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The Foundation ProgrammeOce
All administrative aspects of the FP are overseen by the UK Foundation
Programme Oce (UKFPO) which provides many important documents at Mwww.foundationprogramme.nhs.uk, including the application handbooks, reference guide (the ‘rules’), curriculum (list of
educational objectives), and advice for overseas applicants.
Table. The FP hierarchy
The GMC Overall responsibility for setting the standards for medical
The UKFPO Manages applications to and delivery of the FP
Local Education
Training Boards
(LETBs)
Foundation schools Deliver the FP locally. May overlap with the LETB
Director of
postgraduate
education
Foundation
training
programme
director (FTPD)
Acute trust/ Local
Education Provider
Educational
supervisor
Clinical
supervisors
Specialised FP
supervisor
Local
administrator
FP representative Leadership position(s) where self-selecting/willing trainees
The Foundation
doctor
practice and training in the UK
Part of the Department of Health’s ‘Health Education
England’. They deliver the FP regionally & support nancial
costs of training & trainee salaries (E p. 38)
Responsible for overseeing all medical training in a hospital
(E p. 39)
Responsible for the management and quality control of
the FP in a hospital. Oversees the panel that reviews your
annual progress. Responsible for signing o on successful
completion of each Foundation year
Acute trusts provide the employment contract, salary, and HR
for Foundation doctors. For community placements (eg GP
practice), the responsibility for education passes to the ‘Local
Education Provider’, but the contract of employment remains
with the acute trust. There can be tension between the needs
of the acute trusts (doctors on the wards delivering services to
patients) & some FP educational requirements (E p. 61)
Doctor responsible for the training of individual Foundation
doctors. Ideally for a whole year but occasionally for a single
attachment. Will review your progress regularly, check that
your assessments are up to date, and help you plan your career
Doctors who supervise your learning and training, day to day, for
each attachment. In some posts (often your rst) the roles of the
educational supervisor and clinical supervisor may be merged
Those undertaking a Specialised FP (which replace
Academic FPs, and can include a designated period
of research) will be assigned an individual to oversee
academic work and provide feedback
Individuals in each trust and Foundation school who help
with FP registration and administration
voluntarily facilitate two- way feedback between their peers
and their local or regional educationalists
This is you! You are an adult learner with responsibilities
for your own learning. You are expected to integrate with
the educational processes of the FP, including providing
feedback on the programme to your supervisors, trainee
representatives, and via local and national training surveys
3THE FOUNDATION PROGRAMME
4
CHAPTER 1 Being adoctor
Applying tothe Foundation Programme
All applications to the FP are through the online FP Application System
(FPAS) at Mwww.foundationprogramme.nhs.uk. There are several stages
(Boxes 1.1 and 1.2).
Registration forFPASYou will need to be nominated. For nal year
medical students in the UK your medical school will do this. Those applying from outside the UK should contact the UKFPO Eligibility Oce
in good time to allow checks to take place.
register for an account but cannot access the applicationform.
Completing the application form Within a designated window
each year (usually in early September), nominated applicants will be able
to access the application form. This has a number ofparts:
PersonalName, contact details, DoB, and relevant personal health info.
EligibilityGMC status, right to work in the UK, and immigration status.
FitnessCriminal convictions and tness to practise proceedings.
Referee Details of one referee. Their knowledge of your performance
is more important than their seniority because they contribute to your
pre- employment checks (re suitability for work) rather than your actual
programme allocation.
CompetencesEducational qualications ± postgraduate experience.
EqualityTo monitor NHS recruitment practices.
DeclarationsYou are required to sign various declarations of probity.
Foundation Priority ProgrammeYou will be asked if you wish to apply to a
priority programme (Ep. 6).
Specialised Foundation ProgrammeYou will be asked if you wish to apply to
one of the specialized programmes, which replace Academic Foundation
posts. Selection and application procedures are determined locally for
these posts.
Linked applicationsTwo applicants can join their applications (Epp. 6–7).
