Junior Doctors’ Foundation Programme

Ayoub Khan Excerpts

Wednesday 22nd April 2026 Westminster Hall

[Ayoub Khan (Birmingham Perry Barr) (Ind)]

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.

We cannot ignore the reality that many resident doctors have felt pushed to the point of taking industrial action. Strikes are never a first choice; they are a last resort when people feel that they have no other way to be heard. Concerns about pay erosion, rising living costs and consistently long and demanding hours have created a situation where many doctors feel undervalued and exhausted.

I went to a picket line outside Queen Elizabeth hospital Birmingham. So many young doctors there talked about how they were unable to live in close proximity to the hospital; they were living many miles away, simply because of accommodation costs. That is quite surprising, because we often hear people talk about junior doctors earning so much money. But if in reality, after tax and all the other expenses, junior doctors—people who save lives—cannot afford to pay for accommodation near the hospital, that shows how our system is broken.

If we want to be honest about supporting doctors, we must acknowledge that their concerns are not unreasonable. A system that relies on goodwill alone is not sustainable. Extra investment in the NHS means very little if it does not translate into better pay, safer working conditions and genuine support for the workforce delivering care every day. The Government must do more: not just words, but meaningful action. That means engaging constructively, addressing the pay concerns fairly and ensuring working conditions that allow doctors to provide safe, high-quality care without burning out.

If we invest properly in the foundation programme and support doctors throughout their early careers, allowing them an appeals process for exceptional circumstances and giving them the basic support in addressing their current challenges, we are investing in the long-term strength of our healthcare system. Supporting resident doctors is not optional—it is essential. When we support them, we do not just retain doctors; we safeguard the future of patient care.

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[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.

[Ayoub Khan]

In relation to the consultation on the PIA system, does the Minister agree that, if there is no appeal process in the system, it cannot be fair, because there will be extenuating circumstances that ought to be considered? That is something I suspect the Government could implement relatively easily.

[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.

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[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.

[Ayoub Khan]

I hesitate to interrupt the Minister’s final remarks, but will he shed some light on the strike by young junior doctors? Queen Elizabeth hospital in my constituency serves many local residents. The young doctors I have spoken to talk about the cost of living and the inability to support themselves, at the point when they are entering an exciting career. What more support will the Government provide them with?

[Stephen Kinnock]

That gives me an opportunity to highlight the fact that this Government have delivered a 29% pay increase for resident doctors. Although I absolutely accept that, prior to July 2024, over 14 years of dealing with an incompetent Government, they suffered from being underpaid and neglected, and we had to seek to fix that—we have done that in good faith and with good will—there have to be limits to what we can offer. The sky is not the limit; the limit is the deeply damaged and parlous state of the public finances that were left to us when we took over in July 2024, and the significant pressures across every aspect of Government.

We implore the resident doctors and the BMA to come back to the table. The Secretary of State believed that he had a deal with the officers of the BMA, and those officers then took that deal to the broader committee. There is no doubt that that committee has ideological motivations, and it refused to accept the deal. We are now in a very challenging position. The Secretary of State has asked several times for a face-to-face meeting with the entire committee, and that request has been refused. We have to make progress, but I simply remind its members that most of our constituents would see a 29% pay increase as a pretty positive deal.