Guidance

Education and training tariff guidance and prices for 2021 to 2022 financial year

Published 1 July 2021

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 2021 to 2022 financial year, including:

• an overview of the introduction of the ET tariff payment mechanism for secondary care training placements

• confirmation of Health Education England’s (HEE) additional responsibilities for ET tariff development from April 2021

• powers and requirements with regards to the application of the ET tariffs in 2021 to 2022

• confirmation of the changes to the ET tariffs that are being introduced from 1 April 2021

• confirmation of the early planning and proposed work programme to inform the ET tariffs for implementation from 1 April 2022

• further information relating to the ET tariffs for 2021 to 2022, including prices and scope

• links to further guidance which support and supplement the information contained in this tariff guidance document

• contact details for any further queries relating to the content of this guidance document

2. Overview and background

2.1 Department of Health and Social Care (DHSC), previously known as the Department of Health (DH), introduced tariffs for clinical placements and undergraduate medical placements in secondary care from 1 April 2013. A similar placement tariff for postgraduate medical trainees came into effect on 1 April 2014. 

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 and ensure that learners develop the required skills and knowledge to meet their respective professional competencies.

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

2.4 As part of these new responsibilities, HEE are required to present tariff proposals annually to DHSC for sign-off and ministerial approval. This new approach to developing the placement tariffs does not impact on the existing powers and requirements for the tariffs set out in legislation (see paragraph 2.6 for further information) but does mean this guidance document will now be published on the funding section of the HEE website.

2.5 HEE is currently undertaking a review of the existing governance structures that underpin the tariff setting process and will develop an annual work programme and supporting engagement process to ensure that changes and supporting guidance are communicated to stakeholders to support financial planning for 2022 to 2023. Further information on the early planning underway in preparation for potential implementation from April 2022 is available at paragraph 2.9 of this guidance document.

2.6 Powers and requirements with regards to tariffs for Education and Training (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 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 HEE or one of its local offices must be made with reference to the approved price, or price as varied under the approved procedure

2.7 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, HEE will be responsible for publishing details of any price variation

Summary of changes for 2021 to 2022

2.8 In response to feedback from stakeholders around the importance of stability for 2021 to 2022, there are a very limited number of changes to the tariffs for 2021 to 2022. A summary of the changes is included below, along with links and signposts to additional information and guidance. For ease of reference the changes for 2021 to 2022 have been broken into two groups as follows

1. Changes impacting on payments are:

• the next phase of the changes to the market forces factor (MFF) payment indices will impact on the level of funding that individual providers will receive from the ET tariffs. Further information relating to the application of MFF and the changes to the payment indices from April 2021 can be found on the NHS Improvement website

• the amounts payable from HEE for postgraduate salaries have been uplifted for 2021 to 2022 to reflect the outcomes of the most recent Spending Review. Confirmation of the HEE contribution to salaries are set out in detail at Annex A of this guidance document

• HEE has undertaken work to ensure consistency in the calculation of payments for all clinical (previously non-medical) activity. This responds to feedback around the inconsistent interpretation and calculation of what constitutes a full-time equivalent placement. To ensure that this revised approach to calculating payments remains cost neutral at a system level, we have increased the clinical tariff price per full-time equivalent (FTE) by £128

• confirmation that tariff funding can be paid to providers of eligible simulation-based placement activity. The restrictions on the amount of activity that can be funded are reflective of regulatory expectations

2. Structural changes to the guidance, and additional information aimed at improving the transparency and understanding of the payments.

• the re-ordering of the guidance to bring together profession specific information into three dedicated sections (clinical, undergraduate medical and postgraduate medical)

• guidance on funding arrangements for the placement of Doctors in Training in the Independent Sector. This is intended as an introduction and includes a link to the specific guidance published on the HEE website

• further information and links to the wider funding reforms work currently underway within HEE

2022 to 2023 tariff development

2.9 As part of HEE’s new responsibilities for tariff development, we are already working with stakeholders to finalise the tariff work programme for 2022 to 2023. The work programme will identify priority work areas, including expansion to scope and the resolution of current issues, with the aim of addressing these in time for implementation from April 2022.

