Guidance

Education and training tariffs 2024 to 2025

Updated 16 December 2024

Applies to England

1. Purpose of the guidance

1.1 This guidance document is intended to provide further information in support of the education and training (ET) tariff payment process for the 2024 to 2025 financial year, including:

• details about the introduction of the ET tariff payment mechanism
• confirmation of NHS England’s continued responsibilities for ET tariff development
• powers and requirements with regards to the application of the ET tariffs in 2024 to 2025
• confirmation of the changes to the ET tariffs that are being introduced from 2024
• further information relating to the ET tariffs for 2024 to 2025, including prices and scope
• links to further guidance that supports and supplements the information contained in this tariff guidance document

2. Overview and background

2.1 The Department of Health and Social Care (DHSC) introduced tariffs for clinical placements and undergraduate medical (UGM) placements in secondary care from 1 April 2013. A similar placement tariff for postgraduate medical trainees came into effect on 1 April 2014 and for undergraduate dental trainees on 1 September 2022.

2.2 Prior to the introduction of the placement tariffs, payments for training placements were subject to local arrangements, creating inequities in funding. The placements tariffs aim to ensure that providers are reimbursed consistently for the training placements they provide, that placements are high quality (refer also to the NHS England Education Quality Framework and the Quality and Improvement Outcomes Framework) and ensure that learners develop the required skills and knowledge to meet their respective professional requirements and/or capabilities.

2.3 NHS England is responsible for administering the tariff payments to placement providers in line with this tariff guidance document, which is published annually by DHSC. Alongside NHS England’s existing role in administering tariff payments to placement providers, from April 2021, NHS England assumed responsibility for tariff development, including production and publication of this tariff guidance document.

2.4 As part of these responsibilities, NHS England continues to be required to present tariff proposals annually to DHSC for sign-off and ministerial approval. This approach to developing the placement tariffs does not impact upon the existing powers and requirements for the tariffs set out in legislation (see paragraph 2.5 below for further information) but does mean this guidance document will now also be published on the funding section of the NHS England website.

2.5 Powers and requirements with regards to tariffs for ET placements were set out in legislation, in the Care Act 2014. These powers came into force in April 2015 and are as follows:

• the Secretary of State for Health and Social Care may specify a tariff setting out approved prices, which may be different for different types of ET
• a tariff specified in this way must be published
• the Secretary of State may specify a tariff setting out approved prices, which may be revised or revoked by the Secretary of State
• a published tariff or variation procedure may be revised or revoked by the Secretary of State
• payments made by NHS England or one of its local offices must be made with reference to the approved price, or price as varied under the approved procedure

2.6 The Secretary of State is publishing the approved prices and the procedure for their variation by publishing the tariff guidance. In line with the agreed procedure, NHS England will be responsible for publishing details of any price variation.

2.7 All previous roles and responsibilities of Health Education England have transferred to the new NHS England following the legal merger of the organisations as of 1 April 2023.

Summary of changes for 2024 to 2025

2.8 This document confirms the updated tariff prices and salary support arrangements for 2024 to 2025. The revised rates (included at section ‘3. Tariff payments for 2024 to 2025’ below) are inclusive of the approved medical and Agenda for Change (AfC) pay deals, and are applicable to all activity undertaken from 1 April 2024.

2.9 There are no significant changes to tariff arrangements being introduced in the financial year 2024 to 2025.

2.10 Minor changes have been made to the content of the document where clarity has been requested by stakeholders, or where paragraphs no longer apply.

Eligibility for tariff funding

2.11 Each placement tariff (clinical, UGM, undergraduate dental or postgraduate medical) is applicable to placement activity in England that is explicitly listed in this guidance. Refer to each relevant section of this guidance for confirmation.

2.12 A placement at any type of provider organisation in England that attracts a tariff payment must meet each of the following criteria. The placement must:

• be a recognised part of the education and training curriculum for the course and approved by the higher education institute (HEI) and the relevant regulatory body, as appropriate
• be recognised as having the appropriate clinical exposure, supervision, education, training opportunities and quality to meet the requirements of the appropriate curriculum to the standards set by the regulator
• meet the quality standards of the regulator, the commissioner and NHS England
• be direct clinical training (including time for clinical exams and study leave) with an agreed programme, being a minimum of one week
• have the appropriate clinical and mentoring support as defined by the relevant regulatory body
• not be workplace shadowing or a post-graduation assistantship (for UGM, pre-graduation assistantships and/or activity would be covered by the UGM tariff as they are an integral part of the UGM course)
• have signed the appropriate NHS Education Funding Agreement (see section ‘8. Further information and guidance’ below for more detail about the NHS Education Funding Agreement (previously the NHS Education Contract))

2.13 Any time spent by students and trainees at a provider organisation that does not meet the criteria is not covered by the tariff payment mechanism. Any funding from NHS England for this activity should be determined locally by the placement provider and NHS England commissioner.

2.14 The ET placement tariffs cover funding for direct costs involved in delivering ET by the placement provider, for example:

• direct staff teaching time within a clinical placement
• teaching and student facilities, including access to library services
• administration costs
• infrastructure costs
• educational supervisors and assessors
• pastoral and supervisory support
• trainee study leave and time for clinical exams
• health and wellbeing (excluding any occupational health assessments that are carried out by the university and funded separately)
• course fees and expenses (as required to achieve professional registration)
• student or trainee accommodation costs (UGM tariff only)
• in-course feedback and assessment
• formal examining
• staff training and development relating to their educational role

2.15 The tariffs do not cover:

• tuition costs
• items funded under education support such as:
  • foundation programme directors
  • foundation programme administration support staff
  • heads of schools
  • programme directors
• relocation costs and exceptional travel costs

2.16 Training placements that take place outside England but are commissioned by NHS England should be paid for at a locally agreed rate. Although it may be appropriate to use the published national tariff as a starting point, this is not mandatory - it is for local negotiation between individual medical schools and the placement providers in the devolved governments.

2.17 Where a category of trainee is not covered by a tariff, any placement funding should be agreed locally between the NHS England commissioner and the placement provider. Further detail regarding this can be sourced from the relevant NHS England regional team and will be available as part of the NHS Education Funding Guide for 2024 to 2025.

2.18 Placements commissioned by private universities and self-funded students attending private universities should not be subsidised by the tariff funding available from NHS England.

2.19 For UGM and dental undergraduate clinical placements, tariff funding only applies to clinical placements for students who are part of the Office for Students (OfS) annual intake numbers.

Knowledge and Library Services

2.20 All learners, along with NHS organisations and staff, should be able to access the expertise and resources offered by NHS knowledge and library services so that they can use the right knowledge and evidence to achieve excellent healthcare and health improvement. See the NHS Library and Knowledge Services in England Policy.

2.21 As specified in the NHS Education Funding Agreement, the ET tariff contributes to the costs of delivery of proactive, high-quality knowledge and library services for all learners and the workforce, including access to evidence resources through suitable technology and appropriate learning space. To inform this, NHS England has published the Funding for NHS Knowledge and Library Services in England: policy guidance for NHS employers and the Learning Space within NHS Knowledge and Library Services in England Policy.

2.22 To improve provision to clinical students on placement and postgraduate doctors in training, and to achieve better value for money, there is the opportunity for placement providers within a local area to pool funding into central, regional or co-ordinated procurement of digital knowledge resources.

3. Tariff payments for 2024 to 2025

3.1 The 2024 to 2025 tariff prices are included in Table 1 below. These prices are applicable from 1 April 2024.

Table 1: ET tariff prices for 2024 to 2025

Type of placement	Tariff for placement activity in 2024 to 2025	Inflationary uplift (%)
Clinical	£5,519 plus market forces factor (MFF) per full-time equivalent (FTE)	3.3%
Medical undergraduate (all UGM placements)	£34,355 plus MFF	5.54%
Medical postgraduate	£13,337 plus MFF, plus a contribution to basic salary costs (see Annex A). See paragraph 7.10 for further information on separate funding arrangements for study leave.	5.54%
Dental undergraduate	£36,041 plus MFF	5.54%

3.2 In line with previous years, the tariffs are adjusted by the market forces factor (MFF) to compensate for the unavoidable cost differences of providing training placements in different parts of the country. For simplicity, the MFFs that are used for payment are the same as those applicable to the service tariffs. Further information on the MFF, including current rates and changes for 2024 to 2025, is published by NHS England. The MFF indices for individual providers can be found in the 2023 to 2025 NHS Payment Scheme consultation.

3.3 For placement providers where no MFF payment index exists, NHS England has calculated regional MFF indices. The appropriate regional MFF to be used for payment should be based on the geographical location of the placement provider. Further information relating to the regional MFFs is available in Annex G.

3.4 Note that the salary contribution from NHS England for postgraduate medicine is based on the salary for the post rather than the salary of the individual filling the post and is not multiplied by MFF.

Local prices

3.5 Appropriate local prices, which are the rates agreed upon locally for any placements that fall outside the scope of the national tariff, should be negotiated between placement providers and commissioners. It may be appropriate to agree to use the published national tariff for some of this activity. Placement providers and NHS England should engage constructively to agree transparent local prices that are in the best interests of students or trainees.

3.6 Placement providers and NHS England can agree to adjust tariff prices and/or currencies in exceptional circumstances. This may be appropriate, for example:

• where placement commissioners and providers agree on an innovative way of delivering placements, with the approval from regulatory bodies
• where provision of training is necessary in a given location or type of placement provider

3.7 To determine whether the provision of training is not economically viable, the provider must be able to demonstrate that:

• its average cost of the training placement is higher than the national tariff
• the placement provider’s average costs are higher than the national tariff price because of structural issues that are:
  • specific to that placement provider - that is, not nationally applicable
  • identifiable - that is, the provider must be able to identify how the structural issues it faces affect the cost of the services
  • non-controllable - that is, beyond the direct control of the provider, either currently or in the past (this means that higher costs because of previous investment decisions or antiquated estate are unlikely to be grounds for justifying that the provision of training is uneconomic at the national price)
  • not reasonably reflected elsewhere in the calculation of national tariffs, rules or flexibilities
• the placement provider is reasonably efficient when measured against an appropriately defined group of comparable placement providers, given the structural issues that it faces (if a provider is not reasonably efficient when measured against an appropriately defined group of comparable placement providers, it would have to demonstrate that its costs would still be higher than the national price, even if it were reasonably efficient)
• the placement provider has tried to engage constructively with its commissioners to consider alternative training delivery models, and it is not feasible to deliver the training required at the national tariff level

3.8 To request adjustments to the national tariff price and/or currencies in exceptional circumstances, contact [email protected] in the first instance.

3.9 Any tariffs that are varied from the national tariffs according to the flexibilities set out above will be published by NHS England for transparency.

3.10 Where a small amount of placement activity is commissioned from a placement provider and the burden of administering the payment system to the placement provider would be disproportionately high compared to the appropriate tariff payment, then the commissioner and placement provider may agree to local support arrangements. This could see the continuation of existing local support arrangements, possibly on a payment-in-kind basis, equivalent to tariff value and this will be published for transparency.

4. Clinical tariff

Changes for 2024 to 2025

4.1 The clinical tariff rate for the financial year 2024 to 2025 has been uplifted by 3.3%. This uplift reflects the final pay award for financial year 2024 to 2025 and will be backdated to 1 April 2024.

Tariff payment and scope

4.2 The clinical tariff payment is intended to provide an annual contribution to the funding of placement co-ordination and practice-based learning for all eligible clinical professions. The tariff funding should be used to support all professions for which it has been allocated. The list below provides confirmation of the professions eligible for tariff funding:

• clinical psychologist
• healthcare scientist practitioner training programme (PTP)
• adult nurse
• children’s nurse
• dental hygienist
• dental therapist
• diagnostic radiographer
• dietician
• dual qualification nursing courses
• learning disabilities nurse
• mental health nurse
• midwifery
• shortened midwifery courses
• occupational therapist
• operating department practitioner
• orthoptist
• orthotist/prosthetist
• paramedic
• pharmacist - undergraduate
• physiotherapist
• podiatrist
• speech and language therapist
• therapeutic radiographer
• sonography (pre-registration)

4.3 If a profession is not included in the list in paragraph 4.2 above, it is not eligible for clinical tariff funding. Local funding arrangements may be in place for other professions and further detail regarding this can be sourced from the relevant NHS England regional team or the NHS Education Funding Guide for 2024 to 2025.

