It may not be possible to guarantee all future UK medical school graduates a place on the foundation programme, two new reports are warning.
A surge in applications from Sudan and Pakistan last year resulted in the 2011 foundation programme being oversubscribed, creating for the first time a surplus of demand for places.
There were 7,257 eligible applications for 7,073 places and as a result 184 applicants were placed on a reserve list. These applicants were all eventually offered a place after some students withdrew either for failing finals or for other personal reasons.
The 2012 programme has again been oversubscribed this year and although the UK Foundation Programme Office (UKFPO) is confident that all eligible applicants will eventually all be allocated jobs, there is increasing concern about the future.
Pressure on foundation programme jobs is coming from an unpredictable number of applications from both EU medical students and non-EU students eligible to work in the UK. In addition following an expansion of medical school places increasing numbers of doctors will be graduating in future years.
A recent GMC report on the state of medical education in the UK warns that the prospect of the foundation programme being oversubscribed in future years is an area of potential concern. It says: “Students who enter medical school have legitimate expectation that if they pass their examinations and graduate they should have the opportunity to qualify as a doctor.”
It calls on the Department of Health to expand the number of foundation programme places in order to fulfil this “moral obligation”.
A second report by the Medical Schools Council into steps being taken to improve the selection process for the foundation programme, also warns that it is “likely” in future that the number of posts will continue to exceed the number of applicants.
Unless the application process is made more robust ensuring the “best” candidates are selected it warns there could be legal challenges from unsuccessful applicants.
Proposed measures to toughen up the application process include the introduction of situational judgement tests replacing the current ‘white space’ questions, a prescribing skills exam and an educational performance measure to more accurately reflect performance at medical school.
Dr Ben Molyneaux, deputy chair of the BMA’s Junior Doctors Committee, said they were extremely concerned about the pressure on foundation programme places and were actively working with the Medical Programme Board and the UKFPO to find long term solutions.
“One of our concerns has been that over the last five years the government has consistently reduced the number of foundation posts available. There used to be a headroom of 5-6% more posts than trainees but in the last few years that has been reduced to 2%. Unfortunately in austerity times it is unlikely the Department of Health will want to increase the number of posts.”
He said he was optimistic that the changes to the foundation programme application process would ensure more UK graduates would win FY1 jobs in competition with foreign applicants because they would have a better understanding of how the NHS works. He said there had also been discussions about incorporating the FY1 and FY2 years into the undergraduate curriculum although the jury was still out on this idea.
Marion Matheson, co-chair of the BMA’s Medical Students Committee, said it would be a personal disaster if a medical graduate was not able to get an NHS job. “The BMA has made it clear on numerous occasions that the government and the UKFPO have a responsibility to ensure that all UK graduates receive a foundation post when they leave medical school so that they are able to achieve full GMC registration,” she said.
A UKFPO spokesman said: “We are in ongoing discussions with the four UK Health Departments regarding contingency plans for future over subscription.”
A DH spokesperson said: “To date all eligible applicants to the Foundation Programme have secured a place. We will, of course, be monitoring the situation for future years.”