Junior Doctors’ Foundation Programme

I beg to move,

That this House has considered the Foundation Programme and its role in supporting and retaining resident doctors.

Thank you, Mrs Barker, for chairing today’s debate. First, I must thank everyone for coming and say something about my interests. As many know, I am an ear, nose and throat surgeon and I have a son who is a registrar in accident and emergency medicine. I am a fellow of the Royal College of Surgeons, I have an MD from the University of East Anglia, and my medical school was at Sheffield.

This debate is to consider the foundation programme and its role in retaining resident doctors. It is a privilege to introduce the debate, and I am grateful to all the colleagues who have come along this morning. As we all know, our resident doctors just spent six days on the picket lines; the wards were covered by others, operations were postponed and patients’ appointments were rescheduled. When the strikes ended, as they did just over a week ago, the problems did not go away. That is why I asked for the debate. If we are serious about resetting the relationship between this Government and the medical profession, as I believe we all are, we must begin somewhere, and in my view we should begin where every doctor begins: at the foundations.

From this morning’s papers—perhaps the hon. Member will wish to refer to this—it seems that the Health Secretary had engaged with the British Medical Association and had an agreement with its leader. Does the hon. Member share my disappointment that even with that agreement, it went ahead with the strikes? When it had agreed a wage packet for doctors that could be anything from £50,000 as a starting wage to £100,000, it seemed that we had the recipe for an agreement, yet it was all thrown away by, it seems, the BMA.

I heard the same thing; indeed, I met Dr Fletcher from the BMA yesterday myself and heard exactly this story, so the situation is intensely frustrating, but I believe that we can get ourselves back to a position in which an agreement can be reached.

My argument this morning is simple. The foundation programme, the first two years of a doctor’s working life, is, in its present form, not supporting and retaining doctors as it should. The problem is that the doctors are treated like numbers on a spreadsheet rather than the people they are, and some of our brightest young doctors, at precisely the moment when they need the most support, are considering leaving the NHS altogether.

Let me set out what the system does, why it is failing, what we have learned from recent attempts to reform it and what I believe we ought to do instead; but let me first refer to a Royal College of Physicians survey of resident doctors that was done in 2025, which has some interesting findings. Only 44% of the resident doctors stated that they were satisfied with their clinical training. Just 26% of the respondents felt ready to move on to the next step. About 20% of the doctors thought that the recruitment process was fair, which meant that 80% of them thought that it was unfair. About half of them want to work less than full time and, most alarmingly, only 65% of them said that they thought they would be working in the NHS in five years’ time.

I thank the hon. Member for securing this debate. Given that the foundation programme is typically the first full-time frontline post for doctors and often coincides with the period when they are most vulnerable to stress and burnout, does he agree that the Government should be doing more to address their workload?

Certainly we must address the workload but, as I will reveal later in my speech, there are many things that we can do to help the situation.

Let me say a bit about my own experience, which admittedly was a long time ago—

No!

I know—it is hard to believe. I was a medical student in Sheffield, and my first jobs were at the Royal Hallamshire hospital and the Northern General hospital. I have fond memories of the time that we started there. There was, for instance, a doctors’ mess with hot food. There was somewhere for us to live; we had residences. It is ironic that the name “junior doctors” was changed—just last year, I think—to “resident doctors”, because that is the very last thing they are. The residences have all disappeared—they have been sold off—and the doctors work shift systems, sometimes with absolutely nowhere to rest.

We had six-month rather than four-month rotations, which meant that we got to know the teams we worked with. We worked with named consultants. We had a distinct pyramidal team, with senior registrars, registrars and senior house officers, and we knew the people we were working with. They were people we had known as medical students; they were often the people who had taught us. That meant that there was a sort of support network for young doctors as they started in their careers. On the whole, the newly qualified doctors of today do not experience anything quite like that.

It is great to hear a qualified doctor talking about this matter. Health is devolved in Scotland—I must put that on the record—but in my constituency one finds that an awful lot of social care workers are calling it a day and walking away, with all sorts of unfortunate ramifications such as delayed discharge. Crucially, the support for doctors that the hon. Gentleman is talking about is not there or has been reduced. Does he agree that, if we boosted social care workers’ pay and conditions and retained them, that would help doctors?