4.4 Clinical psychology placement students should not conduct activities that are charged directly to the public. For example, if a clinical psychology student delivers a clinical assessment or intervention, a direct charge to the public may not be made for this, nor should an associated infrastructure cost be charged to the public. This guidance is limited to clinical psychology while a wider review of this principle across occupations is conducted.

4.5 The clinical tariff price is applicable for international students undertaking placements on courses covered by the list of eligible profession in paragraph 4.2. The exception to this would be where a student is already providing funding through course fees towards the costs of placements. Under no circumstances should funding available from NHS England be used as a replacement for fees already paid by students to cover placement activity, or as a top-up to those payments.

Clarification on the use of funding

4.6 The clinical tariff should be used effectively across clinical and/or practice-based learning settings to ensure learners are fully integrated within these environments, enabling high-quality and sustainable educational experiences. In addition, it can be used to enable educators to have the time and resources to deliver high-quality practice education and training as outlined in the NHS Educator Workforce Strategy.

4.7 Recognising the broader ET benefits across the workforce to support both profession-specific and interdisciplinary learning, it is anticipated that the tariff is considered across a range of traditional and non-traditional clinical and non-clinical environments. As well as mechanisms to fund into other sectors such as social care environments, this can include placements within:

• simulation
• primary, independent and voluntary organisations (PIVOs)
• student-led clinics
• technology-enabled care services (TECS) and/or remote or virtual settings
• leadership

4.8 It is recommended that provider education teams and professional leads understand the amount of clinical tariff generated, and how it is used within their organisation, to enable them to maximise the potential within learning environments.

Addition of pharmacy to eligible professions

4.9 From 1 September 2022, DHSC and NHS England agreed that pharmacy would be added to the professions eligible for the clinical tariff.

4.10 Those eligible to receive the clinical tariff are those students completing clinical placements during their General Pharmaceutical Council-accredited Master of Pharmacy (MPharm) degree programme. Clinical placements in years 1 to 4 (or equivalent stages in non-standard delivery models) are eligible.

4.11 Placements in the following settings are eligible for the clinical tariff placement fee:

• NHS managed sector (for example, secondary care, mental health trusts and so on)
• general practice and/or primary care networks
• community pharmacies
• other healthcare providers delivering NHS-contracted services

4.12 At present, placements within the pharmaceutical industry sector are not eligible for the tariff.

Clarity on what constitutes a full-time equivalent (FTE)

4.13 The clinical tariff payment of £5,519 is paid per FTE, rather than being applicable to the placement activity for an individual student per year.

4.14 To ensure a consistent approach to calculating what constitutes an FTE and that all providers receive equivalent payments for the placement activity they deliver, these are based on the following calculation of an FTE:

• full tariff will be paid for each 40.8 weeks of placement activity
• a week of placement activity should be reflective of 37.5 hours of placement activity - note that placements can be less than one week in duration to attract tariff payments, but one week is noted here to the purpose of explaining tariff payment calculations
• there should be no exceptions to this approach to calculating the funding available to providers for eligible placement activity

Example of how to convert placement activity into money  

4.15 For illustrative purposes, we have created an example based on a provider with an MFF payment index of 1.0383 undertaking 5,000 hours of placement activity across the financial year 2024 to 2025 at the 2024 to 2025 clinical tariff rate. All figures have been rounded to 2 decimal places for the purpose of this calculation.

As identified above, an FTE for placement funding purposes is determined as 40.8 weeks of placement activity. The first step in calculating an appropriate payment is, therefore, to divide the tariff price by the number of weeks to get a payment per week:

£5,519 ÷ 40.8 weeks = £135.27

Once we have calculated the payment per week of £135.27, we are then able to calculate the payment per hour, which is calculated by dividing the weekly rate by 37.5 hours:

£135.27 ÷ 37.5 hours = £3.61

The hourly rate should then be applied to the total number of hours of placement activity:

5,000 hours × £3.61 = £18,035

The final stage is to apply the MFF payment index to the total funding:

£18,035 × 1.0383 (Midlands MFF rate) = £18,726.73

The total funding that this activity will generate is therefore £18,726.73.

Simulation-based learning

4.16 The funding arrangements for simulation-based learning will continue for 2024 to 2025 and activity will be funded by NHS England at the clinical tariff rate for activity, which constitutes placement learning hours and meets each of the following circumstances:

• the number of hours is compliant with the regulatory or professional body expectations around the number of hours of placement per student that can be delivered via simulation
• NHS England will not pay the clinical tariff rate for simulation activity delivered as part of the education provider’s teaching requirements

4.17 Information on the amount of activity delivered and the level of funding being requested should be returned to NHS England as part of the Student Data Collection using the Student Data Collection Tool (SDCT).

4.18 All queries on the eligibility of simulation activity for tariff funding should be directed to the NHS England regional team for your area.

Travel and accommodation costs while on placement  

4.19 The responsibility for reimbursing students for excess travel and temporary accommodation costs incurred as a result of attending a practice placement is varied. The excess travel and temporary accommodation costs incurred by UGM and undergraduate dental students are included within the tariff price and appropriate funding is locally agreed. Further information associated with these arrangements can be found in Annex B under ‘Source of funding 2: UGM - student services’ below.

4.20 The excess travel and temporary accommodation costs incurred by students within the scope of the clinical tariff are typically covered by the NHS Learning Support Fund, which is administered by the NHS Business Services Authority.

NHS England-funded placements not covered by tariff

4.21 Alongside the placement funding provided to eligible professions under the tariff arrangements, NHS England also provides placement funding for a small number of other clinical professions at an agreed annual rate, such as trainee nursing associates (TNAs). Further information relating to the current funding arrangements for these professions can be found in the NHS Education Funding Guide for 2024 to 2025.

4.22 NHS England will continue to review the professions being funded for placement activity, at a rate that varies from the national tariff, to determine the reason for the variance in price and establish whether it would be appropriate to extend the tariff arrangements to include these professions in future financial years.

4.23 Where a clinical profession is not listed in paragraph 4.2 above or in the NHS Education Funding Guide, direct all queries on funding to the NHSE Education Funding Reforms team via [email protected].

4.24 NHS England, with its continued responsibilities for the ET tariff guidance and its administration, is working with DHSC to introduce a standardised process for assessing professions for their eligibility for tariff funding for future financial years.

Reconciliation of funding

4.25 All payments to placement providers should be adjusted to ensure funding is reflective of the actual number of placements in hours delivered. A process is now in place to ensure that NHS England receives data from HEIs initially via the SDCT. This is then validated by NHS placement providers to support payments.

Salary support

4.26 Information on the levels of salary support available from NHS England and eligible professions for 2024 to 2025 is set out in the NHS Education Funding Guide.

Apprenticeships

4.27 Placements for apprenticeships are not eligible for the DHSC placement tariff funding.

4.28 The relevant NHS employer funds NHS apprenticeships, with funding for this provided through the Apprenticeship Levy.

4.29 NHS England is working on enhancing apprenticeship programmes to include a wider range of roles and make them more accessible to support the ambitions of the NHS Long Term Workforce Plan.

4.30 There are policies in development on the funding available for apprenticeships that acknowledges their unique role in workforce development.

4.31 See further details about the funding available for apprenticeships.

5. Undergraduate medical tariff

Changes for 2024 to 2025

5.1 The undergraduate medical tariff rate for the financial year 2024 to 2025 has been uplifted by 5.54% to £34,355 plus MFF. This uplift reflects the final pay award for financial year 2024 to 2025 and will be backdated to 1 April 2024.

Tariff payment and scope

5.2 Details of the scope of the undergraduate medical tariff for clinical placements is available in Annexes B, C and D. The undergraduate medical tariff will be the sole source of funding provided by NHS England to support UGM courses. Where flexibilities exist within Annex B for locally negotiated agreements, these will be about the distribution of that funding or agreement of funding from other organisations.

5.3 From 1 April 2024, the undergraduate medical tariff of £34,355 plus MFF is applicable to all UGM students who are included within the OfS approved annual intake control target of medical school places.

5.4 DHSC and NHS England have agreed and confirmed this single tariff payment irrespective of placement setting (secondary care, primary care or PIVO).

5.5 More specific information is available within this guidance document relating to the scope of the UGM tariff to provide clarification regarding how the tariff funding should be used to facilitate clinical placements. It is DHSC’s expectation that the information in Annexes B, C and D is used to provide clarification on responsibilities for funding.

5.6 NHS England will play an important role to ensure locally negotiated proposals support innovation and new delivery models, and that discussions are timely, collegiate and transparent. They will also be identified within the change control mechanism identified in the Tri-Partite Agreement for Undergraduate Medical Education (TPA-UGME) introduced between NHS England, education and clinical placement providers. Furthermore, to receive tariff funding in 2024 to 2025, a signed TPA-UGME is expected to be in place.

5.7 Education and clinical placement providers must ensure that all aspects of clinical placement provision that have funding implication are discussed and agreed with NHS England through the change control process to ensure that clinical training is deliverable within the resources available. NHS England will need to consider and agree any proposed changes to local funding arrangements to ensure consistency and equity in the access to funding across NHS England regions.

Undergraduate medical education tri-partite agreement (TPA-UGME)

5.8 The TPA-UGME is the agreed nationwide framework for governing the financial arrangements between education providers (medical schools), placement providers (NHS trusts) and NHS England, for the purposes of providing undergraduate medical education. The TPA-UGME introduced from April 2021 is a schedule of the NHS Education Funding Agreement: April 2024 to March 2027.

5.9 The TPA-UGME will:

• incorporate the principles set out in Annex B of this guidance
• set out the roles and responsibilities of the 3 parties: education providers (medical schools), placement providers in secondary care and NHS England
• provide a consistent approach to the planned funding for undergraduate medical education that flows between NHS England, education and placement providers
• provide transparency on undergraduate medical education funding that is provided, with clear expectations for the return on that investment

5.10 The TPA-UGME aligns with the National Medical School Liaison Committee governance structures that are in place, which help to ensure that the way funding flows between providers is not a barrier to improving how undergraduate medical education is provided.

5.11 For further information about the TPA-UGME, email [email protected].

Exclusions

Students outside OfS intake controls

5.12 Placements for students who are not within the OfS-approved annual intake controls are subject to locally agreed funding arrangements in the regions.

Clinical research funding

5.13 The funding for all clinical and academic research projects should be agreed locally between HEIs and clinical placement providers. NHS England will not provide funding to support these projects in 2024 to 2025.

6. Undergraduate dental tariff

Changes for 2023 to 2024

6.1 The undergraduate dental tariff rate for the financial year 2024 to 2025 has been uplifted by 5.54% to a rate of £36,041 plus MFF. This uplift reflects the final pay award for the financial year 2024 to 2025 and will be backdated to 1 April 2024.

Tariff payment and scope

6.2 The undergraduate dental tariff of £36,041 plus MFF is applicable to all undergraduate dental students who are included within the OfS-approved annual intake target of dental places.

6.3 This approved annual intake target includes both home and overseas students. NHS England will only pay tariff for the placements of students within the approved annual intake target numbers and will not pay tariff for placements for students outside of the OfS intake target.

6.4 For more specific information on the initial scope of the undergraduate dental tariff, including how the tariff funding should be used to facilitate clinical placements, refer to the information in Annex E.

Dental education tri-partite agreement (TPA-UGDE)

6.5 Following the introduction of the undergraduate dental tariff in September 2022, NHS England introduced a Tri-Partite Agreement for Undergraduate Dental Education (TPA-UGDE) to provide a consistent nationwide framework for governing the financial arrangements between education providers (dental schools), placement providers and NHS England, for the purposes of providing undergraduate dental education. The TPA-UGDE will be introduced in the financial year 2024 to 2025 and will be a schedule of the NHS Education Funding Agreement: April 2024 to March 2027.

