The growing number of prospective doctors given placeholder jobs demands urgent action

The growing number of medical students put on a “placeholder” list after applying for foundation year training raises serious concerns about the capacity and foresight of the UK Foundation Programme Office (UKFPO). In 2024, more than a thousand medical school graduates were left without allocated foundation year training posts and faced a prolonged period of uncertainty while emergency posts were created.1 This has left graduates unable to plan the next steps of their careers and personal lives. Early reports suggest that this year hundreds of students have again been given a placeholder allocation.2

The shortage of foundation training posts is indicative of a growing problem, as the number of students graduating from UK medical schools is expected to continue rising.3 This is the harbinger of an emerging workforce crisis. Unless there is an adequately planned, sustained expansion in the number of foundation training posts available in the UK, the placeholder list is likely to get longer each consecutive year. Talented graduates left waiting with uncertainty are more likely to look for careers outside of the UK or the NHS, taking with them substantial public investment in their education.

Several drivers are contributing to the problem. In 2020 and 2021, the government temporarily lifted the cap on the number of medical school places because the higher grades awarded by teacher-assessed A levels during the covid-19 pandemic led to a surge in university admissions.4 Before this, the number of medical school places in England had already expanded by 25% between 2018 and 2020, from around 6000 to 7500.5 This is only set to rise further as the NHS Long Term Workforce Plan is aiming to increase the number of places to 10 000 by 2028 and to 15 000 by 2031.6 The decision by the UKFPO to remove points for intercalation, which took effect from 2023, will also likely contribute to a decline in the number of students extending their study, bringing forward their point of entry to foundation programmes.789 The culmination of these factors presents a perfect storm for students applying to the foundation programme going forward.

This stark expansion in medical schools’ student intake was aimed at alleviating anticipated healthcare workforce shortages, but this has only worsened the emerging bottleneck faced by students entering the foundation programme—and specialty training beyond that.10 The NHS Long Term Workforce Plan says that it will ensure “adequate growth in foundation placement capacity;”6 however, the placeholder list continues to grow year on year. Data show 258 students were on the list in 2020, 494 in 2021, and 791 in 2022,111213 with reports of around 1000 students being listed in 2024.114 With further increases in the number of students set to graduate in 2025, 2026, and 2027 this list can only be expected to grow if the UKFPO fails to plan properly a parallel expansion in the creation of foundation year training posts.

Entry to foundation training is a critical juncture in the path from student to NHS clinician. Currently, around one in three UK medical school graduates are planning to leave the NHS after foundation training.15 How many committed, talented graduates will act on plans to leave if their first experience of NHS recruitment is so stressful and demoralising?

The UKFPO has not confirmed how they will avoid a repeat of last year’s placeholder problem. A coordinated effort is required from the Department of Health and Social Care, higher educational institutions, and the UKFPO to ensure that the foundation programme has appropriate capacity for the number of graduates entering the workforce. This requires foresight, applicant-centred recruitment policies, targeted investment, and a phased expansion in the number of foundation training posts available.

The 2024 data are a warning signal of a system under stress. A workforce retention problem is insidiously growing. The UKFPO and Department of Health and Social Care must act now to retain highly skilled graduates and avoid a catastrophic waste of public investment in undergraduate training.