2.10 Whilst the tariff work programme is not yet finalised, HEE is already committed to a fundamental review of the current funding and coverage of medical undergraduate placements and the extension of tariff arrangements to include undergraduate dental activity from April 2022.

2.11 The timetable for development of proposals for 2022 to 2023 tariffs will align with the NHS England and NHS Improvement (NHSEI) financial planning timetable and will include earlier and wider engagement on any changes to tariffs than in previous years. Exact details on the engagement process will be communicated in Summer 2021. 

2.12 Further information on the progress of the tariff development work will be shared by HEE as appropriate via the HEE website and regional contacts.

Eligibility for tariff funding

2.13 The placement tariffs are applicable to all placement activity that takes place in England at any type of provider organisation (whether that organisation is NHS funded or not), unless explicitly listed as excluded in this document.

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

• be a recognised part of the education and training curriculum for the course and approved by the HEI and the relevant regulatory body, as appropriate

• meet the quality standards of the regulator, the commissioner and HEE

• 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

• is not workplace shadowing

2.15 Any time spent by students and trainees at a provider organisation which does not meet the criteria, are not covered by the tariff payment mechanism. Any funding from HEE for this activity should be determined locally by the placement provider and HEE commissioner.

2.16 The ET placement tariffs cover funding for all 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

• education supervisors

• pastoral and supervisory support

• trainee study leave and time for clinical exams

• health and well-being (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/trainee accommodation costs

• in-course feedback and assessment

• formal examining

• staff training and development relating to their educational role

2.17 The tariffs do not cover:

• tuition costs 

• items funded under education support

• foundation programme directors

• foundation programme administration support staff

• heads of schools

• programme directors

• core leads

• relocation costs and exceptional travel costs

2.18 Training placements that take place outside England but are commissioned by HEE should be paid for at a locally agreed rate; although it may be appropriate to use the published national tariff as a starting point.

2.19 Where a category of trainee is not covered by a tariff, any placement funding should be agreed locally between the HEE commissioner and placement provider. It may be appropriate to use the published national tariff as a starting point for these discussions.

2.20 Placements commissioned by private universities and self-funded students should not be subsidised by the tariff funding available from HEE.

3. Tariff payments for 2021 to 2022

3.1 The 2021 to 22 tariff prices are included in table 1 below.

Table 1: ET tariff prices for 2021 to 2022

Type of placement	Tariff for placement activity in 2021 to 2022
Non-medical	£3,856 + MFF
Medical undergraduate	£33,286 + MFF
Medical postgraduate	£11,703 + MFF plus, a contribution to basic salary costs as per Annex A See paragraph 6.8 for further information on separate funding arrangements for study leave.

3.2 In line with previous years, the tariffs are adjusted by the market forces factor (MFF) to compensate for the cost differences of providing training placements in different parts of the country. For simplicity, the MFFs that are used for payment remain the same as those applicable to the service tariffs. Further information on the MFF, including current rates and changes for 2021 to 2022, is published by NHS Improvement.

3.3 Please note that the salary contribution from HEE 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

3.4 Appropriate local prices for any placements that fall outside the scope of the national tariff should be agreed 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 commissioners should engage constructively to agree transparent local prices which are in the best interests of students and trainees.

Flexibilities

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

• where commissioners and providers agree on an innovative way of delivering placements

• where provision of training is necessary in a given location or type of placement provider

3.6 In order to determine whether the provision of training is not economically viable, the provider must be able to demonstrate that:

• their 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 as a result 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 as a result 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

3.7 Any tariffs that are varied from the national tariffs according to the flexibilities set out above will be published by HEE for transparency. Prices that are not equal to the national prices due to the provider’s transition plan do not need to be published by HEE as tariff variations.

3.8 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.

