Junior Doctors’ Foundation Programme

Caroline Johnson Excerpts

Wednesday 22nd April 2026 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairship, Mrs Barker. I congratulate the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) on securing this debate and giving a great speech. I need to declare an interest as a consultant paediatrician in the national health service, a member of the Royal College of Paediatrics and Child Health, and a member of the British Medical Association.

Going back a little while to when I was young—in fact, we are going back 25 years—I graduated as a doctor in 2001. I had done a five-year degree and I had provisional registration with the General Medical Council. In order to get full registration, I had to complete a year as a pre-registration house officer, most commonly referred to as a house officer. That was six months of medicine and six months of surgery in adult care in either order. It was, to some extent, an extension of medical school. Indeed, it was supervised by the medical school in terms of placements, and almost everyone—I say “almost”; I will come back to that in a moment—stayed local.

In the process that I followed in Newcastle, where I was a student—I am recollecting this from 25 years ago—we had to apply for two medical and two surgical jobs. I applied for the Royal Victoria Infirmary and the Freeman hospital, but there were other options across the north-east where people were involved in training and medical school placements, such as Carlisle, Sunderland, North Tyneside—which was particularly popular at that time—South Cleveland and others. As with any other job, one was shortlisted, interviewed and potentially offered a job. The system worked so that, if a person was offered both jobs, they had to pick one. When the first round went out, people said which job they wanted and that was theirs. All the other jobs that were not allocated were put back into round two, people applied again, and by the time it got to round three essentially everyone had a job.

The benefit of the system was that everyone knew that they had a job in the region where they trained to complete their full registration with the GMC, and the Government knew that all the people they had invested in for that training would become fully qualified doctors, provided they put in the requisite effort and attainment.

However, changing over deaneries was extremely difficult. I applied for the RVI and the Freeman, and I got offered both. That was straightforward, but then I fell in love. I was proposed to, I accepted and I planned a wedding for no more than a week before I graduated. I did not fall in love with another member of hospital staff; I fell in love with a farmer, and farms are quite difficult to shift.

I then decided that I wanted to move to Nottingham deanery. It is fair to say that Newcastle deanery was not keen on that idea, although it was supportive, and Nottinghamshire deanery was really not keen on the idea because it had to fit an extra person into the system. It made that clear, saying, “Well, you’re not having a job in a big teaching hospital.” That was fine: I just wanted a job near to where my husband’s farm was. I was allowed to move deaneries under those special circumstances.

I first spent time at Lincoln under Dr Patterson, a wonderful consultant, as a young doctor. He was a respiratory physician, and I very much felt part of his team. I then went to Mansfield, where I worked for Mr Moulton, an orthopaedic surgeon. He was a lovely man; we used to do French verbs together during knee operations. After that, I worked for Miss Patterson, a vascular surgeon.

As the hon. Member for Bury St Edmunds and Stowmarket put it, I very much felt part of a firm or part of a team. There was continuity of care, as I was looking after my consultant’s patients. I was not part of a massive group of people performing a list of tasks for a whole range of consultants on a group of patients who I did not know, which is how it can be for many junior doctors now.

The other thing provided at that time was accommodation. Part of the system with a PRHO job was that accommodation was provided for free, on the hospital site or very close to it, for the first year. That meant that when junior doctors were doing those two six-month jobs straight out of medical school, they had accommodation.

In their wisdom, the people negotiating the pay and conditions decided to give that accommodation up for a little bit of extra money. At the time I thought that was mad, but since I had passed that stage, at the time I considered that it was really none of my business. However, I think that it caused a problem, particularly because the European working time directive has meant that instead of working really long shifts, people work much shorter shifts but have much longer travelling times. I was working long shifts but not having to do a lot of travelling. Junior doctors now have to do shorter shifts—more of them, on a much less flexible rota, to get all the required shifts in—and they are also travelling for miles at the beginning and end of each shift. I think that change has been counterproductive; I wonder whether the Minister has any thoughts about it.