Foundation school preferences You will be asked to rank all Foundation
schools in order of preference. Tables showing vacancies and competition ratios for previous years are available on the UKFPO website but
these do tend to vary between years (Box.3).
Allocation process The Preference Informed Allocation pro-
cess, introduced from 2023, entails each applicant being given a
computer-generated rank. This is then used to allocate applicants a post
based on their preferences. This system is designed to match as many applicants as possible to their rst-choice preference.
4
Before nomination you can
4
These include evidence of the right to work in the UK; of having taken medical training solely in English
or having a suciently high international English language testing system/occupational English test
score; of complying with GMC requirements for provisional registration which may include passing the
Professional and Linguistic Assessments Board test; a statement of support from your medical school
dean; academic transcripts; proof of medical qualications; and a practical clinical assessment exam.
You should allow sucient time for this complex process of verication.
K Box .1 The UK Medical Licensing Assessment
From 2024 this new exam will start for international graduates and for
those graduating UK medical schools in the 2024–2025 academic year.
The exam, comprised of a knowledge test and an OSCE, is set to establish
a common national standard for safe practice and medical registration in
the UK. Medical schools, overseen by the GMC, will set and administer the
assessments for their students.
K Box .2 The Prescribing Safety Assessment(PSA)
Prescribing is a fundamental part of the FP and it is now a requirement
for UK FP applicants to demonstrate their knowledge of the safe and effective use of medicines in this national pass/ fail exam. Piloted in 200 in
response to a GMC- sponsored survey which showed that 9% of hospital
prescriptions contain errors, applicants are tested on common prescriptions, medications, drug calculations, and monitoring regimens that are encountered during the FP. Exams take place at UK medical schools between
February and June each year, and non- UK trainees can sit it duringF.
5
Box .3 Units ofApplication and 202 competitiondata
East Anglia 25(48%)
Essex, Beds, and Herts
260(57%)
Leicester, Northampton, and
Rutland 58(55%)
North Central and East
London 332(224%)
NW London 230(289%)
NW of England 786 (03%)
The 20 Units of A pplication (UoAs) shown are the Foundation schools for the 202 application.
Vacancy numbers for 202 are shown, with gures in brackets representing the number of
applicants ranking the UoA as their rst preference, expressed as a percentage of the number of
jobs available.
Source:data from Mwww.foundationprogramme.nhs.uk
Northern 329(89%)
Northern Ireland
236(78%)
Oxford 25(44%)
Peninsula 84(95%)
Scotland 82(99%)
Severn 26 (9%)
South Thames 742
(92%)
Trent 296(65%)
Wales 338(60%)
Wessex 290(74%)
West Midlands Central
80(48%)
West Midlands North
222(4%)
West Midlands South
52(57%)
Yorkshire and Humber
550 (78%)
5APPLYING TO THE FOUNDATION PROGRAMME
5
More information available at Mhttps:// prescribingsafetyassessment.ac.uk
6
CHAPTER 1 Being adoctor
Specialised Foundation Programme For those interested in
research, teaching, or management, the Specialised FP oers 7550 programmes with time allocated for non-clinical work (E pp. 2, 68).
application includes extra white space questions and space for other
achivements but exact recruitment policies are determined locally. You
can rank up to two ‘Specialist’ UoAs (which dier slightly from standard
UoAs). Shortlisted candidates are interviewed and oers made before
the main FP selection process so that unsuccessful applicants can still
compete for a regular FP position.
6
Foundation Priority Programme These include rotations in typ-
ically hard to ll locations or specialties. The application and oers process
precedes that of the regular FP. Postgraduate qualications, mentorship, and
nancial incentives may be oered.
Results Results will be communicated by email and you will have a
limited window to accept. Some UoAs (eg those with more programmes)
have a two- stage match process where you rank groups of trusts before
ranking the programmes within the group to which you have been allocated. However, most UoAs use a one- stage process where you simply
rank all of the individual programmes from the outset. Further information is available on each UoA website.
