The BMA regularly hears from its members about the problems that can arise as a consequence of poor administration, access to support and inflexibility that can lead to negative experiences during this important stage of training. However, the BMA has also heard that, overall, the time spent by newly qualified doctors in the Foundation Programme is generally good, and there is not a desire for wholesale change - rather there is a need to improve flexibility, enhance supervision, and support transitions from medical school and into specialty training.
Throughout the Foundation Programme review, the BMA was seeking to improve flexibility and choice for foundation doctors; resisting changes that would have prioritised service or reduced choice over where foundation trainees were located.
The review focused on six broad areas:
- Clarifying the purpose of the Foundation Programme
- Making sure that foundation doctors had the time and the support to choose their specialty
- Looking at the Foundation Programme in the context of NHS workforce issues
- Supporting and valuing individuals in the Foundation Programme, their personal needs and circumstances
- Ensuring that educational supervision was working for trainees
- Continuing four-nation alignment.
The BMA focused on ensuring that the best parts of the foundation programme were retained as part of the review, and focused on the areas that we know can create difficulties for trainees and can affect work-life balance and wellbeing.
Foundation training is a difficult point of transition for all doctors, but for those with caring responsibilities or health issues, the programme can present some unique challenges.
The recommendations are detailed at the bottom of this page, but if you want to read the report in its entirety, you can find it on the HEE website.
What does the BMA think?
The BMA welcomed the opportunity to be involved with the review, both to ensure that doctors remain at the heart of any changes suggested and to raise issues – including around flexibility and educational support – that we know currently affect junior doctors in the Foundation Programme.
The review contains a number of positive recommendations including much-needed improvements in access to LTFT training and flexibility of working percentages, support for doctors before, during and after the Foundation Programme, and enhanced access to early years careers support. The review also commits to further work on widening participation - as well as improving pre-allocation panels for trainees with special circumstances.
The BMA also welcomes a number of the proposals that will be consulted on further, including a recommendation to roster time for foundation doctors to engage in professional development. This recognition of the importance of time for these activities being included in rotas is long overdue, and we will continue to engage with these recommendations to ensure they are meaningfully enacted.
The geographical distribution of trainees also features in the report, including specialty and location-specific allocation processes, and proposals to provide 'priority programmes' for trainees that want further exposure to certain specialties, or to work in particular areas.
Innovative approaches to improve staffing in under-doctored areas are to be welcomed, although there is still much more to be done to improve working conditions in these locations. It is also important that any changes made do not reduce the ability for junior doctors to choose where to train through a fair, transparent and equitable system.
Furthermore, the proposal that insists that education providers must do more to value their trainees and have appropriate time to train, is a positive start for those at the earliest point of their postgraduate training; however, this must be articulated more clearly in order to make a meaningful difference to trainees working day-in, day-out in the NHS. Equally, while the opportunity for more of a role for senior trainees in mentoring foundation doctors could be valuable for those involved, investment must be made in both time and training for this to be effective, and it cannot be a replacement for good quality educational supervision.
Overall, the report contains a series of positive steps and commitments to changes for postgraduate doctors in the early stages of their training, which, if enacted, have the potential to make a significant difference to the lives of future Foundation Programme trainees.
What does this mean for me and what happens next?
The recommendations of the report can be found below; giving an at-a-glance view of what the findings of the review were. These recommendations do not necessarily mean that change will be immediate – the recommendations will take some time to come into effect, as they are implemented through discussions with foundation schools and employers.
Some recommendations will require further consultation with stakeholders from across the system. The BMA will remain engaged with this work and will continue to ensure they are meaningful for doctors, and that they are realised on the front line.