What is the funding mechanism for medical education?
The ‘Service Increment for Teaching’ (SIFT) pays the costs associated with teaching students.
The costs fall into three broad categories: the time GPs and consultants spend on teaching students; medical schools costs in running and organising courses; and – in hospitals – payments for the space given over to training students.
What’s the problem?
Variability. Currently hospitals get a flat £34,000 per student a year. However the fee paid to practices varies greatly. In a recent review of medical school funding, researchers led by GP Dr Alex Harding identified the average cost for practices was around £36,000. But he argues that a transparent methodology for calculating fees – consistent with that used for hospitals – is necessary, and that a variable tariff is ‘divisive’, as costs are broadly similar for hospitals and practices.
Currently, hospitals are paid for the costs associated with the space given over to undergraduates, and a similar payment is made for postgraduate teaching in general practice, but not undergraduates.
And as premises is already a limiting factor in general practice, with GPs unable to secure funding to expand or update surgeries, let alone give over treatment rooms for students, this is one of the things GPC wants to see addressed.
Finally, there are problems in the way SIFT funding is allocated. Often HEE gives money direct to hospitals – rather than medical schools – and it is redistributed from there.
Health Education England and the Department of Health are currently reviewing SIFT funding allocation, and health minister Dr Daniel Poulter said the fees would remain unchanged until this review is concluded.
But Dr Harding told Pulse the review group have not met since 2013 and the lack of transparency over how fees will be calculated and uncertainty over future tariffs is causing ‘mayhem’ on medical school finance committees.
Dr Harding also has concerns about suggestions that SIFT funding might be removed and replaced with separate tariffs for GP and hospital placements. He told Pulse any significant difference in the payment for either party would be a ‘doomsday scenario’, leading to further skewing of placement allocation.
What would be the ideal resolution to the review/how does the funding need to change?
The GPC want to see more time given over to general practice teaching, which currently only makes up 14% of the curriculum.
They also want funding to be equitable, and the research by Dr Harding and his colleagues in the Society of Academic Primary Care proposes one methodology, but says ultimately any funding should be consistent between primary care and secondary care as the costs are so similar.
The funding stream also needs to be simplified from HEE to practices.