Education And Debate

The medical service increment for teaching (SIFT): a £400m anachronism for the English NHS?

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7214.908 (Published 02 October 1999) Cite this as: BMJ 1999;319:908
  1. Gwyn Bevan, reader in policy analysis (G.Bevan@lse.ac.uk), reader in policy analysis
  1. Department of Operational Research, London School of Economics and Political Science, London WC2A 2AE
  • Accepted 10 August 1999

In 1997-8, over £400m ($640m) of NHS money was designated as the medical service increment for teaching (SIFT).1 The manifest purpose of SIFT is to ensure that the NHS supports quality and innovation in undergraduate medical education. This includes supporting the increasing role of teaching in hospitals other than the main university hospital affiliated with each medical school, general practices, and other community settings.2 3 SIFT is designed to be paid in addition to income gained by medical schools for teaching medical students. The latent purpose of SIFT, which paradoxically dominates its distribution, is to ensure a “level playing field” in the healthcare market by covering “historic infrastructure costs, whether or not they are currently required for education.”2 As designed, SIFT is thus in conflict with one of the aims of the government's white paper, The New NHS, which sought to end the way in which instability in the healthcare market resulted in “shoring up the status quo rather than creating the space to plan and implement major improvement.”4

Allocations of SIFT are based on the product of the annual SIFT rate (about £36 000 for institutions outside London and £39 000 in London) and the number of whole time equivalent students who are in the last three years of the five year curriculum, which are traditionally the years of clinical teaching.2 Thus a medical school that has an annual intake of 150 students will have about £16m in SIFT funding available for distribution to healthcare trusts and general practices that teach students. In 1996-7, nearly 90% of SIFT funds were allocated to the main acute teaching trusts (or teaching hospitals); most of the £170m allocated to the Thames regions is spent in London.1 Details are not published, but income from SIFT for …

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