4. Clinical tariff (formerly non-medical tariff)

Changes for 2021 to 2022

4.1 The 3 main changes to the clinical tariff for 2021 to 2022 are as follows:

Clarity on what constitutes an FTE equivalent

4.2 The clinical tariff payment is reflective of an FTE, rather than an individual student. Prior to 2021 to 2022 the guidance has never included any confirmation of how HEE regional teams should calculate the appropriate number of weeks for full tariff payment, leading to some regional inconsistencies in the interpretation of levels of activity required for payment.

4.3 To ensure a consistent approach to calculating the appropriate payments for this activity and to ensure all providers receive equivalent payments for the placement activity they deliver, HEE regions will move to payments based on the following calculations from 1st April 2021:

• 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

4.4 Whilst the inclusion of an agreed calculation of an FTE equivalent will address the current regional inconsistencies in payments, it should be noted that this will have differing financial impacts on providers depending on the current payment approach for that region.

4.5 Those providers who have historically been paid full tariff based on a higher number of weeks than the agreed rate will see an increase in payments for the same levels of activity, whereas those providers paid full tariff for less activity than the agreed rate will see a reduction in funding for the same levels of activity. Please contact your regional HEE team for more information on anticipated impacts.

Increase to the clinical tariff price

4.6 To ensure that the move to a consistent FTE calculation for 2021 to 2022 does not impact on the overall level of funding from HEE and this remains cost-neutral at a system level, it has been necessary to increase the clinical tariff payment. The new price of £3,856 plus MFF per FTE is applicable to all placement activity within the scope of the clinical tariff.

Simulation-based learning

4.7 In response to the impacts on placement provision of COVID-19, the rules around the use of clinical tariff funding were extended in-year in 2020 to 2021 to enable tariff funding to flow to providers of eligible simulation-based learning.

4.8 These funding arrangements will continue for 2021 to 2022 and activity will be funded by HEE at the clinical tariff rate for activity that constitutes placement learning hours is compliant with regulatory requirements for placement. The funding provided by HEE will not exceed profession specific regulatory expectations around the number of hours of placement per student that can be delivered via simulation.

4.9 Information on the amount of activity delivered and the level of funding being requested should be returned to HEE as part of the Student Data Collection.

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

Tariff payment and scope

4.11 The clinical tariff payment is intended to provide an annual contribution to the funding of placement activity for all eligible clinical professions. The list below provides confirmation of the professions eligible for tariff funding:

• clinical psychologist

• HCS Practitioner Training Programme (PTP)

• adult nurse

• children’s nurse

• dental hygienists

• dental therapists

• diagnostic radiographer

• dietician

• dual qualification nursing

• learning disabilities nurse

• mental health nurse

• midwifery

• occupational therapist

• operating dept. practitioner

• orthoptist

• orthotists / prosthetists

• paramedics

• physiotherapist

• podiatrist

• speech & language therapists

• therapeutic radiographer

• ultrasound / sonographers

HEE funded placements not covered by tariff

4.12 Alongside the placement funding provided to eligible professions under the tariff arrangements, HEE also provides placement funding for a small number of other clinical professions at an agreed annual rate. Further information relating to the current funding arrangements for these professions can be found in the NHS Education Funding Guide.

4.13 As part of the work to develop tariff proposals for implementation in April 2022, HEE will review the professions being funded for placement activity at a rate which 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.

4.14 Where a clinical profession is not listed in table 1 above or in the HEE Funding Guide, please direct all queries on funding to the HEE Education Funding Reforms team educationfunding@hee.nhs.uk.

Reconciliation of funding

4.15 All payments to placement providers should be adjusted to ensure funding is reflective of the actual number of placements delivered. This will require processes to be in place to ensure that placement data flows from NHS placement providers to local HEE teams to support payments and this is triangulated with student numbers from Higher Education Institutions (HEIs).

Salary support

4.16 Information on the levels of salary support from HEE and eligible professions for 2021 to 2022 is set out in the NHS Education Funding Guide.

