The process of allocating foundation programme jobs to new medical graduates is broken. Students lack agency and what should be a smooth passage to employment, is a patently unfair experience for many.

Every year, hundreds of UK medical graduates are assigned to regions in the UK outside their top five preferences, often to areas where they have no personal or professional ties. Last year, the number of students who received their lowest foundation school preference increased exponentially and more than 1000 graduating medical students received a ‘placeholder’ allocation rather than their foundation programme job details. Hundreds did not know where they would be working, just weeks before starting employment.

The foundation programme marks the first NHS medical job for new doctors. Yet, this allocation system severely undermines the goodwill and retention of new doctors who are forced to relocate across the country, often at short notice. These problems are compounded by poor communication to new graduates and frequent changes to the allocation process at short notice, without proper consultation. Our future doctors deserve better, and it is clear something must change. 

Our solution

We are calling for an allocation system to follow our three guiding principles:

• Welfare of students during and after job allocation is paramount. UKFP allocations can have significant and lasting effects on students’ mental health, future career, and personal lives. Issues with allocation seriously harm new doctors’ goodwill and affect retention; a priority of the NHS Long Term Workforce Plan.
• Students should be consulted on changes which affect them. Trust and confidence in UKFP allocation is negatively impacted by short notice changes made without consultation which affect students’ career and personal life planning.
• Detailed and frequent communication with students is essential. Communication should be accessible and use language students can understand. Local communication by medical schools should supplement, rather than replace, national communication.

To ensure any allocation system follows these principles, the UKFPO must be adequately funded. We propose seven specific changes to the foundation programme allocation system:

• Applicants must receive their programme details with sufficient notice
• Prioritise UK medical school graduates in allocation
• Minimise students receiving their lowest preferences
• Re-rank applicants at each stage of the application process
• Offer an opportunity to swap programme allocations
• Model changes to allocation methods with stakeholder involvement
• Do not return to a national reserve list

We also propose specific proposals in relation to FPP and SFP, calling for the expansion of both programmes and a fair and consistent merit-based recruitment process for SFP across all four nations.

With these changes, we can create a foundation programme allocation system which values and supports graduates in this vital stage of their career as they transition from student to doctor. By valuing graduates and prioritising their welfare and agency, we can create a fairer allocation system for new doctors and help ensure their retention in the NHS, a core part of the NHS Long Term Workforce Plan.

As applicant numbers continue to increase with the expansion of medical school places, these changes must be paired with long-term workforce planning for more foundation programme places backed with the necessary funding.

Prioritising graduates from UK medical schools

The BMA is calling for graduates of UK medical schools to be guaranteed a foundation programme post for all future recruitment cycles and have their PIA (preference informed allocation) ranking prioritised over graduates of non-UK medical schools. This is because whilst the BMA recognises the important contributions IMGs (International medical graduates) make to the NHS, after graduation UK medical school graduates are provisionally registered with the GMC and therefore can only work within an approved foundation year one post.

Every year hundreds of graduates of UK universities are allocated to jobs in regions with which they have no geographic connection. When doctors are forced to move away from their families and communities to complete their registration as doctors, we risk alienating them from the NHS.

Our position also recognises the significant financial investment made by the UK taxpayer and students themselves in completing medical school. It is vital to ensure these medical graduates can complete their registration. A similar precedent has been set by the UK dental foundation programme and in the prioritisation of home medical graduates in other countries including the Republic of Ireland, Australia and New Zealand.