6.6 The TPA-UGDE will:

• incorporate the principles governing the undergraduate dental tariff
• set out the roles and responsibilities of the 3 parties: education providers (dental schools), clinical placement providers and NHS England
• provide a consistent approach to the planned funding that flows between dental schools, NHS providers and NHS England
• provide transparency on undergraduate dental tariff that is provided, with clear expectations for the return on that investment

6.7 The TPA-UGDE will align to the regional and local dental school liaison committee governance structures that NHS England has introduced and will help ensure that the way funding flows between providers is not a barrier to improving how undergraduate dental education is provided.

6.8 For further information about the TPA-UGDE, email [email protected].

7. Postgraduate medical tariff

Changes for 2024 to 2025

7.1 The postgraduate medical tariff rate for the financial year 2024 to 2025 has been uplifted by 5.54% to £13,337. This uplift reflects the final pay award for the financial year 2024 to 2025 and will be backdated to 1 April 2024.

7.2 The updated postgraduate salaries, including national and London pay scales, are set out in detail in Annex A.

Tariff payment and scope

7.3 The funding available from NHS England for eligible postgraduate doctors in training from 1 April 2024 is in 2 parts:

• a placement fee of £13,337 plus MFF
• a contribution to the basic salary costs of all postgraduate doctors in training (refer to Annex A) - this element of funding does not attract MFF

7.4 For postgraduate medical placements, tariff funding is based on training posts. Investment specific to individuals will usually be excluded from the tariff. The NHS England regional team for your area may agree to maintain the salary element to support a locum appointment. Prior to any changes to existing tariff payments, this should be discussed and agreed between the NHS England regional team and placement provider.

7.5 The national postgraduate medical tariff is not applicable to:

• postgraduate dentists in training
• placements in GP practices and other primary care settings (although hospital placements for GP specialty doctors in training are covered by the tariff)
• placements in hospices and other PIVO settings
• placements in public health
• National Institute of Health and Care Research (NIHR) postgraduate doctors in training
• less-than-full-time (LTFT) postgraduate doctors in training
• trust-funded posts
• out-of-programme career breaks, where individuals temporarily step off the standard training programme
• out-of-programme experiences, where individuals temporarily step off the standard training programme
• out-of-programme pause, where individuals temporarily step off the standard training programme
• out-of-programme research, where individuals temporarily step off the standard training programme
• postgraduate doctors in training requiring additional support
• Ministry of Defence training posts

Lead employer models

7.6 Lead employers provide an outsourced human resources and payroll system for a number of postgraduate trainees. Providers hosting the post will receive the tariff payment and should refund the salary costs to the lead employer.

7.7 Where there is agreement between lead employer and host, arrangements can be put in place through NHS England for appropriate salary payments to be made direct to the lead employer.

Host providers or pooled support

7.8 Where a provider hosts services, such as knowledge and library services, NHS England may agree the basis for any recharges that the host provider wishes to make. If all the organisations within a local area agree to a pooled support system, they may agree that NHS England, or another named organisation, manages a proportion of the placement fee on their behalf.

Doctors in training in the independent sector

7.9 NHS England has issued guidance relating to postgraduate doctors in training undertaking placements in the independent sector. This includes confirmation of the associated tariff funding arrangements for these placements.

Study leave funding

7.10 In 2018 to 2019, the postgraduate placement tariff was reduced by the study leave funding component to create study leave payment budgets managed by NHS England’s regional teams. This will continue into 2024 to 2025, reflective of the uplifts, and is cost neutral for NHS trusts, with both the funding and costs removed from the tariff funding.

7.11 A high-level overview of study leave processes and financial management of these budgets across NHS England is available at Study budget reforms.

7.12 Any specific questions on study leave funding should be directed to the relevant postgraduate medical and dental team.

8. Further information and guidance

8.1 The following section is intended to provide further information and links to the ongoing work within NHS England that impacts on the NHS England budget and/or tariff funding.

ICB education funding statements

8.2 At the start of the 2021 to 2022 financial year, NHS England began sharing statements that show the financial support it provides for education and training, and the corresponding activity delivered by providers, within each of the 42 integrated care board (ICB) geographical footprints. This will continue for the 2024 to 2025 financial year.

8.3 The aim of this activity is to:

• increase transparency in educational funding flows, enabling ICB-level strategic discussions on NHS England’s investment, including its alignment to ICB clinical strategy delivery and long-term service sustainability
• inform the development of an education and training plan for each ICB
• enable, through the production of an ICB education and training plan, engagement with NHS England on the future investment of educational funds to support the right educational capacity and thus prioritise delivery
• highlight any inequity of activity that will be underpinned by NHS England’s funding strategy and policy
• alongside the production of the NHS Education Funding Guide, standardising and providing clarity of payment rates

8.4 This will remain as an annual publication process. The statements will initially focus on 2 funding pots: future workforce and workforce development funding.

8.5 Each ICB will receive its own statement. The statement will include both ET funding and activity information for retrospective NHS financial years from 2019, and as a ‘forward looking process’ that also incorporates planned funding and activity for the next financial year.

NHS Education Funding Guide for 2024 to 2025

8.6 To support consistent and transparent healthcare education funding across England, NHS England will publish an updated NHS Education Funding Guide on an annual basis that outlines the sources of funding that contribute to the education and training of healthcare professional roles.

8.7 This document brings together information on the sources of funding - NHS England’s and other’s - into one document and will be a point of call for anyone wanting to know more about how healthcare ET is financially supported.

Purpose of the education funding guide

8.8 The NHS Education Funding Guide is primarily a resource for those who receive NHS England funding and is intended to:

• help wider understanding of NHS England’s role in the funding of education and training
• improve the profile and transparency of NHS England’s funding offers
• support systems, employers, education and placement providers to plan and build upon the existing investment

8.9 The intention is for this guide to be published annually and prior to the new financial year. It will help indicate any changes to funding offers because of NHS England’s business processes or wider NHS funding decisions.

8.10 If you are an education or health service provider and would like to discuss any of the content of this guide, email [email protected].

NHS Education Funding Agreement (previously NHS Education Contract)

8.11 The 2021 NHS Education Contract serves as the formal framework governing the relationship between NHS England and healthcare ET providers. This contract facilitates non-competitive, equitable activities outlined in this guidance and the annual NHS Education Funding Guide.

8.12 Staring from April 2024, the NHS Education Contract will be known as the NHS Education Funding Agreement. This revised title more accurately reflects the manner in which NHS England allocates reimbursed funds to clinical training providers throughout England.

8.13 The adjustment in terminology not only improves clarity but also reinforces the commitment to transparent and efficient financial processes within the healthcare ET system.

8.14 The NHS Education Funding Agreement stands as a pivotal instrument in enhancing the quality, impact and value of education and training. It plays a crucial role in driving positive changes and providing essential funding to training providers across England.

8.15 NHS England retains the discretion to employ different arrangements for managing placement activities involving PIVOs. This may include NHS England making placement funding accessible to education providers, who can subsequently sub-contract directly with PIVOs for placement activities, provided the provider supports a relatively small number of placements or is not a holder of the NHS Education Funding Agreement.

8.16 For specific advice regarding a placement provider, reach out to your NHS England regional team as the primary point of contact.

8.17 For inquiries about the NHS Education Funding Agreement template, email [email protected].

Queries and feedback

8.18 Direct all queries, feedback and requests for further information in relation to the tariff guidance and development process to [email protected]. Feedback is vital to NHS England in supporting the ongoing development work and ensuring that it is aware of local issues that the funding may create.

Annex A: salary contributions for postgraduate placements

1. Below are the uplifted salary contributions that NHS England will pay for each postgraduate placement in 2024 to 2025, reflecting the medical and AfC pay awards.

2. The grade structure has been revised to reflect the pay structure from the junior doctor contract reforms in 2016 to 2017.

3.The salary contributions are split between London and national.

Table 2: hospital and community health services (HCHS) - ET tariff salary contributions for 2024 to 2025

Grade and spine point (old contract)	2024 to 2025 NHS England salary contribution - national (£)	2024 to 2025 NHS England salary contribution - London (£)	Inflationary uplift (%)
F1 (Minimum point of the Foundation House Officer 1 scale)	£19,062	£20,882	13.02%
F2 (Minimum point of the Foundation House Officer 2 scale)	£23,434	£25,238	12.61%
ST1/CT1 (Minimum point of the Speciality Registrar (StR) scale)	£25,136	£26,947	13.63%
ST2/CT2 (Point 1 of the StR scale)	£26,674	£28,486	13.63%
ST3/CT3 (Point 2 of the StR scale)	£28,172	£29,944	11.74%
GPST1 hospital (Point 1 of the StR scale)	£26,674	£28,486	13.63%
GPST2 hospital (Point 2 of the StR scale)	£28,822	£30,635	13.63%
GPST3 hospital (Point 3 of the StR scale)	£29,441	£31,213	11.74%
GPST hospital placement - point not specified (Average of point 1 and 2 of the StR scale)	£28,822	£30,635	13.63%
ST4+ higher training (Weighted average across higher training grades)	£33,162	£35,029	11.74%

Annex B: scope of undergraduate medical tariff for secondary care clinical placements

1. This annex includes a principles section, followed by 4 sections identifying the source of funding for clinical placement components.

Principles

2. UGM education in the United Kingdom has a defined set of outcomes set by the General Medical Council (GMC), which can be delivered through a variety of models. Funding arrangements for the clinical training should be based on the following standard set of principles that govern how the source of funding for medical education should be agreed.

3. These principles and accompanying sources of funding are a component of this guidance, setting out what is covered by the tariff funding for secondary care clinical placements in UGM.

4. Stakeholders are expected to adhere to these principles. However, where there are demonstrable benefits to education and training outcomes, arrangements should also try to facilitate flexibility, innovation, patient and public involvement, and exposure to the full spectrum of clinical interactions and environments, in all years of the programme. It is expected that all local and national arrangements can only exist in the context of delivery of innovative or new models of educational delivery and learning experiences, and must be tri-partite, between HEIs, NHS placement providers and NHS England.

5. Selection and assessment of medical students should involve NHS staff and general practitioners, as well as patients and carers, to reflect the diversity of the population served by the HEI.

6. Clinical placement funding to support publicly funded students should not be used to subsidise the costs of placement provision for students required to meet the full costs of their clinical placements. All medical students, regardless of how their education is funded, will have equal access to high-quality clinical placements providing them with opportunities to progress and succeed in their higher education.

7. A clinical placement is any arrangement in which a student spends a block of time engaged in clinical learning in an environment that provides healthcare or related services to patients or the public.

8. Clinical placements take place primarily in a primary, secondary or social care setting, but may also take place in charities, hospices and other non-NHS organisations, including VISOs. Clinical placements often encompass active involvement in patient care, but they can also be classroom based or completed through remote learning to enable the required clinical placement learning or observing health or social care processes.

9. It is the type of activity, rather than the location of training or who is delivering it, that is relevant in deciding on the most appropriate funding source. For example, a component of clinical placement training would be tariff funded even if it is delivered by an NHS clinician on university premises - and conversely, an academic component of medical education curriculum would be HEI funded even if it is delivered by a clinician on NHS trust premises. Establishing and agreeing the source of funding is expected to be part of tri-partite discussions and agreement between the HEI, the NHS trust and NHS England, and will need to be timely, collegiate and transparent, and identified within the UGME-TPA, which is being enacted between NHS England, HEIs and clinical placement providers.

10. Clinical teaching can be delivered remotely as well as face to face and, where academic reading is an essential part of knowledge acquisition associated with clinical placements, this would be NHS tariff funded.

11. Learning activity based in a clinical environment should be funded through tariff at a common rate, with a clear link between funding and the quality of the placements.

12. The facilitation and delivery of teaching and learning will inevitably make greater use of technology in future. Funding models should not prevent against such developments, which will blur the boundaries between university and clinical environments and prevent duplication of effort, such as centrally provided webinars. HEIs must ensure that such developments that affect clinical placement providers are discussed and agreed with NHS England and the placement provider to ensure that it is deliverable within the resources available.

