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AHP Clinical Practice Placement Tariff
Background
Several Allied Health Professions (AHP) teams have accessed the Education and Training Tariff (formally Non-Medical Education Tariff or NMET) to support the development and quality of AHP student practice learning placements and they are keen to share their experiences and learning from this process.
Health Education England (HEE) funds education and training tariffs with healthcare providers to:
- ensure that those providers are reimbursed consistently for the training placements that they deliver
- contribute to the delivery of practice learning placements that are high quality and ensure that learners develop the skills and knowledge they require to meet their respective professional competencies.
Education and Training Tariff eligibility criteria
The guidance for education and training tariffs, including the Education and Training Tariff, is set by the Department of Health and Social Care (DHSC).
To be eligible for education and training tariff, a placement must meet each of the following criteria:
- 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.
- Must meet the quality standards of the regulator, the commissioner and HEE.
- Must offer direct clinical training (including time for clinical exams and study leave) with an agreed programme, being a minimum of one week.
- Must have the appropriate clinical and mentoring support as defined by the relevant regulatory body.
- Must not be workplace shadowing.
Tariff payment and scope
The education and training tariff payment is intended to provide an annual contribution to the funding of practice learning placement activity for all eligible clinical professions. The list below provides confirmation of the professions eligible for tariff funding:
- Clinical psychologist
- Healthcare Science Practitioner Training Programme
- Adult nurse
- Children’s nurse
- Dental hygienists / therapists
- Diagnostic radiographer
- Dietitian
- Dual qualification nursing
- Learning disabilities nurse
- Mental health nurse
- Midwifery
- Occupational therapist
- Operating dept. practitioner
- Orthoptist
- Orthotists / prosthetists
- Paramedics
- Pharmacy (from 1 September 2022)
- Physiotherapist
- Podiatrist
- Speech and language therapists
- Therapeutic radiographer
- Ultrasound / sonographers
Please note that international student practice learning placements are also eligible for the Education and Training Tariff.
In order that the practice learning placement tariffs are utilised and distributed fairly, the guidance from the DHSC states:
- Practice learning placement providers must demonstrate that any funding for clinical placements is being utilised for the delivery of such learning.
- Higher Education Institutes (HEIs) must ensure they involve the NHS practice learning 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.
- All members of the tripartite agreement have access to information on arrangements governed by the agreement, and, in particular, on the funding allocated to placement providers.
Collecting placement activity data – the student data collection tool
HEE has a process for collecting placement activity data from HEIs and ensuring that this is accurate, before releasing funding to the healthcare provider.
HEIs submit placement activity three times per year, aligned to HEE’s financial cycle. Each submission covers a specific time period and the placement activity which occurred within that timeframe, by profession, qualification and year of study identifying each relevant placement provider. Placement activity is recorded in hours as this is the tariff unit of currency.
For example, University X may report that Trust A delivered 100 hours of clinical placements for second year BSc physiotherapy students between 01/11/21 and 15/02/22.
The data is submitted via an online platform, the student data collection tool (SDCT).
HEE undertakes basic checks of the data. For example, ensuring a trust is correctly named or that the HEI has provided activity for all eligible programmes which it delivers. If HEE is aware of consistent relationships between an HEI and a placement provider for specific programmes, it may check that activity is represented in the latest data set.
After these initial checks, the data is released, through the SDCT, to NHS trusts for validation. The data must be validated before a payment can be made.
Different trusts will have different sign off procedures. Some sign all placement activity off centrally through their Clinical Education Team, meaning there are a limited number of trust users on the SDCT. Others may require individual professional leads, or even individual team/clinical leaders, to confirm the activity for the students they hosted in the time period. If you are unsure, contact the Education Department in your trust to check.
The trust can do one of the following:
- Agree that the data submitted by the HEI is correct.
- Dispute the data by providing an alternative figure, and a rationale which supports this (for example, number of students and dates placements occurred).
If the figure is disputed, the line of data returns to the HEI for review. The HEI can either accept the revision or reject it, possibly offering an amendment to their own original figure. If an agreement cannot be reached between the HEI and the trust, HEE will act as arbitrator.
The placement data must be validated within a set time frame outlined for each validation window to ensure that a payment can be made to the trust.
Payment for clinical placements is part of the Education Contract, formally known as the Learning and Development Agreement, held between HEE and the trust. The contract covers all funding streams between HEE and the trust, but the financial schedules issued before an invoice can be raised break these down to specific activity streams. Within the clinical schedule, it is straightforward to identify the profession/university for which placement money relates to and the period of time in which the activity occurred.
Accessing education and training tariff for your organisation
The education and training tariff can provide a useful resource for supporting a high-quality practice learning placement experience. This could be through funding resources for a library, setting up simulation centres or by creating dedicated AHP education teams.
