Intended for healthcare professionals

Rapid response to:


Foundation job allocation in the UK

BMJ 2024; 385 doi: (Published 04 June 2024) Cite this as: BMJ 2024;385:q1191

Rapid Response:

Guarantee desirable placements for geographically flexible graduates

Dear Editor,

I agree with Bharmal and colleagues’ analysis of the job allocation system for newly qualified doctors (1). They suggest reversing the algorithmically generated rankings after deanery assignment, so that lower ranked individuals have more agency over job selection.

The flaw in this solution is that some deaneries are preferenced low, or very low, for a significant proportion of the graduating workforce. Therefore, a proportion of those assigned one of their lowest-ranking deaneries may only receive a middle-ranking job preference.

Many graduating doctors have a strong preference for a single attachment in their foundation year training. For example, those seeking further training in paediatrics may have a strong preference for a Senior House Officer post in paediatrics or neonatology. Those seeking training in surgical specialties may have a strong preference for a Senior House Officer post in their chosen specialty, such as plastic surgery, ophthalmology, or obstetrics and gynaecology. For these individuals, job preferencing may be more important than locality.

A fairer solution to foundation job allocation could therefore consist of a choice to preference jobs or region, whereby a new graduate could be guaranteed a post in a chosen specialty if they are willing to be flexible with training locality. Otherwise, these jobs could be generated or offered as Priority Programmes in historically low-preference deaneries. I suspect that the number of graduates willing to be flexible in exchange for a guaranteed rotation for their chosen specialty rotation would be greater than 0.8%; the number of graduates who were assigned one of their bottom five deanery preferences (2). This could be evaluated through graduate surveys.

An additional challenge to be addressed is that of undesirable or geographically isolated sub-deaneries amongst competitive deaneries. The unification of large deaneries misrepresents the number of graduates who are placed in low-preference areas, as some low-preference areas exist within large, competitive deaneries. Separation of these large deaneries for preferencing, followed by unification for the purpose of the training programme faculty, administration, and provision of training, would facilitate more reliable data collection on the satisfaction of deanery placement.

1. Bharmal A, Sharma I, Majeed A, Pinder R J. Foundation job allocation in the UK BMJ 2024; 385 :q1191 doi:10.1136/bmj.q1191
2. United Kingdom Foundation Programme. 2024 Foundation programme allocation. 2024.

Competing interests: No competing interests

08 July 2024
Daniel J Chivers
Foundation Year 2 Doctor
Sheffield Teaching Hospitals