The other thing is that the system was based on merit—whether or not I got the job at the RVI or the Freeman was based on merit. I had to apply. I had to say that I had done things such as presenting at an international conference as a final-year student. That sort of thing was considered important, as was getting good grades in my exams or in my project work at medical school; now it is not.

I just wanted to examine what happened between that time and now. In 2005, the then Labour Government introduced a modernising medical careers programme, which changed the one-year foundation programme to a two-year foundation programme—I am not clear why that was thought necessary—and the placements were changed from six months to three or four months in duration. I agree with the hon. Member for Bury St Edmunds and Stowmarket that that is too short for someone to really get into a job, and to understand the team they are in and what they are doing, before they have to move on again. People have virtually just arrived and then they are going.

There was then the medical training application scheme, or MTA scheme, in 2007, which was a national scheme. There were lots of errors and data breaches. The Secretary of State apologised, and we went back to the deanery approach. There was then a lot of concern that that system was not fair, and that it was stressful; it required people to perform well in exams, and people did not like that very much.

So we have gone to the Oriel system—this preference-informed allocation system that matches people with places. In the engagement process before it was brought in, there were 14,500 responses, mostly from students, and 66% of respondents said they wanted the system, while about 30% said they did not, so it was brought in. The education performance measure and the situational judgment tests, which have been referred to, were removed, and a lottery system was brought in. Essentially, it means that junior doctors are given a completely randomly allocated number, based on nothing but chance. Junior doctors are then allowed to express a preference for particular foundation programmes.

However, when I refer to foundation programmes, I mean areas of the country. As I said, in the case of Newcastle that can mean an area that goes all the way from one coast to another—for example, right down to Middlesbrough and up to Hexham and Berwick. Those are not small areas; they are quite chunky bits of the country to travel around, requiring many hours of travel, from north to south to east to west, in some of them.

Nevertheless, applicants get to express a preference. The computer system will allocate places on the basis that if someone’s first preference is available, they get it, but if it is not they effectively get put back in the box for later. The computer will go down the list until it has allocated all the first preferences and, as the hon. Member for Bury St Edmunds and Stowmarket said, quite a lot of people do get their first preference although, as he also said, whether or not it was their first preference in truth is another matter.

Then an applicant gets to look in the foundation area that they have been allocated to, and to express a preference regarding the jobs within that region. The computer, using the same number—if the student was lucky the first time, they are lucky the second time—goes down the list and allocates them. If they are not allocated, it has to go round again and allocate them a later preference. That means that people either get their first preference or go very much further down the list: a Newcastle medical student, as I was, could get sent to Penzance, which is a lovely place but a long way from Newcastle. There is nothing the student can do about that. They have no control over their life. Even if they are the best-performing medical student in every capacity in the whole country, they still get sent where they get sent—and that is tough.

[Peter Prinsley]

Some time ago, when I came here, I had working with me an intern, Dr Harry Dunn, who was a medical student at Cambridge University. He graduated last year. He came top, not only of the University of Cambridge medical student cohort, but of the whole of the University of Cambridge, so he was the top student of his year. He was offered a foundation post in Northern Ireland. He chose not to take it, and has now gone into consulting, having given up medicine. That is an extremely sad example of an unintended consequence of this crazy lottery.

[Dr Johnson]

I congratulate that person on his prowess in university. He is clearly an incredible person, and it is a shame that he has been lost to medicine. I am sure Northern Ireland is a great place to work, and it is disappointing that he did not want to go there, but he should have been able to apply for the jobs that he wanted in places where he wanted to work, and to compete fairly for them. That is a bit stressful and competitive—but getting into medical school is competitive.

You may not know this, Mrs Barker, but the hon. Member for Bury St Edmunds and Stowmarket and I grew up on the same street, in the same town, and went into similar-ish careers. We competed for medical school places and for our jobs. We are all here today having competed against others for election—that is the reality of life. To remove the competition, which is based on meritocracy, and replace it with a random allocation is more unfair and stressful than the alternative.

