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.”

The Department of Health should halt their review of training funding as it threatens to cut millions of pounds from junior doctor training, the BMA claims.

The review of the Multi Professional Education and Training Levy (MPET) which will decide the future of how NHS training funding is distributed is currently underway and changes could start rolling out as early as April 2010.

The review deals with the funding of both undergraduate education and postgraduate training for all healthcare workers, and is seeking to better reward excellence in medical education. MPET is likely to be replaced with a tariff-based system where the funding follows the student or the trainee.

But, the BMA’s junior doctor committee passed a motion at its recent meeting expressing serious and urgent concerns in the principles and assumptions underpinning the review.

It is calling on the Department of Health to postpone implementation until all the information in the MPET budget is made available for external independent review; all the research relating to the review is made public; and, the underlying funding principles for external review and stakeholder agreement are explicitly stated.

It is also calling for full and meaningful engagement with all stakeholders in all stages of review and decision-making and for the use of quality metrics.

Fears concern 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.

Dr Shree Datta, chair of the BMA’s Junior Doctor Committee, is concerned the review will make it more expensive for hospitals to employ juniors.  

She said: “We are seriously alarmed that the impact of this review has not been thought through. The idea that the NHS could press ahead with this as early as next year is simply dangerous.

“Fully trained doctors 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 no longer want to do it.

“The time has come for this review to stop and for the Department of Health to listen to the serious concerns of the medical profession.”

Read more news stories on MPET.

The rationale for the MPET review was outlined in High quality care for all: NHS Next Stage Review final report.