Intended for healthcare professionals


The new F3 year

BMJ 2016; 354 doi: (Published 30 August 2016) Cite this as: BMJ 2016;354:i4041
  1. Eleanor Checkley, foundation school careers lead,
  2. Shirley Remington, associate dean
  1. Health Education North West
  1. careers{at}


The NHS must support the increasing number of doctors who are not going on to specialty training at the end of the foundation programme, say Eleanor Checkley and Shirley Remington

Junior doctor morale is reported to be at an all time low. This is a risk to the NHS not only because it may lead to poor performance and patient care, but also because training posts could remain unfilled as juniors vote with their feet.

The foundation programme exit data from Health Education North West shows that if you invest in supporting trainees with their careers they are likely to stay working in the NHS and in the region in which they trained.

After the political storm over Modernising Medical Careers and the subsequent restructuring of medical training, we invested in careers support to help doctors navigate the new structures and run-through training programmes which involved commitment to a specialty much earlier in a doctor’s career. This restructuring was intended to give better training for what had been called the “lost tribe” of senior house officers. However, our data show that although there are more trainees who are not moving straight into specialty training at the end of their foundation posts, they are not yet lost to the NHS.

The lost tribe

Since 2011 we have been collecting our own data for the UK foundation programme exit survey. This enabled us to review long term trends in career behaviour.

This year only 60% (324) of the 544 trainees who left in 2015 applied for specialty training, a further decline in what has been a long term trend of falling application rates. Nine out of 10 of these applicants were offered a training place and 95% of these trainees continued into a UK specialty training programme.

Some 46 trainees (16% of the 294 who were offered a training place) did not accept the post offered. These trainees may have had an offer for a second choice specialty or region, and chose to try again next year. Another 30 (9% of the 324 who applied) did not receive an offer at all. These trainees may have needed more experience or time to make themselves competitive after their foundation training because they wanted to work in a specific region or specialty.

Other trainees who chose to take a career break have told us they wanted some time out after university, and some wanted a pause in payment of their student loans.

Some wanted more time to explore different specialties and find out what they were good at and enjoyed. These trainees often take up service posts and continue to work for the NHS while developing their CVs and gaining more experience. Surprisingly one in 10 of all trainees (57 of 544) were appointed to a service post at foundation year 2 or core trainee year 1 level; 19 took up a trust grade post; 38 took up a temporary post; and only 18 took up service posts outside the UK. Another one in 10 (61 of 544) were still seeking work as a doctor in the UK, which probably meant that they planned to locum for short periods rather than being tied to a rota. These trust grade doctors in locum and fixed term posts are helping to fill the rota gaps. While a few gaps are unfilled training posts, the majority of these jobs are service posts that were developed because local trusts were not able to reconfigure services quickly enough when faced with reductions in training numbers for some secondary care specialties.

These doctors continued to work in the NHS and most continued in our region.

Foundation year 3

Taking up a trust grade post after foundation is becoming such a common practice that it is developing its own name: the F3 year. These posts are often difficult to fill as demand outstrips supply, especially in more geographically remote areas. Consequently many posts offer their own support and training—outside traditional training programmes—to make them more attractive. Is this an example of a complex system adapting to fill both employee and employer needs?

We need to be careful that trainees who do an F3 year do not become another lost tribe. We no longer have the senior house officer title but medical workforce needs and NHS workplace demands may be developing an equivalent role. These doctors need to be supported and developed so they can gain places on training programmes in the future or take on a specialty and associate specialist role.

Careers support for newly qualified doctors must not be lost in the ever increasing pressures on NHS finances. We need to help trusts look after this group of “in transition” young doctors. Spending money now will pay dividends for our patients both now and in the future.

Application rates for specialty training programmes following foundation training, North Western Foundation School