An investigation by the BMJ has identified that approximately £406 million in public funding intended for medical student training in England remains unaccounted for between 2020 and 2023. While NHS trusts received £1.7 billion via the undergraduate medical (UGM) tariff during this period, nearly a quarter of these funds cannot be verified through mandatory accountability reports, raising significant concerns regarding financial transparency in clinical education.
Where Does the Undergraduate Medical Tariff Money Go?
The undergraduate medical (UGM) tariff is a specific stream of funding administered by NHS England (NHSE) designed to cover the costs of training medical students during their secondary care placements. According to the NHS England education and training tariff guidance, these payments are allocated based on the volume of student hours hosted by individual trusts.
On average, trusts receive nearly £2.8 million annually, though payments vary significantly based on the size of the teaching program. Despite these clear objectives, the BMJ investigation found that 38% of trusts failed to provide any explanation for their UGM spending in the 2022-2023 financial year. Researchers Jonathan De Oliveira and David Hutchison highlighted that this lack of oversight creates a "black hole" where funds intended for clinical education may be redirected to support general frontline hospital operations without official documentation.
The Impact of Dropped Accountability Requirements
Although the Department of Health and Social Care previously mandated that trusts submit annual reports detailing the expenditure of UGM funds, this requirement has shifted. NHSE confirmed to the BMJ that it has discontinued the mandatory collection of these accountability reports.
This policy change has drawn criticism from professional bodies. The British Medical Association (BMA) has argued that the current lack of transparency threatens the high standards of UK medical education. Dr. David Strain, the BMA’s medical academic co-chair, stated that "every penny of placement funding must be protected and fully transparent" to ensure that medical schools are not treated as "cash cows" for wider NHS budgetary pressures.
Accountability Gaps in NHS Funding
The UGM funding issue is part of a broader concern regarding the transparency of the total healthcare education and training budget, which exceeded £1 billion last year. An opinion piece published in the Future Healthcare Journal in 2025 noted that decision-makers often lack consistent, accurate data on how these funds are deployed at local and regional levels.
For comparison, the BMJ analysis revealed that the amount of unaccounted funding rose by over 50% during the three-year study period, climbing from £110.7 million in 2020-2021 to £171.9 million in 2022-2023. This trend suggests that as financial pressures on NHS trusts have intensified, the formal mechanisms for tracking education-specific spending have weakened rather than strengthened.
Frequently Asked Questions
What is the UGM tariff?
The undergraduate medical (UGM) tariff is a specific funding stream provided by NHS England to hospital trusts to cover the costs of hosting and training medical students.
Why is there an "accountability gap"?
The gap exists because many NHS trusts have failed to submit reports detailing how they spent their allocated training funds, and NHS England has opted to discontinue the mandatory collection of these documents.
How much money is currently unaccounted for?
According to the BMJ investigation, £406 million of the £1.7 billion allocated between 2020 and 2023 remains unaccounted for, with some trusts admitting they possess no records of how the specific funds were used.
What are the consequences for medical training?
Critics, including the BMA, warn that without full transparency, it is impossible to ensure that funds are actually reaching the students and the educational programs they are intended to support, potentially jeopardizing the quality of clinical training in England.
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