A shake up in the way clinical training is funded by the NHS could result in trusts axing junior doctor and medical academic posts, the BMA fears.
The proposed changes could destabilise the NHS, claims junior doctors’ committee (JDC) vice chair Dr Tom Dolphin.
The Department of Health has been reviewing education funding in England because it is no longer considered to be fairly distributed between different organisations or professions. It believes the current system also fails to reward quality in education.
The current Multi-Professional Education and Training levy (MPET) is likely to be replaced with a tariff-based system where the funding follows the student or the trainee.
There are proposals to cut the money paid to trusts for the provision of undergraduate medical education. Current funding of between £10,000 and £100,000 a year for each student is to be replaced with a flat rate of £40,000.
Funding that trusts receive for the salaries of junior doctors is also likely to be re-allocated to fund only the education and training element of posts and not the service contribution.
Trusts currently receive 100% funding from the DH for the salaries of foundation doctors but this is to be cut to 80%. Funding for ST1, ST2 and ST3 doctors is to be cut to 40% and for ST4 doctors to 25%.
Savings from these changes are intended to free up money for training nurses, midwives and other healthcare professionals. Trusts will receive a placement allocation of £90 per student week for this group.
A decision by the DH on the proposed changes is imminent and the new system is likely to be run as a ‘shadow’ programme from April so that trusts can prepare for the shift in funding over a transition period of up to four years.
Dolphin said they were concerned about the speed of the review. He said: “We are deeply concerned that the massive shifts in funding that will occur could result in the loss of many medical academic posts. This means that there will be insufficient staff to train the next generation of doctors let alone carry out research.
“We’re talking about changing the flow of several billion pounds through the NHS, and we can’t be sure that at the end of it employers are still going to find it worth their while to have junior doctors.”
He said the JDC was not satisfied that the impact of the review has been thought through properly and they did not feel the DH had any clear idea how they will measure quality of training even though the changes are designed to shift money in order to incentivise and reward high quality training.
“Consultants and GPs don’t grow on trees and the Department of Health needs to be very careful that they don’t end up making the training of doctors so unattractive, or the funding system so unstable, that hospitals will no longer want to do it.”
NHS Employers head of programmes David Grantham admitted there would be “pain” for some trusts which had been receiving thousands of pounds more for training doctors than others.
But he said: “I don’t think there is anything here for junior doctors to worry about. This is about a redistribution of funding rather than an attempt to cut junior doctor training posts. Some trusts will lose money but others will gain. It might mean that some hospitals will be willing to lose a few training posts but others might be able to expand their training.”
A spokesman for Medical Education England, which has been providing independent expert advice on the review, said: “We are supportive of moves to tackle historical difficulties in this area and of work to ensure greater transparency about funding for clinical training.
“However, we have expressed concern during this ongoing debate about any potential impact, whether intended or unintended. We believe that any proposed changes should be piloted and introduced slowly, with the full engagement and support of appropriate stakeholders and backed by evidence where it exists.”