One of the issues raised about the old scheme was that it was difficult to recruit in some areas. The competition for the best jobs, or at least those perceived to be the best or most wanted jobs, means that some areas of the country and some specialties could find themselves with the people who did not succeed in getting the jobs they wanted. How do we manage that? It used to be managed with rotations. When people went to the interview for specialist jobs, they would be called in one at a time and told, “These are the rotations available. Which one do you want?” The best jobs—the most popular ones—would be mixed with the least popular, so that would mitigate the problem.

There is one issue that I want to raise briefly. Some medical schools in the UK, including Newcastle, have overseas campuses in Malta, Cyprus and Malaysia. Some British people have gone to those branches of UK medical schools and have found themselves completely excluded from places in the United Kingdom under the medical training changes that the Government have made in the past couple of months, which seems wrong. We talked about that when the Bill went through, and the Minister was keen to reassure us that all would be well, but we have found that British students have not been able to get jobs in the British training programme. Will the Minister look at prioritising at least those who went to medical school before the changes for British jobs?

The current system gives junior doctors—resident doctors, as they are called now—no agency, no control, no appeal and no alternative. It is clearly unfair. Could the Minister update the House on how he intends to fix the system?

[The Minister for Care (Stephen Kinnock)]

It is a real pleasure to serve under your chairship, Mrs Barker. I congratulate and thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this vital debate, and all the hon. Members who have contributed. I pay tribute to my hon. Friend’s significant and distinguished career and experience in our NHS. I take the opportunity to thank resident doctors up and down the country for the vital contribution they make to our NHS and to treating the patients it serves.

As my hon. Friend said in his opening speech, the UK foundation programme is a central part of the pathway to becoming a doctor, bridging the gap between medical school and specialty or general practice training in the NHS. It supports newly qualified doctors to develop the clinical and professional skills needed to deliver safe and effective care, preparing them for progression into core, specialty or general practice training. Resident doctors who currently work in the NHS have made it clear that they have concerns and frustrations with their training experience. We are committed to listening to and addressing that and to improving the training pathway for the medical workforce, for the benefit of NHS services and patients.

Through phase 1 of the medical training review we conducted extensive engagement to ensure that doctors, patients and NHS leaders had the opportunity to describe what works well in medical education and training and what needs to improve to meet the needs of both resident doctors and patients. The phase 1 diagnostic report was published last year and made 11 recommendations centred on four key priorities: more flexible training; removing the divide between service and training; ending the damaging recruitment bottlenecks and rewarding teams where doctors feel valued.

The implementation team, led by Dame Jane Dacre, who has been appointed as the independent chair for this work, will now work with doctors, the General Medical Council, the Medical Schools Council, royal colleges and other bodies to drive this much-needed change.

[Dr Johnson]

Could the Minister highlight the timing of that in relation to the workforce plan, and when that will be published?

[Stephen Kinnock]

The workforce plan will be published this spring, so there is not too long to wait. It has taken a little longer than we initially hoped, but we think it is really important to ensure that it is anchored in very solid engagement with our partners and stakeholders.

Earlier this year, the Government delivered fast-track legislation to put UK medical graduates at the front of the queue for foundation and specialty training places, reducing uncertainty and ensuring that they can progress to full registration as doctors. We have confirmed that all eligible UK medical graduates will be offered a place on the foundation programme this year. Of course, our fast-track legislation seeks to rectify the unforgivably reckless and damaging decision made by the previous Government to remove the resident labour market test after Brexit, which in many ways is the root cause of the mess created by the neglect and incompetence of the previous Government over 14 years.

I turn now to the process for allocating places to applicants for the UK foundation programme and the steps the Government are taking to improve it. We recognise that the location a foundation doctor is assigned for training has both professional and personal impacts. The four UK Health Departments determine the number of places available each year based on workforce planning across the continuum of postgraduate medical education and training. Applicants are allocated across the UK using a nationally applied preference informed allocation system, which has been extensively commented on in the debate.

