UK foundation programme recruitment needs urgent change
Many medical students find their allocation to be both delayed and hundreds of miles away from friends and family causing considerable distress
In March last year, graduating medical students received their foundation school allocations. This represents a pivotal moment, discovering the location of their first jobs as doctors. However, as the education deputy chairs of the BMA medical students committee, we have spoken to many students for whom that day was devastating.
In a short, automated email, one student found out he had been allocated to his eighteenth and last choice of foundation school. It meant to continue his medical training he would have to move several hundred miles from family and friends to a place where he knew no one. In the following days, this prospect caused an acute mental health crisis. Ultimately, he was forced to withdraw from the programme.
Another student received their thirteenth choice of foundation school. Already shocked at that news, they later found out that they had received a ‘placeholder’ spot, meaning they had not been allocated an NHS employer.
They were told time and time again to expect their job details soon but months passed without information. They were finally told where they would be working just six weeks before their start date, at which point the hospital accommodation was fully booked.
Many estate agents required in-person viewings, but as this was happening during their finals, they were unable to travel the four-hour journey. They did eventually find somewhere to live, after months of unnecessary uncertainty and stress. Having six weeks’ notice to uproot your life is unacceptable.
These experiences are distressing. But with more than 1,000 students given placeholder jobs last year, there are many more like this. Retaining doctors in the NHS is key for its survival, but our peers are already disillusioned. Just 17 per cent of medical students are satisfied with the prospect of an NHS career. We hear from resident doctors that many of their colleagues now work abroad, and we are concerned that our fellow students are also going to find working in the NHS untenable.
We have seen how residents, consultants, GPs and specialty and associate specialist doctors have insisted on being a part of the decisions which affect their careers, and it’s time for medical students to do the same.
We have published our proposals for change, a vision for improving the UKFP (UK foundation programme) recruitment system. We drafted these with three guiding principles in mind:
– That the welfare of students is paramount
– Students should be consulted on changes that affect them
– Students need detailed and frequent communications about their futures.
These principles have so far been sorely neglected. With more than one third of resident doctors experiencing a high degree of burnout, welfare must be of paramount importance. However, it seems that the system currently considers it to be a low priority, even before they start work. Last year’s allocations saw a sharp rise in students being given their last choice of deanery.
We know there must be a balance between the requirements of the health service and of medical students. However, the pendulum has swung too far.
The job should not come at the cost of our wellbeing. We are calling on the UKFPO to prioritise welfare and modify their algorithm to minimise the number of students receiving allocations outside their top-five choices. This simple change would limit as far as possible the numbers of students being forced to move somewhere they have no connection with.
Last year, NHS England unexpectedly announced that recruitment to the specialised foundation programme (a key entry point to academic training) was being moved to preference informed allocation. This damaging decision was made without consultation with students or the BMA.
Guidance on these changes for students and the medical schools expected to implement them was published only on the day applications opened.
The limited communication between those making these policy decisions and the student body leaves students alienated and in the dark. We know from local representatives that these sentiments are felt across the UK. Students and stakeholders must be consulted before changes are made.
For those who received placeholder allocations, their problems were compounded by communication failures. Hundreds still did not know where they would be working weeks before they were due to start work. We are clear, graduates must receive their programme details at least 12 weeks before commencing. Communication should be frequent, detailed and compassionate. We must not see any more medical students spending months chasing information that never seems to come.
The Government needs a medical workforce, which attracts and retains the best talent in the country, and medical students are integral to that. The government’s investment in training medical students means their retention must be a top priority. If these issues are not addressed the NHS risks losing its investment and jeopardising the long-term sustainability of the workforce. To meet the population demands of the future, we need medical students to stay in the NHS.
Elgan Manton-Roseblade (pictured top, right) and Callum Wiliams are the joint deputy chairs for education on the BMA medical students committee
Find out more about the proposals for change
