Applying for training England Junior Doctors Committee

Last updated:

Supported from the start; ready for the future: HEE's review of the Foundation Programme

Health Education England (HEE) released its review of the Foundation Programme on 17 July 2019 - the culmination of a 12-month long review into the efficacy of the Foundation Programme in England.

The Foundation Programme is one of the most important steps of any doctor’s career. It represents the first step into employment, into the NHS, into deciding what they want to spend the rest of their careers doing, and can be a stressful and challenging experience for all those who undertake it.

This review took in a breadth of issues, and the BMA steadfastly stood up for trainee interests throughout the process, to protect trainees and to make sure that it delivered the best educational platform to start any doctor’s career.

While this was led by Health Education England, the other nations of the United Kingdom were involved throughout. Given the status of the Foundation Programme as a four-nation programme, there is a high likelihood that these recommendations will have an impact of some sort on the Foundation Programme in Scotland, Wales and Northern Ireland.

Read the review



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.

  • Recommendations

    1. The transition for, and preparation of, those entering foundation training must be improved to better prepare foundation doctors for the next stages of their development.
    2. HEE will consult with stakeholders to define the principles which should govern an expansion in the use of pre-allocation due to 'special circumstance' to make it accessible to a broader range of students.
    3. HEE will develop and consult on policy options to support widening participation initiatives for graduates entering the Foundation Programme.
    4. HEE will work with NHS Employers to develop a Foundation Doctor Charter defining how Local Education Providers (LEPs) will support foundation training, including best practice and minimum standards.
    5. Doctors who do not progress to training directly from FY2 will be able to access on-going support via their foundation school, and return to training support initiatives, such as Supported Return to Training (SuppoRTT), will be encouraged for those who have spent time away from NHS practice.
    6. HEE will establish a common framework for early years careers support, in line with NHS People Plan, to better inform the expectations of doctors in training about the changing needs of the NHS in England.
    7. HEE will preferentially distribute the 1,500 foundation doctor training places in the geographies where the NHS most needs them in alignment with regional plans to support population healthcare needs and local specialty recruitment.
    8. During 2019/20 and 2020/21, HEE will introduce and evaluate a number of Foundation Priority Programmes, specifically designed to attract and retain trainees in: remote, rural and coastal geographies, under doctored geographies and shortage specialties, aligned to the Long-Term Plan with psychiatry as the initial priority.
    9. HEE will work with the relevant UK bodies to introduce and evaluate adaptations to specialty and foundation programme application and allocation processes to help address geographic variations in fill rates.
    10. HEE will work with foundation schools to identify opportunities to enhance support to doctors with specific needs including wider use of supportive placements.
    11. Foundation schools will support greater flexibility in foundation training, including expanding access to less than full time training (LTFT) and allowing access to a greater variety of working patterns and percentages of full time.
    12. LEPs must ensure that foundation supervisors are valued and have appropriate training and skills and specific time allocated for their roles.
    13. Senior trainees should be encouraged to take on the role of mentors. Trusts should develop this based on successful local 'good practice' schemes. To support this, HEE working with the Academy of Medical Royal Colleges (AoMRC), will develop plans for a sustainable model for the role of senior trainees as mentors, including how such a role could be incorporated as a training opportunity for senior trainees.
    14. HEE will engage with key stakeholders to assess how foundation doctors can be given time in the working week for professional self-development ('self-development' time).
    15. HEE will work with the devolved administrations and the AoMRC to explore the need for a structure to support for the foundation programme and faculty.
    16. There should be a local academic lead involved in the design and running of research in AFP programmes to ensure good integration with the training and wider local research community, and links to NIHR. New options for AFP recruitment should be agreed to ensure those without research experience are not excluded from academic foundation training. Priority Foundation Programmes should be developed for management and leadership, QI and education and teaching with a similar structure to academic programmes.