The PIA system was introduced in 2024, following extensive engagement with the four UK statutory education bodies, medical students and key stakeholders. The move to the new system aimed to address concerns that the previous system was unfair and stressful for applicants and that there was a lack of standardisation within and across schools. It is worth mentioning that the consultation on the PIA system received over 14,500 responses, 66% of which favoured a move to the PIA option against the status quo. There were 106 organisations among those 14,500 responses. It was an extensive consultation with fairly conclusive feedback on the change that was required.

[Stephen Kinnock]

It is worth highlighting that around 82% of applicants get their first preference. That is a significant improvement—it was 71% in 2023. We are taking steps in the right direction, but we would love to get to 100%. It is difficult to get to 100% of anything in a large and complex system, but that is our aspiration. Of course, those who do not get their first place are welcome to re-engage with the system, and efforts are made to ensure they get their preference, although we do not always succeed in that process. I will take the hon. Member’s question away and discuss it with my colleague the Minister of State for Health—she leads on this portfolio, although she was not available for this debate—and we will write to him with further clarifications on the important point he makes.

The introduction of the PIA was broadly supported by stakeholders, and I am pleased that we have seen an improvement under this system in the number of students allocated their first preference programme. As I said, 82% of applicants to this year’s foundation programme were allocated their first preference, up from 71% in 2023. However, we are committed to ensuring that the system remains fit for purpose. NHS England will conduct a review to ensure that it is still working for applicants. The timelines of that review will be confirmed in due course.

Furthermore, although some individuals may want to move away from their university area for foundation training, some need greater certainty, for a range of reasons, about their foundation placements. In the last two years, we have supported a portion of students in three UK medical schools by allocating them to foundation programmes in their local area. Last Friday we went further, announcing that we will work with medical schools and foundation schools to extend that support to trainees across the country from disadvantaged backgrounds. Providing a post close to where they live will mean more stability for trainees and will support employers in developing a local workforce.

I would like to say a final word on the PIA. I think we all accept that it is not perfect—it is very difficult to have a perfect system—but I take issue with the characterisation by some Members in the debate that it is a random system. We do not agree with that characterisation. We are clear that the system in place is enabling people to clearly articulate their first preference, and in the overwhelming majority of cases they are getting their first preference. That does not feel like a random system to us, but we absolutely accept that it is not perfect, and there is always room for improvement.

Let me turn to rotations. We recognise the importance of stability for doctors in training and the impact that frequent relocations can have on wellbeing, retention and workforce planning. Following the 2024 resident doctors agreement, the Department of Health and Social Care conducted a review of rotational training and found that rotations can provide valuable breadth of experience. However, we know that in some cases they can disrupt learning, wellbeing, team integration and patient care. To tackle that, NHS England is developing pilots under the medical education and training review to test longer placements and more flexible arrangements for less-than-full-time trainees. The evaluation of those pilots will inform future policy decisions on placement length and continuity benefits.

I turn now to the wider working conditions for resident doctors. It is essential that we create a supportive environment for doctors throughout their training that looks after their health and wellbeing. NHS England’s resident doctors’ working lives programme continues to implement several measures aimed at supporting resident doctors, encouraging them to stay in training and the NHS and reducing overall attrition. That includes measures such as the less-than-full-time training options to allow trainees to continue to work in the service and progress with their training on a reduced working pattern where that is beneficial for their personal circumstances.

We have made significant progress over the past year to improve the working lives of resident doctors, including agreeing an improved exception reporting system, which will ensure that doctors are compensated fairly for additional work, and rationalising statutory and mandatory training to reduce unnecessary burden and repetition.

[Dr Johnson]

The Minister talked about less-than-full-time training, which has obviously had an impact on the number of doctors we need. The Secretary of State said before the general election that if Labour was elected, it would double the number of medical school places. Is that still the Government’s intention?

[Stephen Kinnock]

Yes, that is the Government’s intention. Obviously, we have had some challenges in April around our hope that we could create 1,000 additional places. We have not been able to do that, unfortunately, because of the reckless decision of the BMA to go back out on strike. The absorption of huge capacity, as well as operational issues, has meant that we have not been able to do that.