5. Medical undergraduate tariff

Changes for 2021 to 2022

5.1 There are no significant changes to the medical undergraduate tariff payments for 2021 to 2022 and the payment will remain consistent with 2020 to 2021. Instead, HEE plans to undertake a wider review of the existing funding for undergraduate placements across medical and dental. This review will inform proposals for changes to tariffs for implementation starting from April 2022. Further information is available at section 7 of this guidance document.

Tariff payment and scope

5.2 The medical undergraduate tariff of £33,286 plus MFF is applicable to all medical undergraduate students who are included within the Office for Students (OfS) approved annual intake control target of medical school places.

5.3 We published in earlier tariff guidance, more specific information on the scope of the medical undergraduate tariff to clarify how the tariff funding should be used to facilitate clinical placements.  It is the Department’s expectation that the information at Annex B, together with tables 1 to 4 reproduced here from last year, is used to provide clarification on responsibilities for funding.

5.4 HEE will play an important role to ensure any flexibilities allowing locally negotiated proposals support innovation and new delivery models and that discussions are timely, collegiate and transparent and identified within the Change control mechanism identified in the Tripartite Agreement (UGME) which is being introduced between HEE, Education and clinical placement providers. Education and clinical placement providers must ensure that all aspects of clinical placement provision that have funding implication are discussed and agreed with HEE through the change control process to ensure that clinical training is deliverable within the resources available. HEE will ultimately need to consider and agree any proposed changes to local funding arrangements to ensure consistency and equity in the access to funding across HEE regions. 

Undergraduate medical education tri-partite agreement

5.5 Health Education England is introducing an Undergraduate Medical Education (UGME) Tri-Partite Agreement (TPA) to provide a consistent nationwide framework for governing the financial arrangements between Education Providers (Medical Schools), placement providers (secondary care) and HEE, for the purposes of providing undergraduate medical education. The TPA will be introduced from April 2021 and will be a schedule of the NHS Education Contract.

5.6 The UGME TPA will:

• incorporate the principles set out in “Annex B – Scope of UGM Tariff” in the DHSC’s Healthcare Education and Training Tariff guidance

• set out the roles and responsibilities of the 3 parties: education (medical schools), secondary care placement providers and HEE

• provide a consistent approach to the planned funding that flows between medical schools, NHS Providers and HEE

• provide transparency on UGME funding that is provided, with clear expectations for the return on that investment

5.7 The UGME TPA aligns to the Medical School Liaison Committee governance structures that HEE has introduce and will help ensure that the way that funding flows between providers is not a barrier to improving how undergraduate medical education is provided.

5.8 Engagement on the draft framework has commenced and implementation of the UGME TPA forms part of wider regional implementation plans for the new NHS Education Contract.

5.9 For further information about the UGME TPA, please email  UGMDE.Funding@hee.nhs.uk.

Exclusions

Students outside the OfS intake controls

5.10 Placements for students who are not within the OfS intake controls are subject to locally agreed funding arrangements.

Dental students

5.11 The tariffs are not applicable to any dental undergraduate activity, including dental students on a medical placement (“medical for dental”). Funding for dental undergraduate placement activity continues to be subject to local agreements for 2021 to 2022, however the intention is to introduce a national consistent payment for dental undergraduate placement activity from April 2022.

Medical placements in GP practices

5.12 DHSC announced additional funding to support the introduction of a national minimum rate of £28,000 for all undergraduate medical placements in general practice from 2020 to 2021. This minimum rate is intended to ensure that no placement activity attracts a rate lower than £28,000. It is not intended that this minimum rate will reduce payments that currently exceed the minimum payment level, which should continue in line with existing arrangements.

5.13 As these placements continue to be funded under locally agreed arrangements, these placements are not subject to the tariff arrangements set out in this tariff guidance document and do not attract MFF.

5.14 Work is continuing to review the approach to funding all undergraduate medical placements, including bringing placements in GP practices into the scope of tariff. It is expected that the outcomes of this work will be implemented from April 2022.