PostsA typical Fyear usually consists of three placements of 4mth:one
in a general medical specialty, one in a general surgical specialty; options
for the third specialty vary widely in almost all areas of medicine. F2 posts
also typically consist of three 4mth jobs; for 80% of F2s one of these will
be a GP placement. Allocation to F2 posts varies between UoAs, with
some assigning all F and F2 posts at the outset, while others may invite
you to select F2 posts during your F year. Once you are appointed to
the FP, you are guaranteed an F2 post in the same Foundation school, but
often in a dierent acute trust. If you do not get an F2 post in a specialty
you are particularly interested in, most will allow individual FP doctors
to swap rotations, providing they have the support of their educational
supervisors. Some Foundation schools will organize ‘swap shops’ to facilitate this process, but swapping can be notoriously dicult. You can also
arrange ‘taster weeks’ in another specialty to help plan your career; to
arrange these talk to your educational supervisor, clinical supervisor, and a
consultant in the relevant specialty.
Linked applications During the FPAS application process, it is pos-
sible for any two individuals to link their applications. In this case, you must
both supply each other’s email addresses in the relevant section of the
application form, and rank all UoAs in identical order.
Although policies vary between UoAs, linking does not necessarily guarantee appointment to the same trust or town— check individual UoA
websites for their policies. Note also that if one of you accepts a place on
a Specialised or Priority FP or is put on the reserve list, the link is broken.
6
The
6
Information about the Specialised Foundation Programme can be found here:
Mhttps://foundationprogramme.nhs.uk/programmes/2-year-foundation-programme/
specialised-foundation-programme/
If you are unsuccessfulIn recent years, the supply of applicants has
threatened to exceed places on the FP. Unsucessful candidates will be
placed on a reserve list and are often able to gain a training post when an
unexpected event befalls another candidate. If you are not successful in
securing a post rst time round, do not give up hope! Should you still be
without a post after you know you have qualied from medical school,
contact LETBs and hospitals directly; some of your peers may not be
able to take up their posts due to exam failure so you may be able to
apply directly to these standalone posts.
Another option is to consider taking a year out, to strengthen your application by doing research, further study, or other activities that add to
your skills. Also consider applying overseas; it has been possible to complete at least part of the FP abroad. Alternatively, although since Brexit
it requires a little more paperwork, it is possible to apply to posts within
the EU or to consider equivalency exams for other countries.
Finally, there is always the option of a career outside of medicine. Advice
on this and other options will be available from your university careers
oce, from websites such as Prospects (Mwww.prospects.ac.uk) or
certain courses/ conferences (eg Mwww.medicalsuccess.net).
Special circumstances For those who meet the very specic cri-
teria, it may be possible to be pre- allocated to a specic Foundation
school, regardless of your FPAS score. These cases includeif:
• You are a parent or legal guardian of a child <8yr, for whom you
have signicant caring responsibilities
• You are a primary carer for a close relative
• You have a medical condition or disability for which ongoing follow- up
in the specied location is an absolute requirement.
If any of these apply to you, discuss with your medical school dean or
tutor well in advance of the application process opening.
Less than full- time training If you wish to train less than full-
time, you should apply through the FPAS alongside other candidates;
upon successful appointment, you should contact your new Foundation
school to discuss training opportunities and plans. Programmes have
good arrangements for LTFT, whereby trainees are paid on a ‘pro rata’
basis for all work done, as a proportion of the full- time salary.
7APPLYING TO THE FOUNDATION PROGRAMME
8 CHAPTER Being adoctor
The FP curriculum and assessment
The FP curriculum acts as a guide for what you will be expected to
achieve over the 2yr of the FP, how you will get there, and how you will be
assessed. There are 3 Foundation training outcomes (Box .4) that are
grouped according to the GMC’s ‘Good Medical Practice’. To complete
the FP you must keep a record of your experiences, reections, and
study (the NHS ePortfolio) to demonstrate that for each of the outcomes you have acquired the minimum level of competence required.
These are grouped into three higher-level outcomes (HLOs): () an accountable, capable, and compassionate doctor; (2) a valuable member
of the healthcare workforce; and (3) a professional, responsible for their
own practice and portfolio development.
