avoid damaging academic medical departments. The Department of Health is aware of these risks already.”
Is this another case of the ‘bean counters’ trying to count the different sizes of bean? Postgraduate training ahs always been, and always will be, a mixture of ‘training’ and ’service’; but it is often difficult to separate the two because an awful lot of ‘learning’ is by ‘osmosis’ from being around - seeing and hearing what is being done and said.
Of course one should see the results of any pilots before proceeding to ‘roll it out’ generally - but then that is the way of the scientist, not the way of politicians!