Foundation Programme and its role in supporting and retaining junior doctors

What is the Foundation Programme?

UK Medical Students go to medical school for five or more years before graduating.

After medical school, graduates do two years of postgraduate foundation training through the Foundation Programme. The programme is operated and developed by the UK Foundation Programme Office (UKFPO). The UKFPO is jointly funded and governed by NHS England and the four UK health departments.

Doctors in the Foundation Programme are salaried doctors who are continuing their training while employed in the NHS or the health services in the other UK nations. Typically, doctors do six four-month placements in a range of different specialities and settings over the two years.

Doctors may apply for provisional registration with the General Medical Council (GMC) after achieving their degree and they are eligible for full registration after successfully completing their first year of foundation training. Doctors must register with the GMC to practice medicine in the UK.

After completing foundation training, doctors can then apply for postgraduate specialty training posts with the ultimate goal of becoming a GP, associate specialist, or consultant in a specialist area of medicine. Not all doctors go straight into specialty training posts: some do ‘locally employed doctor’ or locum jobs after their foundation training.

Doctors in foundation and specialty training posts are known as ‘resident doctors’. They were formerly known as ‘junior doctors’.

What is the role of the Foundation Programme in supporting and retaining resident doctors?

The transition from being a student to working as a doctor and taking responsibility for the care of patients can be difficult. The role of the Foundation Programme is to bridge the gap between medical school and specialty training, and allow resident doctors to make the transition in a safe, supported environment. Functions of the Foundation Programme include (PDF):

• supporting resident doctors to develop professional and clinical skills
• providing a safe space for resident doctors to learn
• providing resident doctors with an increasing level of responsibility to care for patients as the Foundation programme progresses
• allowing resident doctors to gain exposure in a wide range of clinical environments to help them better understand patient and service needs and choose a specialty

Various research reports have highlighted issues around poor retention rates of resident doctors, high stress levels, doctors not feeling valued, a lack of support in the workplace and having a poor work–life balance.

Government activity The Medical Training Review

In February 2025 NHS England launched a review into postgraduate training for medics. The review is led by National Medical Director Professor Sir Stephen Powis and Chief Medical Officer Professor Sir Chris Whitty and the first report (The Medical Training Review: Phase 1 diagnostic report) was published in October 2025. In April 2026, the government said it is working with various stakeholders to design reforms based on the findings of the report, and that timelines for this “will be confirmed in due course”.

The report found various issues related to the support of resident doctors in training (this may include doctors in both foundation training and specialty training):

• Resident doctors have to rotate through different hospitals when on different placements. This can be disruptive to their personal life, contribute to stress, and deter some from entering training.
• In each placement, a resident doctor may work with a different team and supervisor. Constantly changing teams may impact their ability to develop a relationship with their supervisor, which can impact their training.
• For disabled and neurodivergent doctors, obtaining reasonable adjustments that don’t impact patient care can be stressful, and changes in training locations make this harder.
• Resident doctors experienced variable supervision quality and capacity. Some cited inadequate access to mentors, peer support or engaged supervisors. Many called for better training for trainers and consistent oversight mechanisms.
• Protected training time was insufficient and insufficiently applied across specialities and providers.

The report also highlighted issues relating to the retention of resident doctors once they had completed the Foundation Programme.

Data from the General Medical Programme found that in 2023, over 77% of UK doctors completing foundation year 2 in England do not or cannot progress directly into specialty training. Instead, many take up locally employed doctor roles or choose to work abroad for a time. The Medical Training Review explains there are a variety of reasons for this, including:

• seeking career opportunities
• taking a break from formal training
• taking time to make career decisions
• increasing competition for specialty training posts

The report made various recommendations, including that postgraduate medical education and training is reformed, and that the government address increasing competition for foundation and specialty training places. The report also made various recommendations to improve the support that resident doctors get (which are relevant to doctors in both foundation and specialty training):

• A review of doctors doing different rotations whilst training is already underway. The report recommended that the output from the review be incorporated into reforms to postgraduate training.
• There should be a strategy for those training doctors and funding should be transparent. Training should become less bureaucratic.
• Resident doctors should have time to develop skills, particularly early in their training, and particularly for those specialising in “procedure heavy” subjects, such as surgery, where skills development requires lots of operating time.

Medical Training (Prioritisation) Act 2026

The government introduced the Medical Training (Prioritisation) Bill on 13 January 2026. The bill was fast-tracked through Parliament and received Royal Assent on 5 March 2026 to become the Medical Training (Prioritisation) Act 2026. The act introduces a system that prioritises medical training places (for foundation and specialty training) for graduates of UK medical schools in the UK and certain other groups. The government has said the act implements its commitment to prioritise UK medical graduates for training in the 10 Year Health Plan for England, published in July 2025.

Other reforms to improve support for doctors in training

In 2017, former Health Education England (which is now part of NHS England) established the Enhancing doctors working lives (EDWL) programme. The Medical Training Review said the EDWL resulted in increased access to flexible training for resident doctors, such as self-directed learning time in foundation training, expanded access to part time training, and support returning to training for those who had taken a break.

NHS England has a webpage titled Enhancing the working lives of doctors in training which outlines various initiatives to improve the experience of doctors in training.

Recent parliamentary questions

Doctors: Training (UIN 123432, 13 Apr 2026)

Doctors: Training (UIN 123581, 13 Apr 2026)

Medicine: Higher Education (UIN 118412, 13 Mar 2026)

Medicine: Training (UIN 114211, 02 Mar 2026)