Box .4 Foundation professional capabilities
Clinical assessment
2 Clinical prioritization
3 Holistic planning
4 Communication and care
5 Continuity of care
6 Sharing the vision: working
within the MDT
Source:data from Mwww.foundationprogramme.nhs.uk
NHS ePortfolio The ePortfolio is an electronic record of your progress
through the FP. The syllabus lies at its centre, to which you can link evidence
of achievement of competence using a number of tools. Alongside this lies
your supervisor and end- of- year reports. The ePortfolio may also be used for
specialty training interviews to show competence and achievement, and as a library for a wide range of supporting material (see Boxes .4, .5, and E Box
.9). It is vital that you engage with your ePortfolio early on and keep it updated, as it is the primary measure by which you are assessed. While the eort
required is not small, the time and energy your supervisors need to review your
ePortfolio should also not be underestimated. You are both helped by keeping
your electronic and paper portfolios organized, current, and complete
(E Box .9). Be mindful of timing. Your Annual Review of Competence
Progression (ARCP), which determines your eligibility to move on in training,
will take place well before the end of the training year.
Assessment Assessment is based on observation in clinical practice,
your ePortfolio evidence supporting curriculum competence (Table.2),
and evidence of engagement in learning. Direct observation comes from
your supervisors but also other work colleagues in the form of a team
assessment of behaviour and feedback from your Placement Supervision
Group. Formative assessments are ways of seeking feedback whereas
summative assessments are to demonstrate competence— both are
equally important. The burden of what many see as a tick- box exercise is
still signicant, though improving slowly with each FP curriculum revision.
Each year, assessment culminates in the ARCP.
MeetingsThere are a number of meetings you need to record in your
ePortfolio. These are detailed in Box.6.
7 Fitness for practise
8 Upholding values
9 Quality improvement
0 Teaching the teacher
Ethics and law
2 Continuing professional development
3 Understanding medicine: career planning.
Table.2 Supervised learning events (SLEs) and assessments
K SLEs are a way to evidence your learning by linking them to curriculum items;
however, practically speaking they are a way of getting useful feedback from trainers
and reecting on the learning events you encounter, all vital parts of the learning
process. There are many types of SLEs but each serves an important purpose.
They can be planned in advance and/ or completed retrospectively. Whenever an
appropriate learning opportunity presents itself, ask a trainer whether they would
mind providing some feedback and if possible, completing an SLE ‘ticket’ for you,
for which you will need their email. Bear in mind that they can take some time
to complete and that your seniors will be grateful for gentle reminders, plenty of
time, a word of thanks, and perhaps a ‘form’ in return. The curriculum has no
prescriptive requirement for how many SLEs must be completed but all of the
HLOs must be covered by examples of your practice across various placements.
Direct observation of doctor/ patient encounter:
Mini- clinical evaluation exercise
Direct observation of procedural skills
For mini- CEX, you will be observed speaking to and/ or examining a patient
and receive feedback on your performance. For DOPS, you will be observed
performing a clinical skill and receive feedback on your interaction with the patient.
Case- based discussion (CbD)
You will present and discuss a case (or an aspect of a complex case) you have
been closely involved in and discuss the clinical reasoning and rationale.
Developing the clinical teacher ≥ per year
This requires you to deliver an observed teaching session— you will receive
feedback based on your preparation, teaching, knowledge, and audience
interaction.
K Assessments dier from SLEs in that they are summative— they evaluate your
progress and achievements. In addition to your end- of- placement and endof- year assessments with your supervisors, you will also complete two other
assessments:
Summary narrative per HLO for each nal educational
You will complete a summary narrative (maximum 300 words) for each HLOs
before your nal educational supervisor meetings. These narratives should be
developed throughout the year with evidence of ongoing progress.
