For several consecutive years, the UKFPO has consistently failed to meet the standards expected of a professional recruitment organisation.

Its repeated shortcomings have caused significant distress and uncertainty for medical students across the UK, undermining the transition from academic study to professional practice.

The UKFPO’s incompetence has manifested itself in numerous ways.

Many students have been left in limbo regarding their future work locations, with some being allocated positions hundreds of miles from their support networks and given the stark choice of accepting or reapplying the following year.

An increasing number of students have found themselves on national or regional waitlists, unsure of their final placements and, consequently, their future salaries.

The UKFPO has repeatedly failed to meet its own deadlines, leaving students in a state of prolonged uncertainty about their futures.

It has not provided job information in a timely manner, hampering students’ ability to arrange long-distance relocations.

The UKFPO’s communication has been woefully inadequate, with instances of crucial, last-minute announcements being made only on social media.

The latest debacle, in which students were provided with entirely meaningless rankings generated by a random number generator, exemplifies the UKFPO’s profound lack of insight into the anxiety and distress they continue to inflict upon students.

This action demonstrates a clear disregard for the dignity of medical students and fails to treat them as the professionals they are training to become.

Not fit for purpose

It is evident the UKFPO is failing in its duty to support students in their transition to working life as doctors.

In its current format, the organisation is not fit for purpose as a recruiter for the medical profession.

DAUK is therefore requesting a formal, urgent review from the Department of Health into the current UKFPO system.

Furthermore, we seek immediate clarification on whether final year medical students will be guaranteed employment in the coming year.

We also strongly urge the Department of Health to reconsider its plans to increase medical school places without a corresponding increase in the number of foundation, clinical fellowship, specialty training, and consultant posts.

We will be writing to the UKFPO in due course.

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Trisha Suji, DAUK medical student lead, said it was ‘grossly unfair’ that students who have been left unallocated on the placeholder system will get only a few weeks’ notice of where they will start their first job as a doctor.

She said: “Final year medical students need to be allocated a place of work so they can plan and get on with their lives.

“Many will be moving away from home, some will have family, children, caring responsibilities and will need to put things in place.

“Some medical students have been sharing their frustrations on social media – and we share those frustrations.”

Journalist Alison Moore posted on X, formerly Twitter, said that there could be as many as 1,000 graduating doctors currently without jobs, and some may find out as late as 4 July.

She posted: “Their induction may start w/c 22 July leaving them 18 days to find a home. They will have applied as early as October.”

The numbers of students on the national reserve list has been growing in recent years, as seen on the UKFPO Reports.

‘Perfect storm’

Since 2019, medical practitioners have been on the occupation shortage list meaning local graduates are no longer prioritised for foundation jobs.

Dr Ajay Verma, a consultant gastroenterologist, posting on X, said: “This is the perfect storm, the change in the allocation process and a record number of applicants (from UK and abroad) means that there are 100s of final year medical students who don’t have a post as yet.

“There are lots of discussions with local hospitals to create additional posts (without additional funding).

“However this is a slow process and doesn’t help individual’s understandable anxiety. It is a scandal that there are future colleagues going through this uncertainty (and possible unemployment).”

Physician associates

Concerns have also been raised on social media that it appears some oversubscribed deaneries are welcoming physician associates (PA) onto new foundation-like programmes.

PAs who qualify after a two year masters course are replacing traditional doctor roles, their placement and education perhaps being prioritised over medical students who are about to qualify.

A post on X highlighted a new 12-month Secondary Care Foundation Programme (education programme) for PAs sharing elements of the traditional doctor teaching.

Trisha said: “The current allocation system for the UKFPO (the organisation that places doctors in their first jobs) does not appear to be functional.

“It does not serve final year medical students. A growing number of medical students are left unallocated year on year, with the problem only set to get worse when cohorts of new medical schools and expanded years begin to graduate.

“Graduates of UK schools must undertake foundation year one to receive their full license to practice as a doctor.

“For newly qualifying doctors the uncertainty, as they take their final exams, with no guarantee of where they might be working of living is beyond description.

Funding

“Neither is it appropriate for foundation schools and hospitals, as they try to place these medical students, to be left trying to create jobs without appropriate funding.

“It does not serve patients or the future of the NHS when the newest cohort of doctors are treated in this way.

“The system needs to change.”

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The Doctors’ Association UK (DAUK) are supporting overseas doctors from COVID-19 red list countries who are unable to travel to the UK to complete an exam required to be eligible for medical training in the UK. 