I absolutely agree that doctors are only part of a much bigger healthcare system. We certainly need to look after all the people involved in health and social care. Of course, that is more of a problem in geographically remote districts such as the hon. Gentleman’s constituency, where I believe it is difficult to recruit professions of all sorts.

I do not want only to sound nostalgic this morning, although of course I am. I am not arguing that absolutely everything was better in my time, because it certainly was not, but in one important respect it was better: it was designed around human beings. It understood that newly qualified doctors are individuals, not one of a herd to be simply moved across a map by a computer. It also recognised that pastoral support and clinical teams matter, and that the transition from medical student to doctor is a particularly vulnerable moment in a medical career. Let us come back to that point soon.

Today, we have a thing called the foundation programme. In 2024, the foundation programme office replaced the application process with something called preference informed allocation. What happens is that medical students list the foundation schools in order of preference, and are each assigned a computer-generated rank. The rank is not informed by academic achievement, personal circumstance, where the student trained or what they did; it simply works through the ranks and places the student accordingly.

The UK foundation programme’s 2026 figures show that of the 10,810 graduates allocated this year, 82% received their first preference. Superficially, that sounds quite reassuring, but I do not really think it is. Every year, a minority of graduates—this year it is roughly 1,900 young doctors—end up somewhere other than their first choice. The minority who do not get their first preference find themselves, aged 22 or 23, packing up their lives for a city where they know nobody. As I put it in the Chamber last month, it is a

As always, it is a pleasure to serve under your chairship, Mrs Barker. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for setting the scene incredibly well. We all appreciate his in-depth portrayal of the issues. I thank him for his 40 years, as I understand, of service to the NHS. It probably does not seem that long but, on paper and statistically, it clearly is.

The hon. Member has forgotten more than I will ever know about the procedures, as I speak from a layman’s point of view. I can, however, outline what young doctors have told me, which certainly bears repeating. They work through their F1 and F2 years in fight-or-flight response. They work unsociable hours without a support network. They make life and death decisions, then return home from that night or day on duty and wonder whether they made the right decision. They wonder whether they missed something and they worry about their patients.

Doctors are empathic with their patients, they are compassionate and they understand the issues incredibly well. They follow shift patterns that on paper look like a different week but, in reality, they are working 80 hours over seven days. Off days on call keep them on tenterhooks waiting to know if they will be called in to do more work, which they will respond to out of duty and compassion. They are scheduled to finish work at 8 o’clock and on a regular basis they only leave at 9.30 pm. They start work before 8 am and take their first break at 2.45 pm, and that is not a one-off on a busy day—every day is a busy day. It is almost like “Groundhog Day”—that film where the alarm goes off at 6 am, he gets up, he does all the things, he goes back to bed and the next day starts the same—but for doctors, it is life and death.

When I asked how they function on that lack of sleep and sustenance, one 23-year-old doctor told me:

Another problem we have in Northern Ireland is that many doctors are moving over to private care, which is leading to shortfalls of NHS doctors. Is that something we need to tackle to retain doctors in the NHS?

It certainly is. To be fair, I do not know of any doctors who have made the journey, but I know that they are certainly aware of the bigger wage packets available in, for instance, Australia, Canada and New Zealand, where they can go for two or three years. The problem is that if they go away for two or three years, they may never come back. It is not just a matter of going to earn big money to pay off student fees and move forward—it is more than that. It is a critical issue, so the hon. Member is right to mention it.

I wonder whether the Minister would consider in his response the option of having student doctors sign a retainer that would keep them in the NHS, and consider providing a bursary for their fees. I understand that Wales does that; I know it is a regional matter for us in Northern Ireland, but if Wales can do it, there are certainly points for us to consider.

I have constituents who have gone to Wales from Northern Ireland for the purpose of going away for two or three years—I think of one young lady in particular whose family I know well. She went to Wales and completed her full studies there at university and in the hospitals. Then, of course, what happens? She meets a young Welsh guy and he sweeps her off her feet and the next thing we know, she is engaged, she is married—she is never coming home.

