Junior Doctors’ Foundation Programme

Peter Prinsley Excerpts

Wednesday 22nd April 2026 Westminster Hall

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab) [R]]

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.

[Jim Shannon (Strangford) (DUP)]

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.

[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—

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

No!

[Peter Prinsley]

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.

[Jamie Stone]

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?

[Peter Prinsley]

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

“crazy foundation lottery that sends a doctor from Norwich to Belfast and a doctor from Belfast to Norwich.”—[Official Report, 26 March 2026; Vol. 783, c. 452.]

That is what we mean when we talk about a lottery. It is not a figure of speech, but a literal description of how the system works.

There is another reason why this headline figure flatters to deceive: the system incentivises what we call strategic preferencing. The students know the ranking system is random and that a high rank does not protect them tomorrow, so they game it. They preference the foundation schools they think they can realistically get, rather than the ones they actually want. A high first preference rate is, in part, a measure of the student lowering their ambition to protect themselves against a coin toss. That is not a system working; that is a system being worked around.

Let me say a bit about couples. Medical students often form a couple with other medical students or other people who work in hospitals, because that is the nature of a hospital. The foundation programme offers something called linked applications, but the unfairness is particularly acute. Two medical students in a relationship can choose to link their applications so that they are allocated together, but the pair is placed using the lower of the two ranks, so that if one of them is lucky in the ballot and the other is not, both are placed in the worst ranked situation. Should the algorithm be unable to accommodate both in a single school, the link is broken. A student cannot unlink once they have applied, and there is no appeal. The system quite simply cannot see that these are two people trying to begin their careers side by side. It just sees two records on a database.

That has knock-on consequences throughout the rest of the service. When foundation doctors are disorientated, unsupported and demoralised, their work does not disappear; it flows upwards to the more senior doctors, who take more and more of it on themselves. Young doctors should not be deployed by ballot into strange cities, with only limited account taken of their circumstances—their partners, their dependants, their health or their need to be near home. The claim that the current system is somehow fairer than the one it replaced is, I am afraid, one we cannot accept.

Let me talk about how we got here and the recent reform. The old system was not perfect. For many years, medical students competed on a combination of academic decile and a national examination known as the situation judgment test. The SJT was quite unpopular: it was stressful, it had unpredictable validity and there was a documented score gap that consistently disadvantaged candidates from ethnic minority backgrounds. That was a real and serious unfairness, and those who reformed the system were right to try to address it. When the students lobbied against the SJT, they had a good reason to do so, but they did not ask for a random number generator—yet that is essentially what they got.

In 2024 the SJT was abolished and academic achievement stripped out. In their place came PIA, underpinned by a computer ranking. It is hard to think of a clearer case of throwing the baby out with the bathwater. Students asked for fairness, and they were given randomness. Those are not the same thing. Fairness takes account of circumstance; randomness ignores it. Fairness rewards merit and responds to need; randomness does neither. What we have is not a reformed system, but an experiment that has gone wrong.

That is not just my view. The medical training review led by Professor Stephen Powis and Professor Chris Whitty, published last October, drew on more than 8,000 responses, 6,000 of them from resident doctors. Its very first recommendation was that

“a reform of postgraduate medical education and training is undertaken as a matter of urgency.”

It also recommended that recruitment to medical training be reviewed so that it is

“fair and equitable to all candidates”.

It is not sufficient, on any reading of the report, for allocation merely to be random. Random is not fair.

The BMA has taken a big interest in this question, which is not surprising, and I will read out some of its recommendations:

“The BMA is calling for: meaningful improvements to working lives with greater access to support services, supervision, rest and mess facilities; increased flexibility in rotations, including the option to swap placements; a guarantee that all UK graduates will be offered a foundation post, with full details provided at least 12 weeks before the start date; and any review of the allocation system to include proposals for a new recruitment process developed with meaningful consultation with students.”

There is another group of doctors that we should consider: those who will progress to become academic doctors. There is a crisis in this country of clinical academics, the doctors who teach the next generation of doctors. It has become very difficult to recruit into clinical academia. The career pathway for clinical academics has become very uncertain, and we have an emerging crisis—a real and present crisis—that must be addressed. One way to do that is to think about how we recruit foundation doctors into academic programmes.

Here is a straightforward proposal, which I hope colleagues will improve rather than simply accept. Let us return to a firm-based model for the first year of training. The F1 placement should be arranged by the medical schools, not by a centralised national algorithm, with each new doctor placed alongside peers they already know with consultants who have taught them. That is the system we had so many years ago. Medical schools know their students; they know who has the caring responsibilities, who has a linked partner, who has health needs, who has a strong reason to stay close to home. They are in the best possible position to start designing a year that makes sense for each individual.

