Discussion paper: Commissioning of medical education in the post-registration arena

Medical education is expensive. In some circumstances, this expense has led to new models of funding post-registration education. One such approach is commissioned or tendered education. Th is model is based on a purchaser–provider split, where centrally funded authorities commission or seek tenders for post-registration medical education from education providers. Despite the growth of commissioning of medical education, there has been little public debate on its advantages or disadvantages. Th ere are a number of advantages of a commissioning model. It can act as an incentive to quality improvement, and it drives competition between providers. In addition, commissioning decisions can be devolved so that local purchasers can decide what forms of medical education they wish to pay for. It also acts as a means of increasing choice. Th ere are also disadvantages to the commissioning model. Th e process of commissioning is in itself expensive. In addition, competition might act as a barrier to integration and induce destabilisation in the system of medical education. Th is model may also suggest that there is a price for everything and that all components of medical education must be reduced to their lowest common denominator of cost. It would work best if pure market forces were unleashed, but the truth is that medical education is rarely a pure market.