13. The funding sources based on an undergraduate placement can be found under headings ‘Source of funding 1: UGM - corporate functions’ to ‘Source of funding 4: UGM - roles and posts’ below. The funding sources are:

• academic funding (funded by HEIs through a combination of tuition fee loans and supplementary funding from OfS)
• clinical placement tariff funding (funded by clinical placement providers from tariff funding received through NHS England)
• dependent on locally negotiated arrangements

14. ‘Source of funding 1: UGM - corporate functions’ to ‘Source of funding 4: UGM - roles and posts’ below give a clear distinction to guide the source of funding between:

• requirements and activities of the academic curriculum
• activities as part of clinical placement
• activities and resource that include all healthcare learners (for example, libraries)
• the ET placement tariffs cover funding for all direct costs involved in delivering ET by the placement provider, including a number of areas that would likely designate as overheads, for example:
  • teaching and student facilities, including access to libraries services
  • administration costs
  • infrastructure costs
• these are explicitly addressed as being in scope and what the UGM tariff can be used for
• there are also certain things that the UGM tariff cannot be used for, for example general top-slicing for overheads to cover areas such as occupational health

15. NHS England will be responsible for identifying and implementing the most appropriate funding routes for payments to placement providers. Avoiding a ‘one-size-fits-all approach’ allows NHS England to implement differing mechanisms for payments where appropriate. For example, activity covered by the NHS Education Funding Agreement (formerly the NHS Education Contract) and involving a single placement provider will be able to be paid differently from activity where there are potentially multiple smaller placement providers involved. Such flexibility would be expected to deliver innovation in the delivery of the learning environment.

16. All clinical placements should be agreed and signed off by placement providers with consideration of the associated cost in clinical placement provision. Placement providers must demonstrate that such funding for clinical placements is being used for the delivery of such learning. It is expected that the funding provided for clinical placements will be managed through the education directorate, and accountability reports on the use of such funding will be required by NHS England in line with the reporting requirements within the TPA-UGME between NHS England, HEIs and placement providers.

17. HEIs must ensure they involve the NHS placement provider budget holder in discussions on the provision of clinical placements, who must be able to identify, manage and control the costs of the placement. Transparency of usage of placement funding will be monitored by NHS England. It is expected that there will be regular discussion between the placement provider, HEI and NHS England on the quality of the placement learning environment and the achievement by learners of the required outcomes.

18. The TPA-UGME between HEIs, placement providers and NHS England is the national framework that ensures:

• any agreed variations in funding arrangements - this may include but is not limited to adjustments to reflect additional:
  • costs to trusts where they provide activity on behalf of other trusts across a region
  • services provided for undergraduate education - for example, objective structured clinical examinations (OSCEs)
• HEIs have defined student learning outcomes for each placement, and educational providers must be able to facilitate students meeting those objectives
• any changes to the delivery of curricula or assessment that have an impact on clinical placement capacity and delivery must be discussed and agreed with NHS England and the placement provider to ensure that it is deliverable within the resources available
• the parties to the TPA-UGME have access to information on arrangements governed by the agreement, and, on the funding allocated to placement providers

19. ‘Locally negotiated arrangements’ are defined as arrangements that:

• have been negotiated between the parties on a local level - the ‘parties’ mean the education provider (HEI) and the placement provider (NHS trust)
• are related to the local flexibilities allowed for within this annex of the guidance
• are a defined split locally negotiated between the education and placement providers

Source of funding 1: UGM - corporate functions

20. All funding arrangements need to be part of the TPA-UGME between NHS England, HEIs and clinical placement providers.

Human resources (HR) or recruitment

21. This includes:

• the preparation of job descriptions
• preparing, issuing and managing job advertisements
• managing job interviews
• the appointment and induction of academic staff and defined academic lead roles

22. Examples of defined academic lead roles include:

• course directors
• curriculum leads
• professional service roles
• year tutors
• assessment leads
• personal tutors
• HEI placement co-ordinator roles responsible for organising which students go to which placement provider

23. Responsibility for funding of HR or recruitment falls to the HEI.

Finance

24. Responsibility for funding of finance activity, as far as this relates to university and university finance administration, falls to the HEI.

Academic staff development

25. This includes essential activity such as the induction of education provider staff, and the training and professional development of clinical teachers employed by the HEI who are responsible for delivering for such activities within the education provider.

26. Responsibility for funding of academic staff development falls to the HEI.

Clinical staff development

27. This includes clinical teaching continuing professional development (CPD) - for example:

• Academy of Medical Educators
• Training the Clinical Trainers
• Association for the Study of Medical Education

28. Responsibility for funding clinical staff development falls to the NHS tariff.

Marketing and public relations (PR)

29. Responsibility for funding marketing and PR in relation to the UGM course falls to the HEI.

Selection of medical students

30. Responsibility for funding the selection of medical students falls to the HEI.

Quality and standards of education

31. This includes internal and external (such as GMC, universities or the Quality Assurance Agency for Higher Education (QAA)) quality assurance functions.

32. Where the education provider identifies any issue relating to the quality of the clinical placement learning environments, the education provider shall promptly notify NHS England in writing of any such concerns in the first instance.

33. Responsibility for funding quality and standards of education falls to the HEI.

Registry services

34. This includes the enrolment and documentation of students’ progress towards graduation. Clinical elements include investigation of complaints and ‘fitness to practise’ procedures (which are mostly deal with by sub and associate deans).

35. Funding for registry services falls to the HEI.

Staff Disclosure and Barring Service (DBS) checks

36. This applies to staff DBS checks, which should be undertaken at the point of recruitment in respect of those who are directly employed by the education provider, and any mid-course DBS checks that may be required.

37. Responsibility for funding of staff DBS checks falls to the HEI.

Assessment

38. This refers to the collation and review of learner assessment results.

39. Responsibility for funding falls to the HEI.

Widening participation

40. This refers to the process of expanding access to medicine to suitable candidates who would not otherwise apply due to socio-economic reasons.

41. Responsibility for funding widening participation falls to the HEI.

IT services

42. This refers to university IT systems, including email and other infrastructure systems.

43. Responsibility for funding university IT services falls to the HEI.

IT infrastructure

44. This refers to the provision of IT infrastructure by placement providers, and includes:

• ensuring PCs are available to students
• ensuring wireless access is available on site
• providing appropriate infrastructure and software to support remote consultations

45. Responsibility for funding IT infrastructure falls to the NHS tariff.

E-learning

46. This refers to technology-assisted learning and encompasses current methods such as telematics and virtual learning, as well as emergent related technologies that facilitate learning.

47. Responsibility for funding e-learning falls to the HEI and locally negotiated arrangements.

University library services

48. Libraries should be available at each university campus where medical students are based.

49. Responsibility for funding university library services falls to the HEI.

NHS knowledge and library services

50. Library and knowledge management services should be available to all learners and staff.

51. Appropriate knowledge services and learning space within the library should be available at all hospital sites, along with facilities to access IT and facilitate learning.

52. Responsibility for funding NHS knowledge and library services falls to the NHS tariff.

Accommodation and travel

53. Responsibility for the funding of accommodation and travel relating to academic teaching falls to the HEI.

Committee management

54. This includes room bookings, note taking, typing up actions and following through actions for meetings held at the education provider.

55. Responsibility for funding committee management falls to the HEI.

Source of funding 2: UGM - student services

56. All funding arrangements need tri-partite discussion between HEIs, NHS providers and NHS England, and agreement by NHS England.

Accommodation and travel

57. This refers to accommodation and travel relating to clinical placements in secondary care.

58. Responsibility for funding accommodation and travel falls to the NHS tariff, where there is demonstrable evidence of exceptional circumstances or particular challenges associated with extra costs of travel and accommodation over and above the normal journey for UGM students, creating barriers for students to continue accessing clinical placements with remote, rural and coastal providers.

59. Regions may consider providing additional, non-recurrent funding, where it is affordable, on top of the funding allocated for travel and accommodation from the harmonised UGM tariff.

Student support, including DBS

60. This includes student support for:

• DBS checks
• students with disabilities
• financial hardship
• arranging pastoral support for students

61. Responsibility for funding student support with DBS checks falls to the HEI.

62. Responsibility for funding support for students with disabilities primarily falls to the HEI. Where reasonable adjustments are related to clinical placements, trusts can access funding through the Department for Work and Pensions Access to Work Scheme.

63. Responsibility for funding student support for financial hardship falls to the HEI.

64. Responsibility for funding pastoral support for students falls to HEI. In circumstances where additional pastoral support of learners may be offered, where appropriate, locally negotiated arrangements may be agreed between the education provider and placement provider.

Student counselling

65. Student counselling services should be made available through university services. Learners also have access to NHS counselling and chaplaincy services.

66. Therapeutic counselling should be provided for a limited period (such period to be agreed between the parties) for learners who have been referred to it by occupational health.

67. Responsibility for funding student counselling falls to the HEI. Where appropriate, locally negotiated arrangements may be agreed between the education provider and the placement provider.

Prizes and awards

68. Responsibility for funding learning prizes and awards falls to the HEI. Where appropriate, locally negotiated arrangements may be agreed between the education provider and the placement provider.

Student occupational health

69. This includes:

• ensuring that students working with services users are vaccinated and checked for bloodborne viruses (such as HIV or hepatitis B) before they are involved with exposure-prone procedures to service users
• providing specialised advice as to whether learners with health issues and disabilities require reasonable adjustments, and how this can be facilitated

70. Responsibility for funding student occupational health falls to the HEI. Where appropriate, locally negotiated arrangements may be agreed in writing between the education and placement providers.

Careers advice

71. Careers advice is provided in close contact with NHS England, and helps students find the right speciality. It is also a requirement of the GMC and helps reduce problems later in students’ training and working lives.

72. Responsibility for funding careers advice falls to HEI. Where appropriate, locally negotiated arrangements may be agreed between the education provider and the placement provider.

Source of funding 3: UGM - teaching and learning

73. All funding arrangements need tri-partite discussion between HEIs, NHS providers and NHS England, and agreement by NHS England.

Academic teaching

74. Responsibility for funding the development and management of the curriculum, including all non-clinical aspects of the UGM programme, falls to the HEI.

Clinical training in clinical setting

75. Responsibility for funding clinical teaching in a secondary care setting falls to the UGM tariff.

76. Funding for equipment will vary in each clinical - or academic (non-clinical) - setting depending on which element of the undergraduate medicine curricula they are supporting.

Equipment

77. Responsibility for funding the equipment that is required to deliver clinical teaching falls to the NHS tariff.

78. Responsibility for funding the equipment that is required to deliver academic teaching falls to the HEI.

OSCEs

79. For clinical examinations such as observed structured long examination records (OSLERs), OSCEs or similar, examiners are largely NHS clinicians and require training beforehand to maintain a fair and reasonable quality standard.

80. Exams may take place in education providers, placement providers or neutral territory (a hired conference facility).

81. Responsibility for funding OSCEs falls to locally negotiated arrangements.

Student-selected components (SSCs)

82. This refers to clinical placements that are chosen by the students.

83. Responsibility for funding SSCs falls to the NHS tariff.

Electives

84. In line with the Medical Schools Council Electives Advisory Guidance (updated 24 May 2022), electives are an integral part of UGM programmes and, like SSCs, deliver core learning.

85. In comparison with other areas of the course, they provide students with some choice in the topic area.

86. For the elective, students are often encouraged to experience healthcare in a different setting, including gaining experience in overseas settings.

87. Elective programmes vary by school and may include opportunity for students to engage in activities that are not patient facing and may be closely linked to the global health learning course.

88. Responsibility for funding electives falls to locally negotiated arrangements.

Source of funding 4: UGM - roles and posts

89. All funding arrangements need tripartite discussion between HEIs, NHS providers and NHS England, and agreement by NHS England.

Clinical roles

90.This includes roles that are directly involved in the delivery of clinical teaching - for example, clinical tutors who are supporting clinical placement activity at the placement provider.