As you work through the process of identifying your placement tariff, consider how you will utilise it and how you will demonstrate that this is having a beneficial impact on the placement experience.
Step 1
Speak to your education team and understand what resources are currently available to support AHP student placements. For example, is there an AHP student placement coordinator or a practice education facilitator to support student placements? They may be able to help provide information about your placement activity and how your organisation is supporting placements across the 14 AHP professions.
Step 2
Understand how many AHP students your organisation supports per year. This step will be easier if all your placement activity is centralised through a team who have responsibility for AHP education. Your education team may be able to provide you with some placement activity data (this is how the Education and Training Tariff is calculated).
The DHSC set two financial uplifts for the Education and Training Tariff for the 2022-23 financial year. From 01/04/22 to 31/08/22, it is set at £3,933 plus local Market Forces Factor (MFF), which increases from 01/09/22 to 31/03/23 to £5,000 plus local MFF per full time equivalent, with 1 FTE being defined as 40.8 weeks per year at 37.5 hours per week.
MFF is the rate at which the DHSC recognises the differences between cost of delivery in different areas of the country. For example, a central London trust will have a higher MFF rate than a trust based in Kent.
Example of how to convert activity into money
We have used the rate from 01/09/22 to 31/03/23 of £5,000 plus local MFF.
Trust B has a MFF rate of 1.012%.
Trust B offers HEI third Year Occupational Therapy (OT) students a 6-week placement.
This means each OT student is undertaking 225 hours (6*37.5) or 675 hours for all three.
675 hours is also 0.44 FTE ((675/37.5)/40.8=0.44).
This FTE is worth (0.44*5,000)*1.012 = £2,226.40
With average MFF rates for London, this is approximately £2.52 per hour.
Step 3
Speak with your trust education finance lead, service finance lead or budget accountant to ask them to help you to understand the current situation. For example, is the Education and Training Tariff money already paid in to your local or departmental budget? How is the Education and Training Tariff broken down per professional group?
Utilising AHP Education and Training Tariff - case studies
Situation
West London NHS Trust is an integrated provider of community and mental health services, with a broad range of inpatient and outpatient services. There are approximately 300 AHPs working across all clinical pathways.
The Associate Director for AHPs commenced in post in January 2016 and made it an immediate priority to ensure that there was a strong culture of supporting pre-registration clinical placements for AHP students within the Trust. Central to supporting the development of this culture is the placement tariff that the Trust receives for the placements it facilitates.
The placement tariff is paid by HEE to placement providers and exists to support them with being able to provide a high-quality learning experience. However, from discussion with colleagues regionally and nationally, we know that, for many AHPs, the placement tariff goes unidentified within providers and the opportunity for using it to support practice placements is lost.
Who has been involved?
The Associate Director for AHPs worked with the Director of Nursing and Directorate Accountant over several months to identify where the placement tariff for AHPs was and introduced a mechanism to ensure that, going forward, this money was filtered into a central budget so that it could be clearly identified for use to support the delivery of AHP practice placements.
In doing so, this also increased the governance and accountability of these funds and ensured the Trust was more easily able to report back to HEE on the activity the money is being used to support.
Action taken
In the first 12 months of having access to the placement tariff, the Associate Director for AHPs used the funds to create a Darzi Fellow role who led a project to improve the quantity and quality of AHP practice placements across the Trust.
They developed a range of systems and structures to ensure that the oversight of practice placements across the organisation was greatly improved and that the experience of AHP students having a placement in the Trust was positive and rewarding.
In 12 months, they increased practice placements in the Trust by 50 per cent and in doing so provided proof of concept that, having a centralised role (funded by placement tariff), could have a significant impact on the culture of supporting AHP students within the Trust.
Outcomes – how has the clinical tariff made a positive difference?
After this, the placement tariff was used to create an AHP education lead post that worked directly to the Associate Director for AHPs. This was on a 0.3 WTE basis originally and so, given their limited capacity, they focused largely on supporting the practice placement agenda within the Trust.
Over time, they were able to increase placement capacity sufficiently to increase the hours of the role, eventually to full time. In 2020, the Associate Director for AHPs successfully secured funds for an additional AHP education lead on a 12-month fixed term basis, but this was with a specific objective of increasing AHP placements to the place where the placement tariff would be able to fully fund the two AHP education lead posts on a substantive basis.
Within 8 months of having these two posts in place, that objective had been reached and the posts were made permanent in December 2021.
This success was driven by robust use of data, which demonstrated the impact that these roles were having on AHP placements, and this is key to anyone wishing to replicate what was achieved in West London NHS Trust.
