Service Increment for Teaching (SIFT): a review of its origins, development and current role in supporting undergraduate medical education in Englandand Wales

Objectives To describe the ways in which total resources available for the Service Increment for Teaching (SIFT) have been determined and related to n umbers of undergraduate medical students; and the development and current a rrangements for allocating SIFT to the providers of service support for tea ching. Design The derivation of SIFT from excess costs of teaching hospitals over general hospitals is described. The official principles of organizing SIFT to reimburse the service costs of teaching undergraduate medical students a re explained. The crucial development that is examined is the change from S IFT being a global subsidy to being related to educational contracts. This development has facilitated both the specification of standards and innovat ive uses of SIFT. These are illustrated with examples. Setting Hospital and Community Health Services and Primary Care in the Nati onal Health Service (NHS) in England and Wales. Subjects Medical students. Results There is often confusion caused by SIFT being intended to cover the service costs of teaching but not having been derived in this way. This ca uses problems in deciding what providers should be paid through contracts f or teaching of different kinds. Conclusions The new contractual basis has enabled medical schools to use co ntracts to improve the clinical teaching of undergraduate medical students in the NHS. These developments may offer useful models for other countries.