91. Responsibility for funding clinical roles falls to the NHS tariff.

Clinical Impact Awards (CIAs) in clinical roles

92. CIAs are for NHS trust consultants working for medical schools in ‘education provider’ roles.

93. Responsibility for funding the national Clinical Impact Awards (NCIAs) falls to DHSC (centrally funded).

94. Responsibility for funding local CIAs falls to the local employer. Under locally negotiated arrangements, the employer may agree with the HEI to pass on any element of the local CIA associated with UGM educator salary recharge.

Academic roles

95. This includes:

• year tutors
• curriculum leads
• assessment leads
• personal tutors
• a range of other HEI-based roles supporting the delivery of the academic components of the UGM programme

96. Responsibility for funding academic roles falls to the HEI.

Annex C: arrangements for funding of undergraduate GP clinical teaching of medical students

1. This section provides the context and arrangements for funding of undergraduate GP clinical teaching for medical students.

Definitions and abbreviations

2. The term ‘central GP team’ (CGPT) refers to the defined team of general practitioners (GPs) and administrators based within each medical school responsible for all aspects of clinical general practice education in the UGM course.

3. ‘Undergraduate GP teaching’ relates to clinically orientated teaching for medical students and the associated co-ordination, management and administrative functions required to support this.

4. ‘Head of undergraduate GP teaching’ (HUGPT) relates to the individual who leads the CGPT. They would normally be a GP and educationalist and a member of the Society for Academic Primary Care National Heads of Teaching Committee.

5. The term ‘GP services provider organisation’ (GPSPO) denotes GP practices or other providers of GP or primary care clinical services.

6. ‘Sub-contract’, as covered under the NHS Education Funding Agreement (formerly the NHS Education Contract), is the method for the HEI to pass on the devolved funding for undergraduate primary care clinical teaching to GPSPOs for delivery of undergraduate clinical placements.

Introduction

7. The nature, organisation and delivery of undergraduate primary care teaching is considerably different from undergraduate secondary care. Undergraduate GP teaching has therefore over the years developed processes and arrangements that necessarily reflect this difference.

8. The nature of UK general practice means that processes are already in place that provide great accountability and granularity in terms of the amount, type, quality and location of teaching delivered. This, combined with the fact that management of undergraduate GP funding occurs above the GPSPO level, means that processes and controls have been in place for decades that preclude diversion of teaching funds towards clinical service delivery. Equally, the wide range of models of delivering primary care services has necessitated flexibility and variability across the country in terms of how these processes and controls are designed and applied.

9. The scale, heterogeneity and dispersed nature of UK primary care means that key elements of undergraduate GP placements are, in most schools, being delivered centrally by a medical school GP teaching team. These elements include a major placement management and co-ordination operation, as well as running a complex layer of financial, quality and planning processes. In addition, undergraduate GP placements commonly include clinical teaching delivered by GPs at central university locations.

10. Each medical school has a CGPT responsible for all aspects of undergraduate GP placement activities: both centralised and dispersed. In some respects, undergraduate GP teaching at any medical school could therefore be considered analogous to a dispersed medium-sized teaching hospital with the CGPT fulfilling the placement delivery functions that occur above the ward (GPSPO) level. Hence, in addition to funding GPSPOs, undergraduate GP teaching funds are used to support the major placement management and co-ordination operation undertaken by the CGPT, as well as centrally delivered primary care clinical teaching.

Arrangements for primary care clinical teaching funds

11. The placement or education provider split is not a useful or workable distinction when applied to undergraduate primary care teaching. Consequently, funding for primary care clinical teaching will be managed by the education provider as already provided for under clause 7.1.17 of the TPA-UGME within the NHS Education Funding Agreement (formerly the NHS Education Contract), which covers devolved funding for undergraduate primary care placements.

12. Where a historical NHS England payment model exists in a small number of medical schools, the intention is that these will be moved onto a devolved model during 2024 to 2025 with the medical schools taking on responsibility for all payments, following receipt of the devolved funding envelope for undergraduate primary care. In the interim period, the existing contractual framework arrangements for NHS England to make payments directly to GPSPOs for delivery of undergraduate clinical placements will be retained.

General principles

13. A clinical placement is any arrangement in which a student spends a block of time engaged in clinical learning. It is the type of activity - rather than the location where it is delivered - that is relevant in deciding on the most appropriate funding source. For example, a component of clinical placement training would be DHSC or NHS England funded even if it is delivered by a clinician on university premises - and, conversely, an academic component of medical education curriculum would be HEI funded even if it is delivered by a clinician on NHS premises.

14. Clinical placements often encompass active involvement in patient care, but they can also be delivered through simulation, remote learning or classroom based to enable the required clinical placement learning or observation of health or social care processes. HEIs must ensure that they are able to identify, manage and control the costs of the clinical placements. Further explanation and how these are applied in undergraduate primary care is provided in section ‘7. Postgraduate medical tariff’ above.

15. Any major changes planned to the delivery of curricula or assessment that have an impact on clinical placement capacity and delivery and devolved funding need to be discussed and agreed with NHS England to ensure that they are deliverable within the resources available.

Assurance on the use of the devolved funding

16. The education provider (HEI) is responsible for assuring NHS England on the use of all the devolved funding for undergraduate primary care, specifically to ensure that:

• in common with the tariff requirements in secondary care of the director of medical education being responsible for the budget of UGM clinical teaching, it is expected that the university HUGPT will be the budget holder for all undergraduate primary care funding that is devolved by NHS England. As the internal structure will vary within HEIs, where the budget holder is not the HUGPT, the expectation is that the HUGPT will be seen as the key link to the budget holder to support the full reconciliation of the devolved NHS England funding for undergraduate primary care
• if there is a requirement in a HEI for this to be the head of school and not delegated to the HUGPT, the head of school will be expected to liaise closely with the HUGPT and both individuals will be required to sign the statement of assurance in the annual accountability report required by NHS England
• an annual accountability report on the use of the undergraduate primary care funding is provided to NHS England (in the required format and by the required deadline) that includes:
  • the name of the HUGPT and details of the receiving account for which they are the budget holder
  • the total amount of funding devolved by NHS England to the HEI that was received into this account during the relevant financial year
  • how all the funding was used
• financial reconciliations of all undergraduate primary care funding that is devolved by NHS England are provided to NHS England (by all the required deadlines)
• a committee chaired by the HUGPT (or their nominated deputy) and attended by the HEI finance lead (or their nominated deputy) convenes regularly to review all funding devolved by NHS England for undergraduate primary care and the annual accountability report

Appropriate use of primary care clinical teaching funds

17. This guidance aims to reflect the nature, scope and delivery of undergraduate primary care clinical teaching as it currently stands and to be sufficiently flexible to encompass the range of models and processes already in place. It also aims to support the following strategic objectives:

• facilitating a wider understanding of how the organisation and delivery of undergraduate clinical teaching differs between primary and secondary care settings
• facilitating educationally valuable medical student exposure to GPs and general practice
• increasing the acceptability of GP careers to UK medical graduates

18. Undergraduate primary care funding that is devolved by NHS England may be used in support of the activities listed below. Examples are provided for each item below - however, there are, and will be, other justifiable ways of supporting the following activities. Examples given are therefore intended to be illustrative rather than prescriptive.

Matching students to GPSPOs

19. In undergraduate secondary care placements, matching students to specific clinicians and ward settings is an administrative activity supported by the UGM tariff that is undertaken by a trust education centre manager and their team.

20. Similarly, in primary care, the CGPT matches students to individual GPSPOs. For general practice, however, this is an extremely complex task that involves detailed familiarity with:

• local geography
• GPSO characteristics
• clinician factors
• specific constraints or needs regarding specific students

Calculation, monitoring, processing and provision of funds to GPs and GPSPOs

21. Placement spend may be used by CGPTs to support the placement funding and monitoring processes necessitated by the fee for reimbursement for time devoted to undergraduate clinical teaching rather than patient care.

22. For example, teaching fees to GPSPOs are commonly calculated by CGPTs according to time that GPSPO personnel are expected to spend delivering, preparing or administering teaching activities and the cost of backfill to cover these.

23. Furthermore, invoices from GPSPOs are scrutinised to ensure they match expected activity, after which they are logged so that teaching fees can be centrally tracked across each year and monitored to compare against overall budgetary forecasts.

Monitoring, processing and funding of undergraduate primary care travel and accommodation

24. Accommodation and/or travel are an essential element of GP placements. The nature, scale and dispersion of this activity is a key difference to secondary care placements. An essential element of this placement activity is the supporting administrative and financial operational processes delivered centrally by CGPTs.

25. This draws on a detailed knowledge of:

• GPSPO characteristics
• geography
• student constraints
• relevant policies
• educational imperatives

26. For example, invoices require:

• scrutinising for relevant proof (for example, tickets and/or receipts)
• checking they match scheduled activity
• ensuring that travel and/or accommodation policy has been correctly followed
• cross-referencing to ensure that relevant risk assessments and standards have been followed

27. Complex financial modelling is commonly required for setting budgets against which this spend can be tracked.

28. Where there is demonstrable evidence of exceptional circumstances or particular challenges associated with excess costs of travel and accommodation over and above the normal journey for UGM students, creating barriers for students to continue accessing clinical placements with remote, rural and coastal providers, regions may consider providing additional, non-recurrent funding, where it is affordable, on top of the funding allocated for travel and accommodation from the harmonised UGM tariff.

Centrally delivered primary care clinical teaching

29. The dispersed nature of primary care means that it can be more efficient to deliver certain aspects of undergraduate primary care clinical teaching centrally rather than at GPSPO locations. Hence, undergraduate GP teaching funds may be used to support these activities as described under section ‘5. Undergraduate medical tariff’ above.

Monitoring GPSPO or clinical teacher performance

30. CGPTs monitor metrics for their GP clinical teachers and clinical placement performance, and will have systems for monitoring the performance of clinical teachers and the delivery of clinical placements.

31. Where issues are identified, these are escalated to a GP member of the CGPT for further action. Escalations are cross-referenced according to GPSPO, clinical teacher and year so that emerging themes can be identified, enabling early proactive remediation by the CGPT.

Addressing concerns raised by students about undergraduate GP teaching

32. Students commonly raise placement-related problems with the CGPT rather than with the GPSPO. Informal resolution is always the first and preferred approach and the CGPT plays a vital role in this.

33. Issues raised include (but are not limited to) perceived problems with clinical teaching, travel or accommodation.

34. A GP member of the CGPT will engage with affected parties (referring to the sub-contract and related protocols). Discussions and outcomes at each stage are documented and filed centrally by the CGPT to form part of the performance record for the GPSPO and/or GP.

Representing the needs of undergraduate primary care teaching delivery

35. CGPTs provide a voice for undergraduate GP placements at a range of committees that support delivery of undergraduate clinical teaching activities where matters such as student feedback, curriculum, examinations and finance or audit are discussed. This representation ensures that impacts on primary care placement capacity and delivery are considered, and that proposals consider what is feasibly deliverable by GPSPOs at that point in time.

36. As some changes to the delivery of curricula or assessment may impact on clinical placement capacity, delivery and resources, any major changes need to be discussed with NHS England as well as the placement providers to ensure that the changes are deliverable within the resources available from NHS England.

37. CGPTs also provide similar representation at local, regional and national meetings, which are valuable for troubleshooting, advising and sharing best practice regarding GP placement delivery.

Primary care clinical teacher support and development

38. Secondary care education centre teams and associated clinical placement leadership provide support, guidance and development for their clinical teachers.

39. Similarly, for undergraduate GP teaching, CGPTs undertake, create and deliver clinical teaching support, guidance and development. This occurs on a formal and informal basis involving online and/or written media and in-person contact.

Providing clinical training advice, content and materials in undergraduate GP teaching

40. CGPTs undertake clinical placement leadership for undergraduate general practice. This often includes (but is not limited to) creating, providing and advising-on clinical training content or delivery, as well as providing equipment in support of clinical training.