--- Later in debate ---

[Dr Johnson]

I thank the Minister for that answer, but I believe that it relates to postgraduate training places. I was asking whether it is still the intention to double the number of medical school places?

[Stephen Kinnock]

Sorry; I misunderstood the question. Yes, it is still our intention to double the number of medical school places.

The Government remain committed to publishing a 10-year workforce plan this spring to set out how we will create a workforce ready to deliver the transformed service that we set out in the 10-year health plan. The 10-year workforce plan will ensure that the NHS has the right people, in the right places, with the right skills to care for patients when they need it.

NHS staff told us through the 10-year health plan engagement that they are crying out for change. The workforce plan will set out how we deliver that change by making sure staff are better treated and have better training, more fulfilling roles and hope for the future.

I thank all hon. Members for taking part in this important debate.

--- Later in debate ---

[Stephen Kinnock]

The short answer is yes, absolutely—our door is always open. We have to find a constructive way through this. I accept that it is not always just about pay; it is also about broader terms and conditions—exactly the things we have been debating today. That is why I was so excited by the fast-track legislation we brought forward specifically to address the bottlenecks and the impact of the disgraceful decision under the previous Government to remove the resident labour market test. We are seeking to fix all those problems, and we need a constructive partner on the other side of the table to do that. We are starting to see in opinion polls that public support for the action taken by the BMA and resident doctors is eroding quite seriously, and I hope they take that into account before they make their next decisions.

[Dr Caroline Johnson]

As a doctor, I feel uncomfortable with the morality of going on strike and leaving patients to suffer in order to get more money for oneself. I think the morality of the strikes is outrageous. However, does the Minister regret the repealing of the minimum service levels legislation, which could have enabled the Government to put in firmer boundaries around the strikes to prevent harm to patients? Will the Government consider banning doctors from striking altogether, as a Conservative Government would, in the same way that people in the Army and the police are banned from striking?

[Stephen Kinnock]

The hon. Lady’s point about morality is important and interesting, but people also have to be able to put bread on the table, pay the mortgage or rent, and feed and clothe their kids. Morality is fine, but it does not put bread on the table. The two things are very important.

On the retrograde steps the Conservative party is proposing around industrial relations, that is just not what the Labour party is about. The Labour party is about constructive, positive industrial relations and respect. It is about treating the workforce and unions with the respect they deserve and finding a constructive solution. We do not want to move to some kind of police state, where we restrict the rights of trade unions. We see the right to organise and go on strike as a fundamental right of citizens in our country, and it would be a retrograde step to remove it. It is pretty extraordinary to hear that suggested by the Conservative party when we live in a liberal democracy. So the answer to the hon. Lady’s question is no. I believe we will find a way through this dispute. It will be hard going—it will be two steps forward and one step back, I am sure—but in the end I believe we will get there.

[Dr Johnson]

I thank the Minister for being extremely generous with his time. He says the Government will not consider removing the right of doctors to strike, but he seems to be going further and suggesting that doing so would be wrong in principle. Do the Government therefore intend to allow the right to strike for those who are currently not allowed to, such as the police and armed forces?

[Stephen Kinnock]

We have those restrictions on the right to strike in the police and the armed forces for obvious reasons of national security. I think that is a very different issue; our critical national infrastructure must be protected, and there cannot be any dispute about that.

We are dealing with a workforce whose pay and conditions had clearly been neglected. The previous Government used the moral argument the hon. Lady was trying to make as leverage to keep pay and conditions down, which I would say is a deeply immoral position to take. The right to be a member of a trade union and to go on strike is relevant to certain sectors of our labour market, and that right, where it exists, should be protected; where it does not exist, that is a completely different debate.

I thank all Members for taking part in this important debate. The Government are taking important steps, and we remain committed to improving the working lives and prospects of resident doctors, and to ensuring an effective foundation programme.