The luck of the draw

Final year medical student David Griffith takes a look at the highs and lows of the new UKFPO preference informed allocation system and the effect it has had in Northern Ireland

Location: Northern Ireland
Published: Wednesday 17 April 2024
David Griffith

This year the UKFPO (UK Foundation Programme) introduced a new system for allocating newly qualified doctors to their foundation place locations which created quite a bit of a stir.

In previous years measures of academic achievement, further study and the SJT (situational judgement test) were combined to give us all a score that determined our ranking and where we would be placed for the first two years of our medical careers.

But under the new PIA (preference informed allocation) system, applicants were instead assigned a random number and asked to rank which part of the UK they would like to go to from 1 to 18 (regions being as geographically diverse as 'all of Scotland' vs 'London'). The system would then endeavour to allocate as many applicants as possible to get their first-choice placement.  

This new approach was designed to bring about a more equitable allocation of foundation places and to better support new doctors who needed to be based closer to their support networks.

Teething problems

Last month, this new system was put to the test and, initially, it looked like it was a success. Just under 75% got their top preference location for this year, an improvement from 71% in 2023, but not as high as the 75% of 2020/21 or the peak of 77% in 2018.

However, many new ‘mainland’ UK-based doctors took to social media to complain about being sent to their 18th choice. This may seem minor considering 75% still got their first-choice location, but we have to remember a lot of these cases are new doctors that may have just been asked to move from London to Aberdeen away from support networks, or worse, as quite a few of them remarked unhappily online, to Northern Ireland …

Poor Northern Ireland

Why would ‘our wee country’ be worse than elsewhere in the UK? While it has a lot of pluses – we have a reputation of being well supported in jobs by seniors and the majority of students studying here will remain here for foundation training – we do have our ‘issues’:

  • The worst waiting lists and the lowest junior doctor pay in the devolved nations
  • A little thing called the Irish Sea that turns a car journey home to family into a boat or plane journey. No surprise then that this affects the foundation programme uptake here, with 30 resigning before taking up post last year, leading to a shortfall on already understaffed rotas.


To combat this, Northern Ireland was allocated 61 'placeholder' jobs among the 355 foundation jobs for 2024 that have yet to be described on the oriel application system and are listed as ‘TBC’. Essentially, they will cover any gaps that will occur with those dropping out of the foundation programme. The details on where and what these placeholder jobs will be would then be decided based on where the remaining gaps were after the outstanding 279 foundation jobs were filled.

While this is good to ensure under-staffed rotas get much-needed new doctors, it’s not great for the 61 ‘TBCs’ who have absolutely no idea where in NI they could be placed and no date as to when they will receive further clarity on this as that is dependent on who drops out of the of the foundation programme. This will also not placate those among the 61 who had Northern Ireland down as their 18th choice.

I am myself grateful I have been placed in Northern Ireland and got one of my top-10 choices, knowing many others have been forced to take options 180 or lower. I also feel for those waiting on the ‘TBC’ list with no definitive timeframe to find out where they will work. We all appreciate medicine provides work stability, but I don’t think it is demanding or entitled to know where we might need to live from July.

What needs to change?

Ultimately, I and many others were glad to see the back of the SJT, but I still think the system needs work. Perhaps the next time the UKFPO thinks about changing the allocation programme, it will consult more extensively with the BMA nationally and regionally, chat to students and reflect on the views of the doctors they put through tough years of separation from family and friends owing to a computer algorithm.