Placements in hospices and private, independent and voluntary organisations

5.15 Placements in hospices and private, independent and voluntary organisations continue to be funded under locally agreed arrangements. Work is underway as part of the review to consider bringing these placements into scope to create a single national price for all activity, irrespective of setting.

Clinical research funding

5.16 The funding for all clinical and academic research projects should be agreed locally between Higher Education Institute (HEI) and provider. HEE will not be providing funding to support these projects in 2021 to 2022.

6. Postgraduate medical tariff

Changes for 2021 to 2022

6.1 The changes to the postgraduate tariffs for 2021 to 2022 are as follows:

• the amounts payable from HEE for postgraduate salaries have been uplifted for 2021 to 2022 to reflect the outcomes of the spending review. These vary to reflect national and London pay scales and are set out in detail at Annex A

• additional guidance on the funding for trainees on placement in the independent sector.

Tariff payment and scope

6.2 The funding available from HEE for eligible postgraduate medical students is in two parts:

• a placement fee of £11,703 plus MFF

• a contribution to the basic salary costs of all postgraduate medical students. This element of the funding does not attract MFF

6.3 For medical postgraduate placements, tariff funding is on the basis of training posts. Investment specific to individuals will usually be excluded from the tariff. The local office of HEE may agree to maintain the salary element to support a locum appointment; however, the placement tariff payment could be withheld for long term vacant posts. Prior to any changes to existing tariff payments, this should be discussed and agreed between the HEE local office and placement provider.

6.4 The national medical postgraduate tariff is not applicable to:

• dental trainees

• placements in GP practices (although hospital placements for GP specialist registrars are covered by the tariff)

• placements in hospices

• placements in public Health

• National Institute of Health Research (NIHR) trainees

• less than full time (LTFT) trainees

• trust funded posts 

• nationally introduced one-cycle posts (for example any remaining Hewitt and Johnson posts), which remain out of tariff until the end of the individual’s training cycle

• out of programme experiences, where individuals temporarily step off the standard training programme

• doctors in difficulty

• Ministry of Defence training posts

Lead employer models

6.5 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. Where there is agreement between lead employer and host, arrangements can be put in place via HEE for appropriate salary payments to be made direct to the lead employer.

Host providers and pooled support

6.6 Where a provider hosts particular services, such as library services, HEE 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 HEE, or another named organisation manage a proportion of the placement fee on their behalf.

Doctors in training in the independent sector

6.7 HEE has recently issued guidance relating to trainees undertaking placements in the independent sector. This includes confirmation of the associated tariff funding arrangements for these placements. A copy of the guidance is available on the HEE website.

Study leave funding

6.8 In 2018 to 2019 the post-graduate placement tariff was reduced by the study leave funding component to create study leave payment budgets managed by HEE’s local teams. This will continue into 2021 to 2022 and is cost neutral for NHS Trusts, with both the funding and costs removed from the tariff funding.

6.9 A high-level overview of study leave processes and financial management of these budgets across HEE is available within the the study budget reforms document.

6.10 Any specific questions on study leave funding should be directed to the local HEE office.

7. Further information and guidance

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

Integrated care systems (ICS) education funding statements

7.1 To coincide with the start of the 2021 to 2022 financial year HEE will begin 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 integrate care systems (ICS) and sustainability and transformation partnerships (STPs).

7.2 The aim of this activity is to:

• increase transparency in educational funding flows, enabling ICS-level strategic discussions on HEE’s investment including its alignment to ICS clinical strategy delivery and long-term service sustainability

• inform the development of an education and training plan for each ICS

• enable, through the production of an ICS Education and Training Plan, engagement with HEE on the future investment of educational funds to support the right educational capacity and thus prioritise delivery

• highlight any inequity of activity which will be underpinned by HEE’s funding strategy and policy, including medical redistribution

• alongside the production of HEE’s Annual Funding Guide, standardising and providing clarity of payment rates

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

7.4 Each ICS/STP will receive its own statement. Prototypes of the statement are being shared with ICS/STPs which will be retrospective for funding provided in the 2019 to 2020 financial year, but it is intended to progress to a ‘forward looking’ statement for future years.