Instituting and maintaining sub-contracts with GPSPOs

41. The sub-contract governs the working relationship between each GPSPO and the CGPT for a specified duration.

42. Prior to a sub-contract first being introduced, CGPTs deliver a process for determining whether a GPSPO will be able to meet the terms of the sub-contract, which may involve meetings, provision of evidence and a site inspection.

43. Sub-contracts are flagged in advance by the CGPTs before they expire, and CGPTS commonly deliver a renewal process involving a review of a GPSPO performance during the preceding period and requesting further evidence if required.

Placement and clinical training development in undergraduate GP teaching

44. The nature of primary care is such that development activity, often characterised by innovation and/or evaluation, is inherent in the delivery of undergraduate GP teaching.

45. Primary care is comprised of relatively informal small businesses sub-contracted to the NHS. This makes general practice a flexible, innovative and continually evolving environment that rapidly adapts to technological advances, new challenges, and fresh opportunities, with change often occurring from the bottom up.

46. Undergraduate GP teaching must constantly develop and adapt to keep in step with such changes, and ensure the continued availability and validity of training experience. This requires liaison, networking and frequent, agile responses that must be evaluated to ensure their effectiveness. Examples include the design, implementation and evaluation of:

• novel clinical placements
• virtual clinical experiences
• primary care-based clinical learning and assessment activities

Promotion of GP careers

47. CGPTs commonly have a communications strategy and programme of activities aimed specifically at encouraging medical students to consider positively a career in UK general practice following graduation.

48. This is distinct from general student careers advisory services, which are a HEI funding responsibility.

Clinical assessments related to primary care

49. The fee for reimbursement for time devoted to undergraduate primary care clinical teaching - rather than patient care - is such that the DHSC or NHS England funding for primary care is essential to releasing GPs to take part in undergraduate clinical exams.

50. Primary care placements commonly involve progression hurdles to help determine whether a placement has been completed satisfactorily. These can include:

• assessed clinical skills stations
• workplace-based assessments
• assessed clinical presentations
• written reflections or portfolios
• assessment of audio or video recordings of consultations submitted

51. In primary care, these activities may be delivered and assessed by GPs within individual GPSPOs or delivered centrally by GPs attending the CGPT.

52. The collation and review of student assessment results is a HEI funding responsibility.

Management of DHSC or NHS England funding for undergraduate primary care clinical teaching

53. DHSC or NHSE funding for undergraduate primary care clinical teaching requires central operational management by the CGPT. The nature of general practice is such that operational budgeting, tracking spends and forecasting is necessarily more complex than that for secondary care, and requires detailed knowledge of primary care from the HUGPT and other GPs in the CGPT.

54. Responsibility for funding the corporate finance functions of the university remains a HEI funding responsibility.

55. Rental of modular extensions by undergraduate primary care placement providers is an acceptable use of the UGM tariff funding to increase placement space or capacity, providing it is not to the detriment of the quality of the placements and it is by placement providers (not HEIs). However:

• the use of the UGM tariff funding in this way is caveated such that medical schools (HEIs) should not be top-slicing the UGM tariff funding offer to students and placement providers to create such a ‘pot’
• NHS England will need to be assured that the use of the UGM tariff funding for rental of modular extensions has no impact on the quality of existing placement provision

Annex D: undergraduate medical tariff funding for medical student placements within PIVOs

1. This section provides the context and arrangements for undergraduate medical tariff funding for medical student placements with private, independent and voluntary organisations (PIVOs).

Introduction

2. The nature and organisation of UGM placements in PIVOs is different from undergraduate secondary and primary care.

3. The PIVO community is heterogeneous and dispersed in nature. It also differs to undergraduate secondary and primary care in terms of legal entity and operational norms.

4. While there are some similarities to the central arrangements for managing undergraduate primary care tariff funding, the scale of organisations delivering undergraduate placements for medical students is smaller.

5. The organisation and funding arrangements supporting UGM placements in PIVOs are, in most medical schools, being managed by a central model. These elements include placement management and co-ordination operation, as well as financial, quality and planning processes.

6. The management of the UGM tariff for PIVOs may sit with a placement management team within the medical school, which is likely to be, in most HEIs, the management team responsible for undergraduate secondary care placements.

Funding arrangements

7. The UGM tariff funding for medical student placements in PIVOs is, in most of the medical schools, managed by the HEIs (education providers) as already provided for under clause 7.1.17 of the TPA-UGME within the NHS Education Funding Agreement (formerly the NHS Education Contract), which covers devolved funding for undergraduate placements in the PIVOs.

8. Where a historical NHS England payment model exists in a small number of HEIs (education providers), the intention is that these will be moved onto a devolved model during 2024 to 2025 with the medical schools taking on responsibility for all payments, following receipt of the devolved funding envelope for undergraduate placements in PIVOs. In the interim period, the existing contractual framework arrangements for NHS England to make payments directly to PIVOs for delivery of undergraduate placements will be retained.

9. The sub-contract, as covered under the NHS Education Funding Agreement, is the method for the HEI (education provider) to pass on the devolved funding for undergraduate medical placements with PIVOs.

General principles

10. A clinical placement is any arrangement in which a student spends a block of time engaged in clinical learning. It is the type of activity - rather than the location of training or who is delivering it - that is relevant in deciding on the most appropriate funding source.

11. Clinical placements often encompass active involvement in patient care, but they can also be delivered through simulation, remote learning or classroom based to enable the required clinical placement learning or observation of health or social care processes. HEIs (education providers) must ensure that they are able to identify, manage and control the costs of UGM placements.

12. UGM placements may be undertaken in a range of settings that include PIVOs. These include, for example, charities, hospices and not-for-profit organisations.

13. Any major changes planned to the delivery of curricula or assessment that have an impact on UGM placement capacity and delivery, and devolved undergraduate medical tariff funding, need to be discussed and agreed with NHS England to ensure that they are deliverable within the resources available.

Assurance on the use of the devolved funding

14. The HEI (education provider) is responsible for assuring NHS England on the use of all the devolved funding for UGM placements in PIVOs, specifically to ensure that:

• in common with the UGM tariff requirements in secondary and primary care, there is an identified budget holder for all UGM tariff funding that is devolved by NHS England for placements with PIVOs. NHS England is not nationally prescribing who the budget holder for the UGM tariff funding should be to allow for the appropriate budget holder responsibility that fits with the HEI structure
• there is full reconciliation of the devolved NHS England funding for UGM placements with PIVOs
• in common with the UGM tariff requirements for clinical placements in secondary and primary care, an annual accountability report on the use of the UGM tariff funding for medical student placements with PIVOs will need to be provided to NHS England (in the required format and by the required deadline) by the HEI that includes:
  • the name of the HEI budget holder and details of the receiving account for which they are the budget holder
  • the total amount of funding devolved by NHS England to the HEI that was received into this account during the relevant financial year
  • how all the funding was used
• financial reconciliations of all UGM tariff funding that is devolved by NHS England are provided to NHS England (by all the required deadlines)
• a committee chaired by the budget holder and attended by the HEI finance lead (or their nominated deputy) convenes regularly to review all funding devolved by NHS England for UGM placements with PIVOs and the annual accountability report

Appropriate use of UGM funding

15. This guidance aims to reflect the nature and scope of UGM placements with PIVOs as to be sufficiently flexible to encompass the models and processes already in place.

16. UGM funding that is devolved by NHS England for placements with PIVOs may be used in support of the activities listed below. These are not an exhaustive list. Examples are provided for each item below - however, there are, and will be, other justifiable ways of supporting the following activities. The examples provided below are therefore intended to be illustrative rather than prescriptive.

Matching students to placements

17. As in undergraduate secondary care placements, matching students to specific clinicians and ward settings is an administrative activity supported by the UGM tariff, which is undertaken by a trust education centre manager and their team. Similarly, for placements with PIVOs, students need to be matched to placements.

Calculation, monitoring, processing and provision of funds to placements with PIVOs

18. Ensuring that all UGM tariff funding is supported by robust monitoring processes for provision of funds to PIVOs includes the scrutiny of invoices from these organisations to ensure they match expected activity, after which payments should be logged and tracked across each year and monitored to compare against overall budgetary forecasts.

Monitoring, processing and funding of travel and accommodation for UGM placements with PIVOs

19. Travel and/or accommodation is an essential element of UGM placements. The nature and dispersion of this activity is different to those in undergraduate secondary care placements.

20. A key element of this placement activity is the supporting administrative and financial operational processes delivered centrally by the HEIs, which includes, for example:

• scrutiny of claims or invoices with relevant proof (for example, tickets or receipts)
• checking they match scheduled activity
• ensuring that travel and/or accommodation policy has been correctly followed
• cross-referencing to ensure that relevant risk assessments and standards have been followed

21. Financial modelling is commonly required for setting budgets against which this spend can be tracked.

Addressing concerns raised by students about undergraduate placements in PIVOs

22. Informal resolution is always the first and preferred approach when responding to placement-related concerns raised by students in relation to placements with PIVOs.

23. Issues raised include (but are not limited to) perceived problems with clinical teaching or travel or accommodation.

Instituting and maintaining sub-contracts with PIVOs

24. The sub-contract governs the working relationship between each HEI (education provider) and the PIVO (placement provider) for a specified duration.

25. Prior to a sub-contract first being introduced, the HEI will determine whether a placement provider will be able to meet the terms of the sub-contract, which may involve meetings, provision of evidence and a site inspection.

26. Sub-contracts should be flagged in advance by the HEI before they expire, and the HEI commonly delivers a renewal process involving a review of the placement provider performance during the preceding period and requesting further evidence if required.

Annex E: scope of undergraduate dental tariff for all clinical placements

1. This annex includes a principles section followed by 6 sections identifying the source of funding for clinical placement components for dental undergraduate education.

Principles

2. The General Dental Council (GDC) has defined dental undergraduate learning outcomes in the UK in preparing for practice. The overall outcomes can be delivered through a variety of clinical placements involving primary and secondary care settings, and clinical and academic education. University dental schools are responsible for, and deliver, the academic education and clinical outcomes.

3. Most dental schools are linked to acute hospital trusts to deliver the clinical outcomes, with a large component of training provided within a dental hospital with primary care outreach clinical placements. Some dental schools’ clinical training components are entirely primary care based and they are linked to a main primary care provider.

4. The purpose of the dental undergraduate tariff was previously described in the Dental service increment for teaching (SiFT) accountability report (PDF, 15KB) published by DHSC in 2000 as to ensure that:

• the NHS supports dental undergraduate clinical education
• service providers who contribute significantly to dental undergraduate clinical education are not financially disadvantaged

5. Clinical placements for dental undergraduate students require clinical placement providers to provide the following for patients treated by dental students:

• clinical facilities, including dental surgeries
• associated dental equipment and materials
• dental care professional support
• administrative infrastructure and support
• dental technical laboratory support

6. Patients treated by dental undergraduate students usually receive free primary dental care treatment. Costs for the dental treatment should be covered by the dental undergraduate tariff.

7. The dental undergraduate tariff is also intended to provide support for obtaining the general medical and surgical requirements of the GDC outcomes (previously called funding for medical and dental), which may require placement with an alternative clinical placement provider.

8. Clinical placement providers and HEIs are expected to adhere to these principles. Where there are demonstrable benefits to academic ET outcomes, arrangements should be flexible enough to allow innovation, flexibility, and public and patient involvement. It is expected that any proposed changes to dental undergraduate education would be discussed at an annual tri-partite meeting between HEI (dental school), the main clinical placement provider (dental hospital or primary care provider) and NHS England.

9. Selection and assessment of dental undergraduate students should involve NHS staff and general dental practitioners, as well as patients and carers, where possible, in order to reflect the diversity of the population served.

10. Clinical placement funding to support publicly funded students, with the exception of the currently agreed overseas OfS-approved annual intake numbers, should not be used to subsidise the costs of placement provision for students required to meet the full costs of their clinical placements.

11. All dental undergraduate students, regardless of how their education is funded, will have equal access to high-quality clinical placements that provide them with opportunities to progress and succeed in their higher education.