Team assessment of behaviour (TAB) per year
You will be required to engage in a Maoist process of self- criticism, then
select approximately 5 colleagues who will be invited to provide anonymous
feedback, including at least two consultants/ GPs, one other doctor >FY2,
two senior nurses >band 5, and two allied health professionals/ other team
members (eg ward clerks, secretaries, and auxiliary sta). Similar feedback
comes from your Placement Supervision Group but they are nominated by your
supervisor rather than by you. Your educational supervisor will then collate all
the results and share them with you.
(mini- CEX)
(DOPS)
supervisor meeting
9THE FP CURRICULUM AND ASSESSMENT
10 CHAPTER Being adoctor
T Box .5 Keeping theePortfolio
As well as recording your structured learning events, you can upload a
wide range of other documents to your ePortfolio to serve as evidence
of your progress. Some suggestions include:
Clinicalwork
• Copies of discharge/ referral letters (anonymized)
• Copies of clerkings (anonymized)
7
7
• Attendance at clinic (date, consultant, learning points)
• Procedures (list of type, when, observing, performing, or teaching)
• Details of any complaints made against you and their resolution
• Incident forms you have been involved in (useful for reective
practice and demonstrating that you have learned from mistakes)
• ‘Triumphs’— dicult or noteworthy cases that you’ve diagnosed/ treated
• Praise— all thank you letters/ cards/ emails.
Presentations, teaching, audit, and research
• Copies of presentationsgiven
• Details of teaching you’ve done (with feedback if possible)
• Copies of audit or research you’ve been involvedin
• Copies of your publications.
Training
• Details of courses and exams (with certicates)
• Online course modules completed
• Reective practice notes on key learning experiences
• Study leave and associated forms (F2only).
T Box .6 Meetings duringtheFP
There are a number of required meetings which you should record in your
ePortfolio. The onus is on you to schedule and prepare for these meetings: you and your supervisors are all busy clinicians, and it can sometimes
be dicult to arrange these in a timely manner. Be exible but persistent!
InductionAt the start of each placement you should meet with both your
educational and clinical supervisors
8
to agree learning objectives and re-
view what opportunities are available during the placement.
MidpointMeetings in the middle of each placement with your supervisors
to review progress are encouraged, particularly where you or they have
concerns, but are not compulsory. You may also decide to have a midyear review with your educational supervisor.
End ofplacementBoth your supervisors should meet with you separately
to review your achievements, pass on the observations of the team,
provide advice, and listen to your feedback.
End ofyearYou should meet your educational supervisor to discuss your
total progress. Your supervisor will complete a report for the panel performing your annual review to inform their decision to sign youo.
7
Remember that all data you upload is subject to the Data Protection Act. This means that you
should avoid recording patient identiable information within your ePortfolio, since this is not the
purpose for which it was collected. Using hospital numbers rather than names, or completely
obscuring personal details is considered acceptable.
8
Separate meetings:your clinical supervisor should address what is expected of you and what is
available to you; your educational supervisor should take an overview of your progress and goals.
In reality, for some placements they will be the same person.
PATIENT-CENTRED CARE 11
Patient- centredcare
The traditional medical model made the patient a passive recipient
of care. Healthcare was done to people rather than with them. Many
patients were happy with this. Our task as clinicians is to identify patients’ expectations of their relationship with doctors and then try to
full these. From ‘whatever you feel is best doc’ to reams of printouts
from the Internet, neither extreme is wrong and our task is to help
them.
Patient expectationsFind out whether your patient wants guidance
regarding what treatment may be best. Find out their other inuences,
these can be very powerful. Examples include:religious beliefs, friends,
the Internet, and death/ illness of relatives with similar conditions.
Respect their right to make a decision you believe may be wrong. If you
feel that they are doing so because they do not fully understand the situation or because of awed logic, then alert your team to this so that
things can be explainedagain or in a dierent way.
Treatment expectations Patients may have clear expectations
of their treatment (eg an operation or being given a prescription).
These expectations are important sources of discontent when not fullled. Find out what their expectations are and why. Useful questions
may include:‘What do you think is wrong with your health?’ ‘What are
you worried about?’ ‘What were you expecting we could do to help
improve this?’