NHS education funding guide for 2021 to 2022

7.5 To support consistent and transparent healthcare education funding across England, HEE is publishing a new NHS Education Funding Guide that outlines the sources of funding that contribute to the education and training of healthcare professional roles.

7.6 This document brings together information on the sources of funding – HEE’s and other’s – into one document for the first time and will be a point of call for anyone wanting to know more about how healthcare education and training is financially supported.

Purpose of the guide

The guide is primarily a resource for those who receive HEE funding and is intended to:

• help wider understanding of HEE’s role in the funding of education and training

• begin improving the profile and transparency of HEE’s funding offers

• support systems/employers/education/placement providers to plan and build upon the existing investment

7.7 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 as a result of HEE’s business processes or wider NHS funding decisions.

7.8 If you are an education or health service provider and would like to discuss any of the content of this guide, please email educationfunding@hee.nhs.uk.

NHS Education Contract

7.9 Health Education England has introduced a new NHS Education Contract to replace the varying contractual arrangements previously in place (including the learning and development agreement with NHS service providers).

7.10 The new NHS Education Contract will be a key tool for improving the quality of education and training, driving change, and providing funding.

7.11 Over the summer of 2020, to help develop this new contract, HEE sought the advice of partners to identify what can and should be in the new contract. This led to the development of a draft contract which now been revised following feedback.

7.12 We believe a single NHS Education Contract will help us to achieve a nationally consistent approach to contracting and funding for education and training. We also hope that it will making it easier for all parties to understand how public funds are used, and what the public should expect in return for the money invested in training the healthcare workforce.

7.13 The new NHS Education Contract will: 

• be applicable across multiple providers (HEI, Education Providers, NHS, independent, voluntary, private and social care) and settings (for example, secondary care, GP/primary care, dentistry)

• align HEE’s commissioning, procuring and workforce planning arrangements with its contractual and financing activities

• emphasise the roles and responsibilities of each party involved in delivering healthcare education and training

• focus on HEE’s expectations on the outputs (volume, value, impact, quality) for the public investment received 

7.14 We hope it will better accommodate non-NHS education and training partners in training delivery, to encourage a wider selection of training partners to improve training capacity, quality and student experience. 

7.15 The NHS Education Contract is a standardised contract across England to enable, fund and assure the core activity of Health Education England with education and placement providers. Schedules are specific for each signatory of the contract and will be determined through our implementation of individual contracts.

View the new contract.

7.16 If you have questions about the implementation of the new contract, or the wider project, please email educationcontract@hee.nhs.uk .

Queries and feedback

7.17 Please direct all queries, feedback and requests for further information in relation to the tariff guidance and development process to the education funding mailbox. Feedback is vital to HEE in supporting the ongoing development work and ensuring that we are aware of the local issues that the funding may create.

Annex A

Below are the uplifted salary contributions that HEE will pay for each post graduate placement in 2021 to 2022. The grade structure has been revised to reflect the pay structure from the contract reform in 2016 to 2017.

The salary contributions are split between London and National. Prior to 2021 to 2022 we have also included a fringe rate, but as this is no longer applicable in the new junior doctor contract or used for higher training, this has been removed.

Table 2: ET tariff salary contributions for 2021 to 2022

#Grade	#Spine point (old contract)	#2020 to 2021 HEE Salary contribution National (£)	2020 to 2021 HEE salary contribution London (£)
F1	Minimum point of the FHO1 scale	14,997	16,429
F2	Minimum point of the FHO2 scale	18,602	20,034
ST1/CT1	Minimum point of the StR scale	19,877	21,310
ST2/CT2	Point 1 of StR scale	21,093	22,526
ST3/CT3	Point 2 of StR scale	22,792	24,225
GPST1 hospital	Point 1 of StR scale	21,093	22,526
GPST2 hospital	Point 2 of StR scale	22,792	24,225
GPST3 hospital	Point 3 of StR scale	23,819	25,252
GPST hospital placement (point not specified)	Average of Point 1 and 2 of StR scale	22,792	24,225
ST3+ higher training	Weighted average across higher training grades	26,338	27,821

Annex B

Scope of undergraduate medical tariff for secondary care clinical placements

The guidance material includes a principles section, followed by 4 tables identifying the source of funding for clinical placement components.