12. It is the type of activity - rather than the location of training or who is delivering it - that is relevant in deciding on the most appropriate funding source. For example, attendance of dental undergraduate students at placements where patient attendance receives an NHS treatment tariff (for example, consultant consultation clinic) would not be considered dental undergraduate clinical activity, but may be supported in part by the dental undergraduate tariff if student attendance and teaching during the clinical placement decreases the efficiency of the clinic. Establishing and agreeing the source of funding is expected to be part of the tri-partite discussions between the HEI, the clinical placement provider and NHS England, and will need to be timely, collegiate and transparent.

13. The dental undergraduate tariff will be payable to the main clinical placement provider and form part of the NHS Education Funding Agreement (formerly the NHS Education Contract). Payment for clinical placements outside of the main provider would need to be identified and agreed at the dental undergraduate tri-partite meeting. HEI activity data collections will identify activity-based payments for all placement providers. It is expected that the dental undergraduate tariff follows the dental undergraduate student.

14. The facilitation and delivery of teaching and learning will inevitably make greater use of emerging technologies. Funding models should not be a barrier to such developments, which may blur the boundaries between university and clinical environments. HEIs must ensure that such developments that affect clinical placements providers or have a financial impact are discussed and agreed in advance with NHS England and the placement provider to ensure that it is deliverable within resources available and proposed timescales.

15. The funding sources supporting dental undergraduate placements can be found under the headings ‘Source of funding 5: dental - corporate functions’ to ‘Source of funding 10: dental - simulation’ below. The funding sources are:

• HEI educational income, consisting of a combination of student fees and supplementary funding through the OfS grant
• DHSC dental undergraduate tariff

16. ‘Source of funding 5: dental - corporate functions’ to ‘Source of funding 10: dental - simulation’ below give clear distinction to guide the different funding streams between:

• requirements and activities of the academic curriculum for academic education
• activities as part of clinical placements for clinical education
• activities and resources that include all healthcare learners

17. All clinical placements should be agreed and signed off by placement providers with consideration of the associated cost in clinical placement provision. Placement providers must demonstrate that funding for clinical placements is being used and stay within the available funding envelope for the delivery of such learning. HEIs must demonstrate that the funding for academic education is being used for the delivery of such learning. HEIs must ensure they involve the NHS placement provider budget holder in discussions on their requirements for clinical placements. The placement provider must be able to identify, manage and control the cost of the placement within the funding envelope set.

18. Transparency of the usage of the dental undergraduate tariff will be monitored by NHS England through an agreed consistent accountability reporting framework to ensure financial transparency on the use of the funding - and that the funding is assigned to education and training, and not any other services. It is expected that there will be regular discussions between placement providers, the HEI and NHS England on the quality of the clinical placement learning environment and the achievement by learners of the required clinical outcomes.

19. A TPA-UGDE was introduced in 2023 to 2024 between NHS England, education and placement providers that ensures:

• any variations to funding arrangements are agreed. This may include, but is not limited to, adjustments to reflect additional:
  • services provided for dental undergraduate education, such as OSCEs
  • costs to the clinical placement providers, where they provide activity on behalf of other providers
• HEIs have defined student clinical learning outcomes for each clinical placement and stipulate that clinical placement providers must be able to facilitate dental undergraduate students meeting those objectives
• any changes to the delivery of curricula or assessment that have an impact on clinical placement capacity and delivery must be discussed and agreed with the placement provider and NHS England to ensure that they are deliverable within the resources available
• all members of the TPA-UGDE have access to information on arrangements governed by the agreement and, in particular, on the NHS England dental undergraduate tariff allocated to the clinical placement provider and the HEI funding available to support dental undergraduate education

20. Each party will be responsible for funding their costs, in the event that joint funding arrangements are not negotiated locally between the parties to reflect models of service provision.

21. ‘Locally negotiated arrangements’ are defined as arrangements that:

• have been negotiated between the parties on a local level - the ‘parties’ mean the education provider and the placement provider
• are related to the local flexibilities allowed for within this guidance
• are a defined split locally negotiated between the education and placement providers

Source of funding 5: dental - corporate functions

All funding arrangements need to be part of the TPA-UGDE between NHS England, education and placement providers.

HR and recruitment

22. Responsibility for funding HR and recruitment for academic staff, support staff, technical staff and tutors falls to the HEI.

23. Responsibility for funding recruitment of NHS-funded staff involved in the delivery of clinical placements falls to the national dental undergraduate tariff.

Finance

24. Responsibility for funding the financial management of dental undergraduate tariff and undergraduate placement activity falls to the national dental undergraduate tariff.

Staff development

25. Responsibility for funding staff development, university induction and the development of clinical teachers (HEI or NHS employed) falls to the HEI.

26. Responsibility for funding inductions for staff employed to deliver or support clinical teaching falls to the national dental undergraduate tariff.

27. Responsibility for funding NHS inductions for undergraduate dental students falls to the national dental undergraduate tariff. This includes:

• NHS statutory and mandatory training
• basic life support, including medical emergencies for adults and children
• safeguarding
• infection control
• standard placement provider protocols

Clinical development opportunities

28. Responsibility for funding clinical development opportunities falls to the national dental undergraduate tariff.

29. Staff employed to deliver or support clinical teaching should have the same access to staff development as peers not involved in student clinical teaching.

Marketing

30. Responsibility for funding marketing of dental undergraduate courses falls to the HEI.

Admissions

31. Responsibility for funding dental undergraduate admissions falls to the HEI.

32. Contributions to interviews for prospective Bachelor of Dental Surgery (BDS) students can be funded by the 2 types of funding: HEI and the national dental undergraduate tariff.

Quality and standards of education

33. Responsibility for funding quality and standards of education, including both internal and external (GDC), falls to the HEI.

Registry services

34. Responsibility for funding registry services, such as enrolment of dental undergraduate student documentation on progress, including fitness to practise, falls to the HEI.

Staff DBS checks

35. Responsibility for funding staff DBS checks and occupational health checks falls to the HEI.

36. Clinical placement providers should be responsible for all appropriate checks for staff holding honorary contracts or placement provider contracts, and responsibility for funding falls to the national dental undergraduate tariff. Staff employed to deliver or support clinical teaching should have an equitable approach to DBS checks to peers not involved.

37. The placement provider’s HR team needs to ensure valid DBS and occupational health clearance on awarding an honorary contract for HEI clinical staff. Responsibility for funding falls to a combination of HEI educational income and the national dental undergraduate tariff.

IT services

38. Responsibility for funding university IT services falls to the HEI. This includes:

• technology-assisted learning
• electronic student portfolios

39. Responsibility for funding clinical IT services falls to the national dental undergraduate tariff. This includes:

• patient administration systems
• electronic records
• bespoke dental record systems
• radiology
• radiography
• IT access at each dental chair, including accessibility to appropriate university systems (for example, portfolio)

University library services

40. Responsibility for funding university library services falls to the HEI.

41. Responsibility for funding NHS knowledge and library services falls to the national dental undergraduate tariff.

Accommodation and travel

42. Accommodation and travel for more remote placements is the education provider’s funding responsibility.

43. Local arrangements for funding accommodation and travel for clinical placements continue in 2024 to 2025 while further work is undertaken by NHS England in 2024.

Clinical quality

44. Responsibility for funding clinical quality processes that underpin safe and effective care on student teaching clinics falls to the national dental undergraduate tariff.

Information governance

45. Responsibility for funding university General Data Protection Regulation (GDPR) responsibilities falls to the HEI.

46. Responsibility for funding information governance structures falls to the national dental undergraduate tariff.

Source of funding 6: dental - student services

47. All funding arrangements need to be part of the TPA-UGDE between NHS England, education and placement providers.

Student support

48. Responsibility for funding student support, including DBS and hardship funds, falls to the HEI.

Student counselling

49. This includes student-at-risk structures, and mental health and wellbeing support.

50. Responsibility for funding student counselling falls to the HEI.

Prizes and awards

51. Responsibility for funding prizes and awards falls to the HEI.

Student occupational health

52. Responsibility for funding student occupational health falls to the HEI.

Student career advice

53. Responsibility for funding employability and career advice falls to the HEI.

Fitness to practise

54. Responsibility for funding fitness to practise and disciplinary structures falls to the HEI.

Source of funding 7: dental - teaching and learning

55. All funding arrangements need to be part of the TPA-UGDE between NHS England, education and placement providers.

Academic teaching

56. Responsibility for funding academic teaching, academic content, curriculum design and delivery fall to the HEI. Academic teaching activities should be identified in individual job plans.

57. Any teaching activity that is rechargeable between the education provider and the placement provider should be transparent, clearly identified in individual job plans, and agreed between the education and placement provider.

Clinical teaching

58. Responsibility for funding direct staff teaching within a clinical placement falls to the national dental undergraduate tariff. Clinical teaching activity should be identified in individual job plans.

59. Any teaching activity that is rechargeable between the education provider and the placement provider should be transparent, clearly identified in individual job plans, and agreed between the education and placement provider.

Laboratory and technical support

60. Responsibility for funding laboratory, project, and technical support and materials (non-clinical years or provision) falls to the HEI.

Dental nurse support

61. This includes:

• dental nurse support to facilitate safe dental treatment for patients and student learning
• dedicated one-to-one chairside support, when required, to aid student clinical development

62. Responsibility for funding dental nurse support falls to the national dental undergraduate tariff.

Other support

63. Responsibility for funding support for extracurricular opportunities such as short-term research fellowships or experience (for example, INSPIRE) falls to the HEI.

64. Responsibility for funding the provision of clinical placements to cover the human disease curriculum falls to the national dental undergraduate tariff.

65. Actors used for clinical scenarios - for example, teaching communication skills and patient assessments - can be funded by 2 types of funding: HEI educational income and the national dental undergraduate tariff).

Source of funding 8: dental - roles and posts

66. All funding arrangements need to be part of the TPA-UGDE between NHS England, education and placement providers.

Clinical assessment and examinations

67. Responsibility for funding clinical dental undergraduate examinations and assessments falls to a combination of HEI educational income and the national dental undergraduate tariff.

68. Responsibility for funding organising, planning and executing assessments for all 5 years falls to the HEI.

69. Responsibility for funding the following falls to the national dental undergraduate tariff:

• space needed to deliver the teaching and assessments within the clinical placement
• contribution to pool of examiners
• actors used for clinical scenarios in examinations and assessments

Academic and NHS service roles

70. Responsibility for funding academic roles or posts falls to a combination of HEI educational income and the national dental undergraduate tariff.

71. Responsibility for funding NHS service roles or posts falls to the national dental undergraduate tariff.

Administrative posts

72. Responsibility for funding administrative posts relating to the management and administrative support for the delivery of the BDS curriculum falls to the HEI. This:

• includes:
  • timetabling
  • student support
  • exams and assessment
• excludes that which crosses over into the patient interface

73. Responsibility for funding administrative and clinical records, and staff costs to support robust management of student placements, including patient appointments, falls to the national dental undergraduate tariff.

Curriculum leadership

74. This includes BDS curriculum leadership roles such as:

• senior tutors
• dean for education
• head of school or dean
• assessment lead
• all other leadership roles associated with leadership and delivery of the curriculum

75. Responsibility for funding curriculum leadership roles falls to the HEI.

Source of funding 9: dental - space, facilities and uniforms

76.All funding arrangements need to be part of the TPA-UGDE between NHS England, education and placement providers.

Facilities and equipment

77. Responsibility for funding academic facilities and equipment falls to the HEI, including:

• lecture theatres
• tutorial rooms
• study space
• simulated dental learning environments (SDLEs)
• equipment and materials used by SDLEs

78. Responsibility for funding placement facilities and equipment falls to the national dental undergraduate tariff, including:

• clinical facilities for students to undertake treatment of patients
• equipment including personal protective equipment (PPE), instruments and appropriate dental materials necessary to undertake treatment

Common rooms

79. Responsibility for funding student common rooms falls to the HEI.

Laboratories

80. Responsibility for funding laboratory space and materials for biomedical education, such as anatomy or museum, falls to the HEI.

