In February 2024, the UKFPO (UK Foundation Programme) announced all applications for SFP (specialised foundation programme) were to be brought within the PIA (preference information allocation) system, removing the ability for foundation schools to select the most suitable candidates and undermining the purpose and continued viability of these programmes.
A considerable backlash from medical students and academics followed and the BMA called for the decision to be overturned.
Subsequently, the statutory education bodies in England, Scotland and Northern Ireland developed their own hybrid approaches to SFP for the UKFP 2025 intake. Variation in approaches across the UK means the system now includes built-in regional iniquities for applicants, with inconsistency in the number of application opportunities available and in how programmes are accessed.
In England this involves one third of SFP places being selected through local processes operated by medical schools, with the remaining two thirds being allocated through the main PIA system. Further iniquity is present in the availability of certain types of SFP course through the medical school route, disadvantaging graduates in those areas and discouraging them from applying.
In Scotland and Northern Ireland, all applications retain some clinical academic review, while SFP in Wales was already entirely within the main allocation process prior to 2025 and remains so.
In England, the working group set up by NHS England was informed that the 2025 approach was intended to be temporary and that no decision for 2026 would be made without the BMA’s involvement. We were therefore extremely disappointed to learn from NHS England at the start of this year that the decision had been taken to continue with the 2025 system into 2026.
This promise of consultation followed by an imposed decision mirrors what happened with the original decision to move SFP into PIA and we have now written to NHS England to call for the working group to be reconvened to ensure a new approach is in place in time for the 2027 allocation process. We were clear in our response to the 2023 UKFPO stakeholder engagement exercise that allocation through PIA is not the right approach for SFP.
It is frustrating this decision was made when there were a range of valid alternatives on the table for ensuring some degree of consistency in approach to SFP applications that would have still allowed foundation schools freedom to adapt their process to their own needs. It is disappointing the UK health bodies took this decision before these alternatives could be given serious consideration by the BMA and the other members of the UKFPO board, and while there is significant opposition to the decision from medical students and academics.
The academic component of the SFP represents a vital gateway to a clinical academic career and is a crucial component of the integrated academic training pathway, ensuring a pipeline of clinical academics to consultant and GP level and beyond. It is essential there should not be a gap in opportunities for exposure to academic medicine between experience at medical school and specialty training.
It remains our view that specialised foundation programmes must be able to select the most suitable candidates. The method used in England for two thirds of SFP recruitment undermines the purpose and continued viability of these programmes and the hard work students have put in to apply to the SFP.
This is also reflected in the January 2025 report from UK Research and Innovation which specifically calls for allocation to SFP to ‘retain selection criteria which takes account of experience in research, aptitude, motivation and enthusiasm for an academic career’, and we note that NHS England were represented on the task and finish group, which contributed to this report.
It is the view of the BMA medical academic staff committee and BMA medical student committee that recruitment to all UK specialised foundation programmes should return to a fully merit-based system at the earliest opportunity.