Principles

Undergraduate medical 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.

These principles and accompanying source of funding table are a component of the Education and Training Tariff Guidance 2020 to 2021, setting out what is covered by the tariff funding for secondary care clinical placements in undergraduate medicine.

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 tripartite, between higher education institutes (HEIs), NHS placement providers and Health Education England (HEE).

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

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 high-quality clinical placements providing them with opportunities to progress and succeed in their higher education.

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 service to patients or the public.

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 voluntary and independent sector organisations. Clinical placements often encompass active involvement in patient care, but they can also be classroom based to enable the required clinical placement learning or observing health or social care processes.

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 tripartite discussions and agreement between the HEI, the NHS trust and HEE, and will need to be timely, collegiate and transparent, and identified within the Tripartite Agreement in undergraduate medical education which is being introduced between HEE, HEIs and clinical placement providers.

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

The facilitation and delivery of teaching and learning will inevitably make greater use of technology in future. Funding models should not prevent militate 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 HEE and the placement provider to ensure that it is deliverable within the resources available.

The funding sources based on an undergraduate placement can be found in table 3; these are:

• academic funding (funded by HEIs through a combination of tuition fee loans and supplementary funding from the Office for Students)

• clinical placement tariff funding (funded by clinical placement providers, from tariff funding received via HEE)

• out of scope of the tariff (funded by HEE)

• dependent on locally negotiated arrangements

The table gives a clear distinction to guide the source of funding between:

• requirements and activities of the academic curriculum

• activities as part of clinical placements

• activities and resource which include all healthcare learners (for example, libraries)

HEE 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 HEE to implement differing mechanisms for payments where appropriate. For example, activity covered by learning and development agreements (which will in future be replaced with the new NHS Education Contract) and involving a single placement provider will be able to be paid differently to 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.

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 utilised 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 a requirement within the new Tripartite Agreement in undergraduate medical education between HEE, HEIs and clinical placement providers.

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 HEE. It is expected that there will be regular discussion between the placement provider, HEI and HEE on the quality of the placement learning environment and the achievement by learners of the required outcomes.

The Tripartite Agreement in undergraduate medical education between HEIs, placement providers and HEE, will be the national framework that ensures:

• any agreed variations in funding arrangements; this may include but 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 Structural 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 which have an impact on clinical placement capacity and delivery must be discussed and agreed with HEE and the placement provider to ensure that it is deliverable within the resources available

• the parties to the tripartite agreement have access to information on arrangements governed by the agreement, and in particular, on the funding allocated to placement providers

Table 3: Source of funding – corporate functions

All funding arrangements need to be part of the tripartite agreement between HEE, HEIs and clinical placement providers.