81. Responsibility for funding laboratory space to support patient care falls to the national dental undergraduate tariff.

82. Locally agreed key performance indicators should be in place for the placement provider to monitor the timeliness of turnaround times for laboratory work, to ensure that turnaround times do not affect students’ progress on undergraduate dental programmes.

Decontamination facilities

83. Responsibility for funding decontamination facilities for dental instruments and equipment falls to the national dental undergraduate tarifff.

Cleaning and maintenance of academic environment

84. Responsibility for funding cleaning and maintenance of academic spaces falls to the HEI.

Student facilities on clinical placements

85. This includes:

• changing rooms
• showers
• study space
• space to take breaks

86. Responsibility for funding facilities for students while on placement falls to the national dental undergraduate tariff.

Community outreach settings

87. Where undergraduate dental students are treating patients in a range of placement provider settings, including community outreach, the placement activity is funded from the national dental undergraduate tariff.

Clinical environment

88. There is an expectation that dental undergraduate clinical environments are well maintained and there is a rolling programme of refurbishment or replacement of dental equipment, such as dental chairs and radiology equipment, to ensure that equipment and materials available to dental undergraduate students keep pace with innovation and current standards of practice.

89. Responsibility for funding maintenance to the clinical environment falls to the national dental undergraduate tariff.

Student uniforms

90. Funding for student uniforms is dependent on the individual policy of either the education or placement provider.

91. If uniforms are mandated by the education provider, the HEI is responsible for funding these.

92. If clinical uniforms are mandated under the individual placement provider’s policy, the placement provider is responsible for funding from the national dental undergraduate tariff.

Source of funding 10: dental - simulation

93. All funding arrangements need to be part of the TPA-UGDE between NHS England, education and placement providers.

94. Responsibility for funding simulation falls to the HEI where it is:

• part of the academic offering required for the development of clinical skills
• typically delivered outside of places where patient care is delivered

95. Responsibility for simulation funding falls to the national dental undergraduate tariff where it enhances the clinical learning experience, clinical safety or clinical assessment linked to any or all of the following:

• a specific patient receiving care from a student
• a specific clinical setting
• preparation for management of the acutely unwell person

Annex F: scope of postgraduate clinical psychology tariff for all clinical placements

1. This annex includes a principles section followed by sections identifying the source of funding for clinical placement components for NHS-funded clinical psychology postgraduate training.

2. Self-funded and international clinical psychology students are out of scope for placement tariff.

Principles

3. The expansion of clinical psychology training since 2020 has put increased pressure on placement provision. It is therefore extremely important that placement providers and their services are in receipt of tariff monies designed to support them, and that this funding is used to directly enhance placement provision and experience. The relevant Chief Psychological Professions Officer in the organisation hosting a placement should therefore be involved in distribution of appropriate tariff income.

4. The Health and Care Professions Council (HCPC) has defined Standards of education and training in clinical psychology, and the professional body for clinical psychology, the British Psychological Society (BPS), has set accreditation standards for education provision. The clinical psychology tariff is intended to provide support for placement provision meeting the requirements of the HCPC and BPS, and should be used for this purpose.

5. Clinical psychology trainees are employed by a host NHS trust for the duration of their training, subject to a funded hosting contract with NHS England. This covers all aspects of employment including HR, occupational health and travel expenses. Tariff funding should not be used to support activities covered in hosting contracts or in training provider contracts with HEIs.

6. Clinical placements for clinical psychology trainees take place across the region specified in the training contract. This may include but is not limited to the host trust.

7. Placement providers are responsible for providing facilities to support trainee clinical activity, including access to office space, IT, clinic rooms and administrative support.

8. All clinical psychology trainees will have equal access to high-quality clinical placements that provide them with opportunities to progress and succeed in their higher education, and meet professional competency standards.

9. The clinical psychology tariff will be payable to the clinical placement providers - HEI activity data collections will identify activity-based payments. It is expected that the clinical psychology tariff follows the clinical psychology trainee.

10. All clinical placements should be agreed and signed off by placement providers with consideration of the associated cost in clinical placement provision. Placement providers must demonstrate that funding for clinical placements is being used to directly support these costs and enhance the placement experience for the trainee.

11. Transparency of the usage of the clinical psychology tariff will be monitored by NHS England to ensure that the funding is assigned to directly benefit ET for clinical psychologists. It is expected that there will be regular discussions between placement providers, the HEI and NHS England on the quality of the clinical placement learning environment, and the achievement by learners of the required competences and clinical outcomes.

Sources of funding

12. There are 3 primary funding sources supporting clinical psychology trainees, which may be supplemented by other local, regional or national funding. These are:

• HEI educational income (student tuition fees) as part of a contract with NHS England to deliver a regional training programme in clinical psychology
• NHS England funding for a host trust to employ regional clinical psychology trainees as part of a hosting contract
• clinical psychology tariff to support placement provision

13. ‘Source of funding 11: clinical psychology - corporate functions’ to ‘Source of funding 15: clinical psychology - space and facilities’ below distinguish the activity expected to be supported by each source of funding, including:

• requirements and activities of the academic curriculum for academic education
• activities and resources of the host employing trust
• activities as part of clinical placements for clinical education

Source of funding 11: clinical psychology - corporate functions

HR and recruitment

14. HR and recruitment for academic, clinical, and other academic and related staff is funded by the HEI.

15. Any HR and recruitment of a placement co-ordinator or practice education staff is funded by the national clinical psychology tariff.

Finance

16. Management of payroll and expenses for employed trainees is covered by the host trust’s funding from NHS England.

17. Financial management of clinical psychology placement activity is funded by the national clinical psychology tariff.

Staff development

18. The development of clinical academic staff, university induction and the provision of placement supervisor induction programmes is funded by the HEI.

19. CPD for placement supervisors that enhances the placement experience is funded by the national clinical psychology tariff.

Admissions for clinical psychology trainees

20. Clinical psychology training programme admissions, including some recruitment functions on behalf of the host employer, are funded by the HEI.

21. HR and recruitment for clinical psychology trainees is covered by the host trust’s funding from NHS England.

Management of clinical psychology trainees

22. Academic progress overseen by the programme director, plus operational management of trainees on behalf of host employers, is funded by the HEI.

23. The employing trust manages annual leave and expenses claims for clinical psychology trainees, and monitors attendance. This is covered by NHS England funding for the host trust.

24. Monitoring of placement attendance is funded by the national clinical psychology tariff.

Quality and standards of education

25. Quality and standards of education, including internal and external (HCPC and BPS), are funded by the HEI.

26. Quality and standards of placement experience (HCPC and BPS) are funded by the national clinical psychology tariff.

Registry services

27. Registry services, enrolment and documentation on progress, including fitness to practise and fitness to study, are funded by the HEI.

28. Fitness to practise and HR or occupational health processes applying to clinical psychology trainees are covered by the host trust’s funding from NHS England.

29. Monitoring fitness to practise and responding to concerns in collaboration with HEIs and employers is funded by the national clinical psychology tariff.

Staff DBS checks

30. Clinical psychology trainee DBS checks are covered by the host trust’s funding from NHS England.

IT services

31. University IT services, including technology-assisted learning and electronic student portfolios, are funded by the HEI.

32. Electronic staff record services and mandatory training systems are covered by the host trust’s funding from NHS England.

33. Clinical IT services are funded by the national clinical psychology tariff, including:

• patient administration systems
• electronic records
• telephony for placement activity
• IT access to appropriate university systems
• access to placement-provided IT resources

Library services

34. University library services are funded by the HEI.

35. Trust library services are covered by the host trust’s funding from NHS England, and/or the national clinical psychology tariff.

Accommodation and travel

36. Travel costs are part of the contract with the host trust and claims processed using trust systems are covered by NHS England funding for host trust.

Clinical quality

37. Clinical quality structures, including governance processes, audits, patient safety and quality improvement, are funded by the national clinical psychology tariff.

Information governance

38. University GDPR responsibilities are funded by the HEI.

39. Information governance structures are covered by NHS England funding for host trust and/or the national clinical psychology tariff.

Source of funding 12: clinical psychology - student services

Student support

40. Student support, including disability support, is funded by the HEI.

41. Occupational health services available to clinical psychology trainees are covered by NHS England funding for host trust.

42. Facilitating reasonable adjustments in workplace arrangements for placement activities, and provision of practice education support within the placement provider, is funded by the national clinical psychology tariff.

Student counselling

43. Student counselling and mental health or wellbeing support is funded by the HEI.

44. Occupational health staff counselling service available to clinical psychology trainees is covered by NHS England funding for host trust.

Prizes and awards

45. Prizes and awards are funded by the HEI.

Student occupational health

46. NHS occupational health services to ensure the safety of the clinical psychology trainee are covered by NHS England funding for host trust.

47. Facilitating reasonable adjustments in workplace arrangements for placement activities is funded by the national clinical psychology tariff.

Fitness to practise

48. Fitness to practise and disciplinary structures are funded by the HEI and/or the host trust’s funding from NHS England.

49. Contributions to fitness to practise and disciplinary procedures are funded by the national clinical psychology tariff.

Source of funding 13: clinical psychology - teaching and learning

Academic teaching

50. Academic teaching is funded by the HEI, including:

• developing academic content
• curriculum design and delivery
• guest lectures from local clinical psychologists and other clinical staff

Other support

51. Support for CPD and opportunities such as short-term research fellowships are funded by the HEI.

52. Provision of clinical placements to cover the lifespan and clinical psychology specialties is funded by the national clinical psychology tariff.

Supervision

53. Provision of line management support for trainees on behalf of the host employer is funded by the HEI.

54. Provision of clinical and professional supervision meeting HCPC and BPS standards and guidelines, supervision and training, or updates for supervisors is funded by the national clinical psychology tariff.

Source of funding 14: clinical psychology - roles and posts

Academic and clinical assessments and examinations

55. Organisation, planning and execution of academic assessments, including research activities, are funded by the HEI.

56. Clinical psychology supervisors, supported by a programme team in assessment of competence of clinical psychology trainees on placement, is funded by the national clinical psychology tariff.

Academic roles

57. Academic roles and posts are funded by the HEI.

Administrative and managerial posts

58. Administrative posts relating to the management of and administrative support for the delivery of the clinical psychology programme (such as timetabling, student support and assessment), and managerial posts relating to the management of clinical psychology trainees in the host trust are funded by the HEI.

59. Administrative posts relating to the administrative support for the management of clinical psychology trainees in the trust are covered by the host trust’s funding from NHS England.

60. Administrative and clinical records support to trainees’ clinical work, staff costs to support robust management of student placements (including patient appointments), and staff costs and support for placement educators are funded by the HEI.

Curriculum leadership

61. All leadership roles associated with leadership and delivery of the curriculum are funded by the HEI.

Source of funding 15: clinical psychology - space and facilities

Facilities and equipment

62. Lecture theatres, tutorial room and study space, and virtual learning environments are funded by the HEI.

63. Clinical facilities for students to undertake treatment of patients and equipment, including PPE, appropriate assessment materials, and IT necessary to undertake placement activity, are funded by the national clinical psychology tariff.

Cleaning and maintenance

64. Cleaning and maintenance of academic spaces is funded by the HEI.

65. Cleaning and maintenance of clinical or administrative spaces is funded by the national clinical psychology tariff.

Student facilities on clinical placement

66. Facilities for students while on placement such as desk space, clinic rooms and space to take breaks are funded by the national clinical psychology tariff.

Clinical environment

67. There is an expectation that the clinical psychology clinical placement environment is well maintained and there is a rolling programme of refurbishment or replacement of equipment, supervision for placement supervisors, and support for practice educators. This is funded by the national clinical psychology tariff.

Annex G: MFF regional rates

1. The below rates only apply to the ET tariffs and not to any other NHS prices.

Table 3: MFF regional rates for 2024 to 2025

Region	2024 to 2025 (£)
London	1.165719
East of England	1.062976
Midlands	1.034077
North East and Yorkshire	1.024829
North West	1.034745
South East	1.079119
South West	1.037230
National	1.063394