The forthcoming exam -The Stage 2 Clinical Assessment run by the UK Foundation Programme Office* (UKFPO) overlooks current travel limitations enforced by the COVID-19 pandemic, which have left many overseas applicants unable to progress their applications for the Foundation Programme, to enable them to work in the UK. 

Passing the Clinical Assessment is mandatory for candidates who graduated before August 2019 and now wish to apply for a foundation doctor post. The second stage of this Assessment is a test of a doctor’s clinical skills by way of an Objective Structured Clinical Examination (OSCE)-style, face-to-face exam, due to take place on the 26-27^th May this year. 

Pandemic restrictions currently limit travel from countries in the Red List (including Pakistan, Philippines, Bangladesh, Kenya, Zimbabwe and most recently, India), meaning that candidates cannot travel from these countries to participate in the exam.

A candidate who wished to remain anonymous from one of the listed countries raised concerns with DAUK saying, “this directly goes against the UKFPO duty of fair treatment for all applicants and discriminates against those who are unable to travel due to extenuating circumstances.” “Prior correspondence reassured that no candidates would be disadvantaged for their circumstances. However, the UKFPO have indicated its intention to withdraw myself 

(and other applicants in red list countries) if we fail to attend the assessment in person in May, despite having paid the non-refundable assessment fee (£850) and already being allocated to a UK foundation post for August.”

This doctor and colleagues wrote an open letter to the UKFPO proposing reasonable adjustments to the examination, including rescheduling the date of the assessment and/or adapting the format for delivery via an online platform to enable participants from overseas to complete the assessment. These suggestions have been rejected.

Dr Jenny Vaughan, DAUK Chair:

“DAUK supports the adjustments proposed in the letter, to enable experienced international colleagues to join our NHS workforce. These candidates have already invested significantly in the process of coming the work in our system and many have served resignation notices in their current posts. Passing this exam is their key to taking up roles in the UK, and we urge the UKFPO to find solutions for these candidates, to enable them to contribute to an NHS that is much in need of their skills.”

Freya Rhodes, Medical Student Representative DAUK:

“This is huge concern for these qualified doctors who are ready to work in the UK. 1 in 7 NHS workers are from overseas and their vital contribution to the workforce must be recognised.”

“It is a very challenging time to be entering the NHS. Considering current workforce shortages and high levels of staff burnout, inadequate exam provision is an unnecessary obstacle. The UKFPO must make reasonable adjustments to ensure equal access to training and allow as many new doctors as possible to start work in August.”

CONTACT 

Press@dauk.org

FURTHER INFORMATION

*The UK Foundation Programme

-The UK Foundation Programme Office (UKFPO) manages the Foundation Programme – a two-year structured programme of workplace based training for junior doctors, that forms a bridge between medical school and higher specialty training, and allows trainees to practice as a fully registered doctor in the UK.

-The UKFPO is responsible for allocating places on the programme to all qualifying medical graduates in the UK. They also manage applications for non-UK graduates who are eligible to apply.

-The Clinical Assessment is a mandatory requirement for anyone who qualified from medical school on or before 4^th August 2019. This includes many overseas doctors who may have qualified before this date, and gained valuable experience practising as doctors elsewhere.

Last month, the UKFPO decided to allow SJT resits to students who had their exams terminated prematurely by Pearson Vue. While we are glad that the UKFPO listened to our letter and responded to the concerns expressed many medical students and doctors on social media, these students had by this point been left for over a month with the state of their future careers in medicine placed in limbo – yet there was no apology, and resits were offered only as a ‘gesture of goodwill’. 

DAUK remains concerned that without accountability and careful consideration of how this situation was allowed to unfold, students cannot be confident that similar situations will not happen again in the future. Unfortunately, it seems that this is not an isolated incident – just this year there have been repeated issues, including problems with Oriel during Academic Foundation Programme (AFP) applications, a lack of information about when the SJT booking system would open, and technical errors that initially prevented students from booking tests with reasonable adjustments. 

On this basis, DAUK would like to push for student representation within UKFPO, to enable students to have some say in the major decisions that affect the first two years of their training as doctors. A more collaborative relationship, and a clear point of contact within UKFPO with a defined role, could pave the way for more support, clarity and transparency in the application process. 

Please let us know if this is something you’d like to see!

“Less than an hour before it emerged that some students would be able to resit their SJT, the Doctor’s Association UK (DAUK) released an open letter urging the UKFPO to urgently address how grades would be allocated for students who had been interrupted and to arrange resits where necessary.

Anna Sigston, who sits on the DAUK medical student committee told HuffPost UK: “We have received concerns from a number of students whose SJT exam’s were cut short due to technical difficulties and unclear guidance. Ultimately the communication from the UKFPO to these students was poor at best.

