A major shake-up of the way trainee doctors are funded could see hospitals cut training posts for junior doctors and swap their posts for nurses, HSJ has been told.

A briefing document by NHS Employers, seen by HSJ, outlines Department of Health proposals to cut central funding given to hospitals to cover the base salaries of junior doctors.

It’s a delicate ecology. We don’t want to do things [with] unintended consequences

At present 100 per cent of a first year junior doctor’s base salary (£23,000) is funded by the DH in recognition of the fact that they require almost constant supervision and training.

But under proposals circulated to teaching hospitals last week, only 80 per cent would be covered.

Funding to cover the salaries of junior doctors in their specialty training years would be drastically cut from 100 per cent for years three and four to 40 per cent and 25 per cent respectively. The changes mean hospital trusts would have to make up the rest of the salaries themselves.

British Medical Association junior doctors committee vice chair Tom Dolphin told HSJ he was concerned the proposals would lead to some trusts opting to have “fewer doctors around”.

The changes are being made to free up funding to better fund training places for nurses, midwives and all other healthcare professionals.

But they come as NHS organisations are already attempting to cut their pay costs.

Discussions on the changes to the way clinical training is funded are being led by Medical Education England, which was set up after the 2007 debacle over junior doctor training posts when the new Medical Training Application Service was introduced.

But a source close to Medical Education England told HSJ there were now concerns the proposals could “tip the balance” for some trusts, leading to them dropping training posts for some specialties or dispensing with junior doctors altogether.

Cambridge University Hospitals Foundation Trust chief executive Gareth Goodier, who represents foundation trusts on Medical Education England, agreed.

He told HSJ there was “no doubt” there was anxiety that the changes could create a disincentive to hospitals to host junior doctors or train particular specialties. He said he was also concerned trusts “could move quite a few positions from doctors to nurses”.

“It’s a delicate ecology. We don’t want to do things [with] unintended consequences,” said Dr Goodier.

The briefing, circulated last week, said the changes were due to be implemented from next April, but Dr Goodier said that was now on the “back burner” as there were concerns to avoid “a repeat of the Medical Training Application Service”.

HSJ has been told it is likely to be introduced in “shadow” form from April, although strategic health authorities may have discretion to enforce it sooner.

NHS Employers head of programmes David Grantham said the proposals had been developed in an attempt to “level the playing field” in funding for clinical training. At present, there is a tenfold difference between the amount of funding hospitals get for each junior doctor. But he said it was crucial the transition to a more equitable system ensured stability across the service.