DAUK’s Medical Student Committee has set out proposals for reform of the UK Foundation Programme allocation system, which is failing new doctors and patients.
Poor communication, last-minute allocations, and a lack of transparency leave graduates in limbo, destabilise clinical teams, and increase safety risks.
DAUK fully supports the BMA’s proposals for urgent reform, and believes further action is essential.
Here, our Medical Student Committee has set out a series of priorities aimed at building a fairer, more transparent, and safer allocation system.
Clear communication and defined points of contact
Poor, inconsistent communication remains one of the most distressing features of the allocation process. Some deaneries respond within days; others remain silent for weeks. Many new doctors simply do not know who to contact when issues arise.
We recommend:
- Establishing a national communication standard with clear response timelines. For example, acknowledgement within three working days, and a full response within seven.
- Requiring named contacts or dedicated inboxes for each FY1 upon allocation.
- Introducing a centralised FAQ and live update system, particularly for placeholder candidates.
National swap-system for deanery allocations
We propose a structured, UK-wide swap scheme to allow graduates to exchange deanery or job rotations under regulated oversight.
This would reduce stress for those placed far from support networks or facing personal, financial, or health-related barriers.
Fairer allocation by reranking for jobs
Applicants who rank highly in the deanery allocation process automatically carry this advantage forward when selecting jobs within that deanery.
We recommend applicants be re-ranked for job allocation within each deanery, with those in lower-choice deaneries given greater priority when selecting posts.
This would create a fairer, more balanced system, mirroring the principles of the existing Foundation Priority Programme scheme. This already provides additional benefits to doctors in less competitive regions.
National audit: safety risks of last-minute allocations and placeholder roles
We call for a national audit to quantify the risks associated with delayed and placeholder allocations, investigate links to rota gaps and supervision issues, and provide evidence-based recommendations for mitigation (see Annex 1).
UKFPO stakeholder board with voting student and FY1 representation
Reforms must be shaped with, not imposed upon, the doctors they affect.
We propose establishing a permanent UKFPO stakeholder board with voting seats for medical students and FY1s. Embedding lived experience into decision-making ensures policies are efficient, transparent, and grounded in reality.
Caring responsibilities and priority status
From 2026, only applicants formally recognised as a primary carer will qualify for priority allocation.
This narrow definition excludes many graduates with joint or substantial caring responsibilities – such as co-parenting, caring for elderly relatives, or supporting siblings – despite the clear challenges of balancing these roles alongside a full-time medical degree.
In addition, priority allocation will only apply to the deanery linked to the applicant’s medical school.
For many, this is far from their home address and established support networks, which are often critical for new doctors managing caring responsibilities.
This creates unnecessary disadvantage at a time when stability and support are essential for wellbeing and retention.
Recommendations:
- Broadening the definition of caring responsibilities beyond “primary carer.”
- Allowing applicants to claim priority based on either their medical school or home deanery.
- Introducing a fair process of appeal for applicants whose circumstances do not fit rigid definitions.
Annex 1: Proposed audit framework – safety of placeholder FY1 roles
Objective:
To assess the impact of placeholder FY1 allocations on patient safety, rota stability, and trainee wellbeing, and to provide evidence-based recommendations for improving allocation processes.
Cohort Definition:
- Placeholder FY1s: Doctors allocated to temporary or reserve status posts before securing a substantive FY1 role.
- Comparison group: FY1s allocated directly to substantive posts in the same cohort.
Identification sources:
- UKFPO allocation records (reserve/placeholder lists).
- Deanery HR / ESR data (contract type, start dates, interim placements).
- Induction and rota attendance logs.
- Trainee surveys for self-identification and validation.
Data collection:
- Patient safety metrics: incident reports, medication errors, missed handovers, rota gaps.
- Wellbeing indicators: stress levels, preparedness, absenteeism, early attrition.
- Operational impact: use of locum/bank staff, administrative burden, induction delays.
Methodology:
- Mixed-methods: quantitative (HR/rota/incident data) and qualitative (surveys/interviews).
- Multi-deanery national scope with independent oversight.
Outcomes:
- Quantify risks of placeholder roles to patient safety and team function.
- Assess effects on FY1 wellbeing and retention.
- Provide actionable recommendations to improve allocation safety, induction, and planning.