“Graduating medical school is a stressful time, especially during a global pandemic, let alone when a major exam was cut short due to errors with the system. The delayed and dismissive communication from the UKFPO has only made this experience more taxing, negatively impacting many student’s mental health.

“Not only this, but we believe it will negatively impact students applications for an error that was not their fault. Pearson VUE and the UKFPO should take responsibility for their technical faults and unclear guidance, rather than punishing students for their failures.”

Read the full article here: https://www.huffingtonpost.co.uk/entry/nhs-u-turn-final-year-exam-students-inhumane_uk_600ac50cc5b6d64153ab15ca?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cubGlua2VkaW4uY29tL2NvbXBhbnkvdGhlZG9jdG9yc2Fzc29jaWF0aW9udWsvcG9zdHMvP2ZlZWRWaWV3PWFsbA&guce_referrer_sig=AQAAABltF_lIcEmfG0w2GXjRzpbscRnUHP_Z6_MFyn9GiE-BCJpwRl_jE0vZgUY2c92wIGdVziqoF9niDApaeeeOTpAvPRH5EWfkMXVoipSlN_ZD6uROLY9ShiVnV4dQj68N_X_Gwaod0qfkr5ykIpb34aLxaKO7B9pAXcKZKBb7kSFM

In November 2020 DAUK’s medical student committee wrote to the Co-chair of the UKFPO to raise the issues faced with booking extra time slots for the SJT.

Co-Chair UK Foundation Programme Board

It has come to our attention that a decision has been made to discount ‘Extra Achievements’ from the Foundation Programme Application System (FPAS). We understand that additional degrees and publications, which can count for up to 7 additional points when combined, will be discounted for the cohort due to graduate in 2023. 

We acknowledge that this move is well-intentioned, as it moves to mitigate financial disparities between students, some of whom will be unable to afford to study for more than 5 years. However, we would like to highlight some pressing issues with regards to the nature and timing of this decision.

We felt that students were not consulted before the decision took place, and so we at Doctors’ Association UK undertook a survey of 359 UK medical students. 

63% wanted the decision to be postponed till after all current medical students have graduated (2025 or 2026), and 23% did not want the change to occur at all. Overall, 75% have been affected by these changes. This suggests that the decision must be reconsidered. Comments have been summarised into four main concerns:

1. Changes to guidelines will unfairly affect current students. Many took on the cost and time commitment of intercalation under the impression that it would help them in their FPAS application. 
2. Those from widening participation (WP) backgrounds have been harshly affected by the changes. Many have had to partly support themselves through their intercalation, which they wouldn’t necessarily have committed to without the FPAS points. 
3. UKFPO communication has been underwhelming, with Twitter leaks occurring before the official announcement. 
4. To our knowledge, medical students have not been consulted in making this decision.

We acknowledge that there are many excellent reasons for intercalating, and FPAS points will have been only one factor in making that commitment. However, it is a most important factor. With the announcement of this decision, many of those who are currently intercalating before their fourth year feel blindsided. This extends to those who applied for a six year course this year with FPAS points in mind. 

Despite UKFPO’s statement that WP students will be better served by this change, our survey suggests that for a significant proportion of the current cohort of students this is not the case. 30% of our respondents were from WP backgrounds. Although some students commented that this decision would benefit WP students in the future, the timing has left many very frustrated, having self-funded an expensive year out of medical training. Many have suggested this be implemented after the current cohort has graduated to allow the factor of FPAS points to be fairly considered before intercalating.  

A decision of such import must be first communicated through formal channels. Unfortunately, a large number of students only became aware of these changes through social media. Only once these had been discussed in a vacuum of official communication did UKFPO link to the Health Education England document – dated 30th November 2020 – in the late afternoon at around 5pm of 8th December. We, and nearly all our respondents, are saddened to see such an important decision being communicated in this manner.

As we said in our previous letters to you regarding the SJT, the Doctors’ Association UK is committed to standing by its medical student members and advocating for their needs. This most recent announcement has caused widespread ire, confusion and anxiety within the medical student community. We think students are rightly aggrieved to have had no role in a critical decision-making process surrounding their professional futures. 

This has already been a demanding year for us all, especially the students in line to become the doctors of tomorrow. They deserve as fair a recruitment process as is possible. 

As such we would ask that the removal of ‘Extra Achievements’ from FPAS is postponed till 2026, so that students are able to make an informed decision on whether to intercalate, or to apply for longer courses. 

We look forward to your reply. 

Kind regards

Anna Sutton, Medical Student Lead for DAUK