Junior Doctors’ Foundation Programme

Alex Easton Excerpts

Wednesday 22nd April 2026 Westminster Hall

[Peter Prinsley]

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.

[Alex Easton (North Down) (Ind)]

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?

[Peter Prinsley]

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—

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

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:

“I keep sweets in my pocket and pray for guidance.”

It needs to be more than that. I carry sweets in my pocket because, as a diabetic, if I feel myself going down, I have a chew on one and it brings me back up again, but for them, it is to ensure their concentration. Christians always pray for guidance in everything they do. They need wisdom in all the work that they do.

When I asked that 23-year-old doctor what was next for her in life, what she wanted to specialise in and what her hopes were for the future, she said:

“I am so exhausted that I don’t think anything is next.”

The exhaustion takes over. The workload is overwhelming. Put simply, she is burnt out and feels unsupported and uncertain—not because she is not a confident person, but because the workload and all that she has done have overtaken her. That is replicated numerous times, in too many doctors for us to attribute it to personality. It is not her personality, because she is a lovely young lady; it is the current procedure.

I am very pleased to see the Minister in his place. He has empathy and understanding of what we need for our doctors. I am confident that his reply will encourage and hearten us. Hopefully, it will also help with the expectations on young doctors from families and with the paperwork—that has never been more onerous, yet there is no time for them to set aside to do it because they are overwhelmed by the workload in wards and A&E and surgical work supporting doctors. If their placement is in a smaller hospital, they do not have the support of house doctors or consultants during evening shifts, and the pressure is immense. I said earlier that it is overwhelming, and it is, to the extent that they sometimes just say to themselves, “My goodness me, how am I going to keep going?”

We all understand that medicine, by its very nature, is highly pressured and that skills are learned not only in books, but in practice. For the junior doctors I met back home, it is a physical practice—they learn by what happens in the ward. Home-grown students are not being retained, however, so changes to the system must take place, and take place soon. In his introduction, the hon. Member for Bury St Edmunds and Stowmarket referred to one doctor who went from Norwich to Belfast and another who went from Belfast to Norwich. It is unreal, and it seems idiotic—I use that word in a very gentle way—that that should take place.

Training a doctor in the UK costs the taxpayer roughly £230,000 to £327,000 per student from medical school through foundation training. That is a big sum of money, but we are training someone on whom we depend to be the best in a critical situation in hospital. Who of us, when we have a chat with our doctor and ask for their opinion, will not accept what the doctor tells us as gospel? We trust that we can depend on that doctor’s diagnosis of the disease, so that money must result in qualified, capable doctors and not just young people who could have made a difference if they had been given the support and reasonable working hours with reasonable pay to make all the on-calls and missed sleeping patterns worth it.

[Alex Easton]

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?

[Jim Shannon]

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.