We will not have the advantage of that young lady’s expertise, but Wales will. I am very pleased that Wales will have that expertise, because she is an excellent student and person. I am sure there are many other people for whom the same thing has happened, because love is a funny thing, is it not? When it gets you, you cannot get off it. You are caught forever. From my point of view, my wife has stuck with me for 39 years—my goodness, she needs a medal.

I have spoken at length about intelligent, capable young people who feel overworked and underappreciated but who, most importantly, feel overwhelmed. That can change with support—support that must echo from here not with words, but with appropriate pay and staffing. If we do that, we will retain the best of the best within the NHS. I do not doubt that that is the desire of the Minister and this Government, and of every hon. Member here.

It is a pleasure to serve under your chairship, Mrs Barker. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) not just for securing this important debate, but for his service in this sector.

I am shocked by what the hon. Member set out about the algorithm and how students or resident doctors are placed in the embryonic stages of their profession. In fact, I am astounded—I suspect many parliamentarians will not know this, and certainly the public will not be familiar with the process—that there is no appeals process. I suspect that something could quite easily be incorporated, within certain parameters, so that not everybody gets to appeal, but it is possible in exceptional circumstances. That must be right.

When we talk about the future of healthcare in the United Kingdom, we are really talking about the people who hold it together every single day, and resident doctors are at the core of that. These individuals have committed years of their life to rigorous study, they have worked long hours and they have an unwavering dedication to patient care, yet at one of the most critical stages of their career, many feel unsupported, overstretched and uncertain about their future within the NHS.

This is where and how the foundation programme plays a vital role. It is not just about a training pathway; it is the bridge between medical school and a lifelong career in medicine. At its best, the foundation programme provides structured learning, broad clinical exposure, and the opportunity to develop confidence and competence in real-world settings. It shapes not only skills, but professional identity.

If we are serious about supporting and retaining resident doctors, however, the foundation programme must do more than simply place doctors into rotations—it must actively nurture them. That means ensuring fair workloads, access to high-quality supervision and protected time for education. It means creating environments where doctors feel valued, heard and supported not just as clinicians, but as people. Retention is not just about pay or contracts; it is about culture. When doctors, especially foundation doctors, feel respected, when their wellbeing is prioritised and when they can see a sustainable future within the system, they are far more likely to stay and build their careers in the United Kingdom. One of the biggest problems I see around Birmingham is new and young doctors talking about moving abroad.

It is an honour to serve under your chairship, Mrs Barker. I congratulate the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for another insightful speech; this time I will avoid comparing the anatomy of human and dog ear canals—we have covered that already.

We always rightly start these speeches by paying tribute to NHS staff, doctors, nurses and everyone involved in patient care, especially given the pressures on them as a result of sheer patient numbers and working in systems that can make the job even more stressful and pressurised than it already is. They are caring for severely injured or very ill people at the toughest moments of their lives. The emotional burden of caring for people who could be dying is difficult in itself, but resident doctors work in a system that adds extra pressures and conditions that can add stress alongside that. We cannot pay enough tribute to them for even surviving in those areas.

One of the best books highlighting the plight of resident doctors that I have read is Adam Kay’s “This is Going to Hurt”. It did a lot to help the public to understand just how difficult it is for a doctor to not know where their training place is going to be. It is where they are going to be forced to live and work for several years—a place where they may not have any friends or family; they might be taken away from family and spouses. They might have dependants and children. It is really difficult to plan a career, especially such a difficult and challenging career, when working with that level of uncertainty. I lived with medical students when I was a student at Liverpool University and have followed their careers since. The challenges that the hon. Member set out have been reflected in their lives and careers.

I support the Government’s ambition to increase medical school placements. That is important. We have a recognised workforce shortage in the NHS, so that is an obvious thing to do, but we must ensure that we do not carry on falling into the same trap. The previous Government, under Boris Johnson, said that they would increase medical school placements—and they did, but without providing the infrastructure for training resident doctors who want to go on to specialised training. That obvious bottleneck was going to filter through. No mechanism was put in place to ensure that the NHS would have the capacity to train those extra medical students when they finished their F1 and F2.

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.