Concerns that money is being used to prop up frontline care
Medical leaders urge trusts to stop treating universities like a "cash cow"
Hundreds of millions of pounds given to NHS trusts for educating future doctors is falling into a "black hole" and the majority of trusts have failed to explain how they are spending it all, reveals a four-year investigation published by The BMJ today.
It shows that nearly a quarter (£406 million) of the £1.7 billion given to NHS trusts in England for medical student training between 2020 and 2023 remains unaccounted for, while some trusts admit they have no record of how the money they received has been spent.
This includes large trusts with close ties to universities, including Royal Free London and Sheffield Teaching Hospitals; between them, these two trusts have failed to account for more than £54m between 2020 and 2023. According to NHS England data, neither trust has ever submitted an accountability report, a claim Sheffield Teaching Hospitals contests.
Medical school leaders are urging trusts to be more transparent, with one calling on them to stop treating universities like a "cash cow." The British Medical Association (BMA) said the lack of clarity was jeopardising the quality and global reputation of UK medical degrees.
Education leaders are also concerned that the money is being spent propping up frontline care.
Meanwhile, NHS England has confirmed to The BMJ that it has dropped the mandatory collection of accountability reports that required trusts to detail how they spend the money as a condition of receiving it.
NHS England identifies 13 major areas that trusts could spend undergraduate medical funding on, including 'direct staff teaching time' and 'administration costs.' These areas are illustrative, rather than prescriptive - although what is not allowed is "general top-slicing for overheads to cover areas such as occupational health."
Trusts recorded over £146 million – 8.6% of total undergraduate medical funding over those three years – as 'Other' costs outside these guidelines.
Examples include St George's University Hospitals NHS Foundation Trust in London and Epsom and St Helier NHS Trust, both of which spent millions on "contributions to trust departmental operational budgets" – a category outside NHS England guidelines on areas the money could be spent on.
Both trusts say their funding was spent "appropriately and in line with guidance".
The investigation also highlights disparities in spending priorities across trusts. While "direct staff teaching time" was the category most invested in overall, some trusts reported no spend at all on this category.
Other trusts have listed millions of pounds spent on "cost of staff teaching while delivering patient care" or similar, without disclosing how this is calculated or how it differs from "direct staff teaching time."
Medical school leaders say greater clarity and transparency is needed. They note that education hours are often not reflected in job plans, resulting in unsustainable, unpaid work. Consultants share this frustration, warning that understaffing threatens dedicated training time.
One medical student says they feel "demotivated" and a foundation year two doctor says they were "horrified" by these findings, reporting "subpar training" and feeling like this was "just a way of trusts getting extra income."
Both the Medical Schools Council and the BMA stress the need for full transparency on how funding for undergraduate education is spent by trusts to help ensure that resources reach frontline educational activities and to maintain the standards expected from a UK medical education.
Accounting experts also highlight the importance of governance and external audit mechanisms for ring-fenced funding to ensure that undergraduate medical funding is spent in line with its intended purpose.
