A Guide To The Foundation Programme For Doctors

The Foundation Programme (FP) is work-based training for new MBChB graduates. It facilitates the transition from university by allowing doctors to enhance knowledge and skills, behaviours, and attitudes acquired as undergraduates and develop clinical and professional competencies in a supportive environment that is also safe for patients. 

The FP is a common stage in postgraduate training for most doctors and is backed by the health departments of England, Scotland, Wales, and Northern Ireland, and the Academy of Medical Royal Colleges, in its aim to establish uniformity in healthcare standards across the UK nations. 

The purpose of the FP is for doctors to become able to be trusted to practise safely and compassionately without direct supervision in generalist areas and prepare for progression to core, specialty, or general practice training. Foundation doctors are integral members of the workforce and work on the frontline alongside multidisciplinary teams on a day-to-day basis.

 

Programme structure:

Typically, the FP has a duration of two years, namely F1 and F2. However, it can be prolonged in less than full time training and other circumstances, for example, special experience FP or fellowship.1 It features six four-months rotations across a combination of acute and community settings. New UK MBChB graduates, and some International Medical Graduates (IMGs), enter F1 through a national recruitment process. 

Provisional GMC registration is requisite. Foundation doctors work under close supervision and there are some restrictions, for example, around prescribing, employing the mental health act, and transferring care between locations. 

One full year of training must be completed, and foundation doctors must demonstrate evidence of working safely and assuming increased responsibility in a supervised environment to be eligible for full GMC registration and progression to F2. 

F2 consolidates F1 learning and empowers foundation doctors to become dedicated lifelong learners and develop capabilities consistent with independent practice. Foundation doctors must demonstrate an ability to work under indirect supervision to make decisions regarding patient care in the context of uncertainty, which is ubiquitous in everyday clinical practice.  F2 is likely to take a minimum of one year. 

Subsequently, doctors are awarded the Foundation Programme Certificate of Completion (FPCC) and can progress to core, specialty, or general practice training. 

 

International Medical Graduates:

The F2 standalone programme is also available. This is suitable for doctors who are eligible for full GMC registration, for example, IMGs who want to enter the training system in the UK. The F2 standalone programme comprises one-year fixed-term posts. 

Doctors acquire experience in an array of specialties and healthcare settings and have access to the same educational resources and teaching opportunities as F2 doctors on the two-year FP. IMGs may also apply for the two-year FP. This has the benefit of helping to integrate better into the system and making applications to specialty training easier. 

 

Applications:

UK medical graduates must be nominated by their university, who also supply a decile rank based on applicants’ performance at medical school as compared to the graduating cohort. Alternatively, IMGs, UK graduates who completed their MBChB more than two years before the FP start date, and non-UK/settled nationals studying for a UK medical degree at a campus outside of the UK must submit an eligibility application before applying for the FP. 

Eligibility criteria are available on the UK Foundation Programme website. The UK Foundation Programme Office (UKFPO) will nominate eligible applicants to apply for the FP. The first step in the process is to apply via the national FP vacancy on Oriel during the national application window. 

Applicants must provide details of one academic referee, details of their primary medical qualification, and details of educational achievements, for example, additional degrees, publications, presentations, and prizes. Additionally, applicants rank all foundation schools in order of their preference. 

Subsequently, the Situational Judgement Test (SJT) is attempted. This is a computer-based test featuring clinical scenarios that assesses qualities requisite for the job of a doctor.

Applicants are awarded a score out of 100 for their FP application, that is, a maximum of fifty points for each of Educational Performance Measure (EPM) and SJT. The EPM is calculated from the medical school decile and any additional academic achievements. 

Finally, in rank order, applicants are allocated to their highest preference foundation school where a training place is available.

 

Curriculum and assessment:

Foundation doctors are expected to achieve the three Higher Level Outcomes (HLOs), which are divided into thirteen Foundation Professional Capabilities (FPCs) (Table 1). Evidence of achievement of each FPC must be provided at the end of each year of the FP. 

This evidence is collected by the foundation doctor and recorded within an ePortfolio. The forms of evidence required include personal learning log, multisource feedback, and supervised learning events, for example, mini clinical encounter (miniCEX) and case-based discussion. 

This is supplemented by reports on the clinical and professional behaviours exhibited by foundation doctors from other healthcare professionals and supervisors. The ePortfolio is submitted at the end of each year of training and is the basis of the Annual Review of Competency Progression (ARCP).

 

Table 1: Higher Level Outcomes (HLOs) and Foundation Professional Capabilities (FPCs)

HLO	FPC
HLO1: The Clinician. An accountable, capable, and compassionate clinician	Clinical assessment
	Clinical prioritisation
	Holistic planning
	Communication and care
	Continuity of care
HLO2: The Healthcare Worker. A valuable member of the healthcare force	Sharing the vision
	Fitness for practise
	Upholding values
	Quality improvement
	Teaching the teacher
HLO3: The Professional: A professional, responsible for their own practice and portfolio development	Ethics and Law
	Continuing professional development
	Understanding medicine

 

Pay: 

The annual salaries of junior doctors in the four UK nations are listed in Table 2. Table 2: Junior doctor salaries in the four UK nations. For Scotland, Wales, and Northern Ireland, this is the minimum salary; foundation doctors may earn more depending on the pay scale.

	England	Scotland	Wales	Northern Ireland
F1	£28,808	£26,462	£24,818	£24,818
F2	£33,345	£32,822	£30,784	£30,782

 

References:

1. UK Foundation Programme Curriculum 2021 [Internet]. UK Foundation Programme. [cited 20 March 2021]. Available from: https://foundationprogramme.nhs.uk/curriculum/

2. Rough Guide to the Foundation Programme [Internet]. UK Foundation Programme. [cited 20 March 2021]. Available from: https://foundationprogramme.nhs.uk/curriculum/

3. F2 Stand-alone [Internet]. UK Foundation Programme. [cited 20 March 2021]. Available from: https://foundationprogramme.nhs.uk/programmes/f2-stand-alone/

4. UKFP 2022 Applicants’ Handbook [Internet]. UK Foundation Programme. [cited 20 March 2021]. Available from: https://foundationprogramme.nhs.uk/programmes/2-year-foundation-programme/ukfp/ 

5. Eligibility Applications [Internet]. UK Foundation Programme. [cited 20 March 2021]. Available from: https://foundationprogramme.nhs.uk/programmes/2-year-foundation-programme/eligibility-information/ 

6. Pay [Internet]. British Medical Association. [cited 20 March 2021]. Available from: https://www.bma.org.uk/pay-and-contracts/pay