Which Are the Most Competitive Foundation Schools?

Published on: 11 Aug 2022

Most competitive foundation schools

What comes after medical schools is often a mystery to medical students. This article will cover the foundation programme application system, the different deaneries foundation programmes and the different foundation schools in the UK.

Following graduation from medical school, students transition into doctors within the foundation training programme. The UK foundation programme consists of six different rotations in medical/surgical specialities


Applying to the Foundation Programme

The Foundation Programme Application System (FPAS) is the application process for medical students to apply to graduate foundation jobs

Applicants can choose between three different types of applications: 

  • Standard Foundation Programme (compulsory for all)

  • Academic Foundation Programme 

  • Foundation Priority Programme

The FPAS is a points-based system where the points come from the Situational Judgement Test (SJT) and the Education Performance Measure (EPM). Each of these are worth 50 points. 

  • SJT score consists of a national, compulsory, multiple choice exam that tests candidates on their professional behaviour knowledge rather than clinical knowledge. Applicants can only sit the exam once per application cycle. 

  • EPM score: the EPM consists of medical school performance (34-43 points are available depending on individual decile ranking) and educational achievements (up to 7 points available). 

Additional degrees can result in up to 5 additional points as part of the educational achievements. Applicants can only provide details for one additional degree, in the case of having two degrees, applicants are encouraged to provide the one securing most points. 

Publications can result in up to 2 additional points- 1 point for each publication. To gain a point, the publication must have a PubMed ID, otherwise the point will not be awarded. 

The above information relates to all applicants as it is compulsory to apply to the Standard Foundation Programme. 


Academic Foundation Programme

The Academic Foundation Programme is different from the standard medical foundation programme as it has protected time set for academic activities. The structure of the programme and time for research is dependent on the foundation school, with most programmes offering a four-month academic placement during FY2. Some programmes may offer integrated academic time throughout the two years. 

The Academic Foundation Programme expects trainees to achieve all the expected competencies of trainees undergoing the standard foundation programme with extra academic competencies.

Depending on the academic foundation post chosen and applicants’ interest, the academic content within the NHS foundation programme can be medical research, medical education or management and leadership. Some posts may offer all three. 


Foundation Priority Programme

This programme was developed to support areas in the UK that have struggled to retain trainees throughout the years. 

These posts are available in East Anglia Essex, Bedfordshire and Herefordshire (EBH), Leicestershire, Northamptonshire and Rutland (LNR), North Central and East London, North West London, North West of England, Northern, Northern Ireland, Oxford, Peninsula, Scotland, Severn, South Thames, Trent, Wales, Wessex, West Midlands Central, West Midlands North, West Midlands South and Yorkshire and Humber. 

Applicants applying to the foundation priority programme must also apply to the standard foundation programme. 

Applicants who were unsuccessful/declined academic or foundation priority programmes will be included in the standard foundation programme for allocation in graduate jobs. It should be noted that those who accept and then withdraw an AFP offer must reapply the following year’s foundation programme and will not automatically re-allocated to the standard foundation programme. 

What is a Foundation School? 

Foundation schools are institutional groups consisting of medical schools, local deaneries and trusts that offer foundation training to doctors. All schools deliver training that is developed by the UKFPO. Foundation schools are also known as deaneries. 

As part of the foundation training application, candidates need to rank the foundation schools in order of geographical area preference. 

Factors that should be considered when ranking foundation schools is their location, the type of trust in that foundation school (rural vs city medicine), the competition for that area and the number of available posts. 


Foundation School Deaneries Competition Ratios

The information below about the competition ratios between the medical deaneries is obtained from the 2020 Recruitment Stats and Facts Report by the UKFPO 2020. 


Foundation School:

Competition Ratio:

North West London Deanery:


North Central and East London Deanery:


West Midlands Central Deanery:


Severn Deanery:


Oxford Deanery:


Northern Deanery:


North West of England Deanery:


Scotland Deanery:


South Thames Deanery:


Yorkshire and Humber Deanery:


Northern Ireland Deanery:


Peninsula Deanery:


East Anglia Deanery:


Wales Deanery:


Leicestershire, Northamptonshire and Rutland (LNR) Deanery:


Wessex Deanery:


West Midlands South Deanery:


Essex, Bedfordshire and Hertfordshire (EBH) Deanery:


Trent Deanery:


West Midlands North Deanery:


A competition score >1 signifies that there are more applications than there are number of posts. The posts will be allocated to those with higher foundation programme scores. 

London foundation schools are the most competitive with EBH foundation school, Trent Deanery and West Midlands North Deanery being in the three least competitive deaneries. 

Making the correct choice for you between NHS deaneries can be overwhelming. Linked Applications may be an option for some where applicants link their application to another applicant. If this route is chosen, then the pair will be placed in the same deanery. If the scores between the two applicants are different, the deanery will be allocated based on the lower scoring applicant.

It should be noted that for linked applications, the deaneries have to be ranked in the same order. Linked applications will be broken if the deaneries are re-ranked (even if done in the same order for both parties) or if one applicant accepts an AFP offer. 


Foundation Doctor Salary

According to the BMA, FY1 doctors on the 2016 contract in England made £28,243 and FY2 doctors made £32,691. Those on the 2002 contract started on a minimum of £24,504 in FY1 and £30,393 in FY2.  

In Scotland, FY1 doctors start on a minimum of £25,691 and FY2 doctors on £31,866. 

In Northern Ireland, FY1 doctors start at £24,142 with it rising to £29,944 in FY2. 

In Wales, FY1 doctors start at £24,818 and FY2 doctors at £30,784.