Yourself in their shoes Make time to imagine yourself in your
patient’s shoes. Isolation or communication diculties will heighten fear
at an already frightening time. Long waits without explanation are sadly
common. Aggression from friends or relatives is often simply a manifestation of anxiety that not enough is being done. Ask yourself ‘How would
Iwant my family treated under these circumstances?’ and then aim to do
this for every patient.
Ensuring dignityHospitals can rob people of their dignity. Whenever
possible help restorethis:
• Keep your patients covered (including during resuscitation)
• Ensure the curtains are around the bed on the wardround
• Make sure patients have their false teeth/hearing aids in when talking
to them, and glasses/ wigs on whenever possible
• Help them to self- care when possible.
Over- examination Patients are often clerked multiple times for a
single admission. This is frustrating for them and often seen as indicative
of a lack of coordination within the hospital. Patients may need to be
clerked and examined more than once, but the context of this should be
explained carefully— is this to gain more insight about their condition or
to allow a training doctor to learn? People rarely mind when they understand the reasons. Keep invasive or uncomfortable examinations to an
absolute minimum.
12 CHAPTER Being adoctor
Before youstart
Important organizations
The prices quoted change frequently; they are intended to be aguide.
General Medical Council (GMC) To work as a doctor in the UK you need GMC
registration with a licence to practise; £50 for F (provisional registration), £60
for F2 (full registration), and annually thereafter until an increase after 5yr.
NHS indemnity insurance This covers the nancial consequences of mis-
takes you make at work, providing you abide by guidelines and protocols. It automatically covers all doctors in the NHS free of charge.
Indemnity insuranceThis is essential; do not work without it. These organ-
izations will support and advise you in any complaints or legal matters
arising from your work. There are three main organizations; all oer 24h
helplines (Epp. 628–29). Approximate subscription rates:
• Medical Protection Society (MPS)— £0 for F, £20forF2
• Medical Defence Union (MDU)— £0 for F, £20forF2
• Medical and Dental Defence Union of Scotland— £0 for F, £5 forF2.
British Medical Association (BMA) Benets include employment advice,
contract checking service, online access to books and journals, and a
weekly subscription to the BMJ. Costs £9 for F and £235 forF2.
Hospital Consultants and Specialists Association Alternative trade union
for those planning a career in hospital medicine. Benets include employment advice, contract checking, personal injury service, and legal
services. Annual cost is £50 for Foundation trainees.
Income protection Pays a proportion of your basic salary ± a lump sum
(rates vary) until retirement age if you are unable to work for health
reasons. Check if it covers mental health problems, and if it still pays if you
are capable of doing a less demanding job. NHS sickness benets are not
comprehensive (providing Fs mth full pay, 2mth half pay, and F2s 2mth
full pay, 2mth half pay). Available from various providers, typically starting
at £24/ mth as an F, rising according to age, pay, illness, andrisks.
NHS Pension SchemeA proportion of your pay is put into the scheme to
be returned, with additional interest and employer contributions, during
retirement. Despite increasing retirement age in line with the state pension, increasing cost of personal contributions, and a shift from nal
salary to career- average earnings, the NHS Pension Scheme remains an
attractive option. Opting out is a signicant personal nancial decision.
Important documents foryour rstday
P45/ P60 tax formWhen you leave a job you will receive a P45; if you con-
tinue in the same job you will receive a P60 every April. These need to
be shown when starting a newjob.
Bank detailsAccount number, sort code, and proof of address.
Hepatitis BYou need proof of hepatitis B vaccinations and immunity.
GMC registration certicateThis proves you are a registered doctor.
Disclosure and Barring service (DBS) certicate (formerly CRB checks) It is the
employer’s responsibility to perform these checks. You must complete all
paperwork in good time, but payment is the responsibility of the trust.
9
In theory, the medical stang department of your trust should sort a lot of this out in advance of
your rst day; in reality, do not underestimate their ability to mislay your paperwork and request
multiple copies— keep plenty of photocopies and do not part with originals.
9