That does not preclude movement later. F2 can broaden horizons, and specialty training will often mean relocation, but in the critical first year, when doctors are doing their first on-calls up at night by themselves, writing their first prescriptions and being present at their first deaths, they should not be alone in a city where they do not know anybody. They should be doing that with the support of their friends, teachers and colleagues they already trust. I do not think that would be particularly expensive; it might even cost less than the centralised allocation machinery we run today. Whatever we do, I offer one principle: medicine is the most distinctly human of professions and it is futile, and somewhat ironic, to try to reform it with an algorithm. The reform must be human.

Let me close where I began. Resident doctors have just come off picket lines. I do not think that in this debate we can rehearse the pay dispute, which is a matter for another day, but the strikes are not just about pay. At root, they are about a sense that the profession has been treated as though it does not matter. The individual doctor has become invisible behind the workforce spreadsheet. The Government have taken one very important step, with the Medical Training (Prioritisation) Act 2026 giving UK graduates the rightful priority for specialist training places—and that matters. Today’s debate is an opportunity to take the next step to fix the starting point itself.

We have in medicine one of the most extraordinary workforces in the world. Young doctors are among the best trained, most dedicated and most compassionate professionals. We owe them and, more importantly, the patients who depend on them, better than a lottery. We owe them the fair, well-supported, human start they deserve. I believe that would go a long way to resetting the Government’s relationship with the profession, and towards ending these damaging rolling strikes.

--- Later in debate ---

[Peter Prinsley]

Some time ago, when I came here, I had working with me an intern, Dr Harry Dunn, who was a medical student at Cambridge University. He graduated last year. He came top, not only of the University of Cambridge medical student cohort, but of the whole of the University of Cambridge, so he was the top student of his year. He was offered a foundation post in Northern Ireland. He chose not to take it, and has now gone into consulting, having given up medicine. That is an extremely sad example of an unintended consequence of this crazy lottery.

[Dr Johnson]

I congratulate that person on his prowess in university. He is clearly an incredible person, and it is a shame that he has been lost to medicine. I am sure Northern Ireland is a great place to work, and it is disappointing that he did not want to go there, but he should have been able to apply for the jobs that he wanted in places where he wanted to work, and to compete fairly for them. That is a bit stressful and competitive—but getting into medical school is competitive.

You may not know this, Mrs Barker, but the hon. Member for Bury St Edmunds and Stowmarket and I grew up on the same street, in the same town, and went into similar-ish careers. We competed for medical school places and for our jobs. We are all here today having competed against others for election—that is the reality of life. To remove the competition, which is based on meritocracy, and replace it with a random allocation is more unfair and stressful than the alternative.

One of the issues raised about the old scheme was that it was difficult to recruit in some areas. The competition for the best jobs, or at least those perceived to be the best or most wanted jobs, means that some areas of the country and some specialties could find themselves with the people who did not succeed in getting the jobs they wanted. How do we manage that? It used to be managed with rotations. When people went to the interview for specialist jobs, they would be called in one at a time and told, “These are the rotations available. Which one do you want?” The best jobs—the most popular ones—would be mixed with the least popular, so that would mitigate the problem.

There is one issue that I want to raise briefly. Some medical schools in the UK, including Newcastle, have overseas campuses in Malta, Cyprus and Malaysia. Some British people have gone to those branches of UK medical schools and have found themselves completely excluded from places in the United Kingdom under the medical training changes that the Government have made in the past couple of months, which seems wrong. We talked about that when the Bill went through, and the Minister was keen to reassure us that all would be well, but we have found that British students have not been able to get jobs in the British training programme. Will the Minister look at prioritising at least those who went to medical school before the changes for British jobs?

The current system gives junior doctors—resident doctors, as they are called now—no agency, no control, no appeal and no alternative. It is clearly unfair. Could the Minister update the House on how he intends to fix the system?

--- Later in debate ---

[Peter Prinsley]

I thank all hon. Members who came to speak in the debate. I particularly thank the hon. Members for Strangford (Jim Shannon) and for Birmingham Perry Barr (Ayoub Khan), who gave very interesting Back-Bench contributions. I also thank the Minister and the Opposition spokespeople—the hon. Members for Sleaford and North Hykeham (Dr Johnson) and for Winchester (Dr Chambers)—for their contributions. It is quite true that the shadow Minister and I grew up on the same street—probably about 10 houses apart, but many more than 10 years apart.

This has been an interesting debate, whose purpose was to highlight the plight of foundation doctors. As we have said, if we can fix the foundations, we will be able to fix the problems we have with our young doctors. I definitely think that this industrial dispute, which has been rolling and rumbling on for several years, is solvable. It sounds as though we were close to solving it and particularly to attending to the conditions of young doctors.

[Paula Barker (in the Chair)]

Order. I remind the hon. Member that this is not a chance for a second speech; it is just a winding-up speech.

[Peter Prinsley]

I will wind up, then. I thank everyone very much, and I look forward to seeing success in the future.

Question put and agreed to.

Resolved,

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