But, ultimately, this was predicated on being able to access and make use of the placement tariff. This money provided a vital foundation for demonstrating the benefit of a dedicated resource to support practice placements. During this time, both AHP education leads have won awards for their work and the Trust is now recognised as an exemplar of best practice for AHP practice learning.
Helen Lycett (Associate Director for Allied Health Professions)
“Accessing the clinical tariff has transformed what we have been able to offer to both educators and students. By using the money to create AHP education leads, we have a robust and sustainable support mechanism in place for educators, who now have someone who provides all the logistical support around clinical placements, whilst students know there is an extra layer of in-house expertise to draw on during their placements.”
Key learnings
1. Work closely with your trust’s finance team to identify where the placement tariff sits.
2. Create the case for centralising the placement tariff within the budget of the trust’s Chief AHP or similar.
3. Use data to evidence the impact of utilising the placement tariff, to help build the case for additional resource.
Situation
Great Ormond Street Hospital (GOSH) is one of the world’s leading children’s hospitals. It is a tertiary referral centre with patients presenting from other hospitals throughout the UK and overseas. There are 63 different clinical specialities across both inpatient and outpatient services. We have almost 300 AHPs working across these specialties delivering highly specialist and advanced care.
Our Chief AHP post commenced in 2018 – this was instrumental in determining the strategic vision for AHPs working at GOSH. One of the key priority areas outlined in our strategy was Education and Training and this was further supported by our Director of Education. Historically, our Trust had funded an AHP educator post. This was originally on a 0.2 WTE basis which was increased by additional funding from the GOSH Learning Academy to a 0.5 WTE role in March 2020.
Who has been involved?
Engagement and collaboration with Chief AHP, AHP leads, and our finance team allowed us to identify and locate the clinical tariff, and have open and honest discussions regarding the best use of this money.
Action taken
It was recognised at the start of the pandemic that more educational leadership was required to support the AHP placement expansion program, and the Trust funded an Education Lead on a 0.2 WTE basis to oversee this work. This coincided with a successful bid and funding from HEE for an additional 1.0 WTE educator post to lead our Clinical Placement Expansion Programme (CPEP) which further expanded the team.
The CPEP funding was crucial for building capacity and capability within the AHP education team to support and lead AHP placements. Within this work, we scoped barriers to placement expansion, streamlined placement processes, and implemented new ways of working. This allowed GOSH to increase AHP placements by 20 per cent in 2020/2021. This work was carried out in collaboration with local clinical educators and service leads through both our Placement Working Group and AHP Education Working Group, respectively.
Identifying our key challenges and concerns was instrumental in developing a strategy to overcome some of the obstacles to increasing placement capacity whilst ensuring the expansion work was sustainable and high quality of education was maintained.
Outcomes – how has the clinical tariff made a positive difference?
The clinical tariff is now held centrally which ensures this money can be effectively used to support student placements and ensures we can demonstrate accountability for these funds. This was a huge success and highlighted the success of a centralised AHP educator to support practice learning.
Agreement was made to use the clinical tariff money to continue to fund the central educator and this post is currently in the process of being converted to a substantive role. We were also successful in securing further CPEP funding 21/2022 and this has been used to appoint another central educator with the aim of increasing placement capacity by almost 50 per cent for the year 2021/2022. We are also streamlining our induction processes, delivering educator workshops, and developing modules to support students while on paediatric placements.
We plan to use our clinical tariff to ensure the sustainability of this post and placement expansion.
Nivi Behari (AHP Educator, CPEP Lead)
“The clinical tariff helped us to understand the challenges we face in delivering student placements and collaboratively figure out how we not only increase the number of students we take but also improve the quality of students’ experiences.” #OneAHPTeam
Philippa Wright (Chief AHP)
“The clinical tariff has enabled the AHP workforce at GOSH to sustain the workstreams developed through earlier funding. The results are clear as our student numbers have significantly increased, and we know this will now be sustainable into the future owing to investment in specific leadership for student placements.”
Key learnings
1. Work closely with service leads and local clinical educators to drive forward a change in the way the clinical tariff is used and placements are delivered.
2. Showcase the work done and support local teams to demonstrate the worth of a central education team.
3. Work closely with your Chief AHP to identify and drive strategic and priority areas.
More information
Please email the London AHP Team: AHPLondon@hee.nhs.uk
Collaborators
Chloe Keith-Jopp, AHP Workforce Transformation Lead, Health Education England, London
David Marston, Senior Strategic Programmes, Planning and Performance Manager, Health Education England, London
Laura Leadsford, AHP Lead, Health Education England, London
Helen Lycett, Associate Director for AHPs, West London NHS Trust
Paula Breeze, National AHP Clinical Fellow, Health Education England
Thank you to the CapitalAHP Practice Learning Club and CapitalAHP Team for their contributions to this document.