Activity	Explanation of term	Responsibility for funding	Comments
HR / recruitment	Job description, advertisement, interview, appointment and induction of academic staff and defined academic lead roles	HEI	N/A
Finance	Relates to university funding and administration. Funding and payments to clinical teachers outside the trusts are generated by locality teams.	HEI	N/A
Staff development – academic	Essential activity which includes induction of staff, training and developing clinical teachers. Although this is mainly a college activity, because of the large number of NHS teachers, there needs to be some provision for this activity, if only to recognise their time. Ideally it should also facilitate some NHS staff who wish to undertake additional training.	HEI	N/A
Staff development – clinical	Clinical teaching CPD, for example, Academy of Medical Educators	HEI and NHS (Tariff)	N/A
Marketing and PR	Self-explanatory	HEI	N/A
Selection of medical students	Self-explanatory	HEI	N/A
Quality and standards of education	Internal and external (GMC/Universities/QAA) quality assurance function. Mostly university but for clinical teaching, there is an element of peer review/observation which takes up clinical teacher time.	HEI	N/A
Registry services	Enrolment and documentation of students’ progress towards graduation. Clinical elements include investigation of complaints and fitness to practice procedures (mostly dealt with by sub deans and associate deans)	HEI	N/A
Staff DBS checks (previously CRB)	Associated with recruitment but removes need for NHS duplication.	HEI	N/A
Assessment	Collation and review of assessment results	HEI	N/A
Widening participation	Process of expanding access to medicine to suitable candidates who would not otherwise apply due to socio-economic reasons	HEI	N/A
IT Services	University IT systems including email and other infrastructure systems	HEI	N/A
E-learning	Technology-assisted learning, encompassing current methods such as telematics and virtual learning, as well as emergent related technologies that facilitate learning.	HEI and Locally negotiated arrangements	In cases of significant NHS support in relation to CPs
Library - University	Libraries are maintained at each campus.	HEI	N/A
Library - Hospital	Libraries are maintained at all hospital sites – contributions to cover medical student use.	NHS (Tariff)	N/A
Accommodation and travel	Detailed breakdown of relative contributions available.	NHS (Tariff)	N/A
Committee management	Room bookings, note taking, typing up minutes and following through actions. For some roles this will impact on clinical staff who are actively involved in curriculum development etc.	HEI

Table 4: Source of funding – student services

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

Activity	Explanation of term	Responsibility for funding	Comments
Student support, including DBS	Dealing with student disabilities, financial hardship etc. Also, pastoral support of students.	HEI and Locally negotiated arrangements	In cases of significant NHS support in relation to CPs
Student counselling	Mostly available through university services, the students also have access to NHS counselling and chaplaincy services. Therapeutic counselling is provided for a limited period for some students and access is restricted to those referred to it by occupational health	HEI and Locally negotiated arrangements	In cases of significant NHS support in relation to CPs
Prizes and awards	Includes prizes but also limited support for students to undertake approved activities	HEI and Locally negotiated arrangements	In cases of significant NHS support in relation to CPs
Student occupational health	Complex issue but essentially all clinical staff working with patients need to be vaccinated and checked for blood borne viruses, for example, HIV, hepatitis B before they are involved with invasive procedures to patients. Also provides specialised advice as to whether students with health problems are a risk to patients or themselves.	HEI and locally negotiated arrangements	In cases of significant NHS support in relation to CPs
Careers advice	Provided in close contact with HEE/Deanery, this service helps students find the right speciality. A requirement of the GMC, it also helps reduce problems later in their training and working lives.	HEI and Locally negotiated arrangements	In cases of significant NHS support in relation to CPs

Table 5: Source of funding – teaching and learning

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

Activity	Explanation of term	Responsibility for funding	Comments
Academic teaching	Academic content to be funded by HEIs	HEI	N/A
Clinical training in clinical setting	Clinical practice content that needs to be undertaken in clinical environment	NHS (Tariff)	N/A
Equipment	Funding for equipment required to deliver education and training.	Locally negotiated arrangements	N/A
OSCEs	Objective Structural Clinical Examinations. Examiners are largely NHS clinicians. All examiners require training beforehand to maintain a fair and reasonable quality standard. Exams may take place in HEIs, NHS Trusts or on neutral territory, for example, hired conference facility.	Locally negotiated arrangements	N/A
Electives	The Elective period is another student selected period of training. Some students go abroad (self- funded). Currently a proportion arrange local electives in the NHS but there is currently no payment to providers for this. There is a small number of medical students who go to other medical schools in the UK or abroad. The advisers who ensure that students have an adequate learning plan and risk assessment may be NHS clinicians.	Locally negotiated arrangements	MSC education leads to explore alternative options for students to broaden their experience

Table 6: Source of funding – roles and posts

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

Activity	Explanation of term	Responsibility for funding	Comments
Clinical roles	Clinical placement leadership teaching and administrative roles.	NHS (Tariff)	N/A
Academic roles	All other roles	HEI	N/A