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Foundation programme review

One of the biggest challenges facing the NHS is recruitment and retention. Working with partners, the review in 2018 sought to address some of these issues in foundation medical trainees by improving transition periods, addressing geographical issues and widening access to medical training.

The transition from medical school to foundation training is a particularly difficult time for trainees. Supported from the start; ready for the future; The Postgraduate Medical Foundation Programme Review makes recommendations about improving that transition period and highlights the importance of making the NHS an appropriate environment for individuals to learn and work - echoing a key theme in the Interim NHS People Plan.

Undertaken in collaboration with Royal Colleges, the Medical Schools Council the General Medical Council (GMC), the British Medical Association (BMA) and trainees, it re-enforces the commitment to enhancing the experience of doctors in training and in turn their health and wellbeing.

The review contains 16 draft recommendations across the following themes:

  • Improving transition from medical school to foundation and from foundation to core/specialty training
  • Addressing geographical and specialty distribution issues
  • Enhancing the Working Lives of Foundation Doctors
  • Improving Supervision and Educational Support
  • Improving Faculty Support

Since publishing this report HEE, with the help of our key stakeholders, have been addressing each of the 16 recommendations from the report. A progress report was published in 2019 and can be found here. It contains a lot of useful detail for trainees and employers. Please contact your local office for definitive local guidance.

An infographic and You Said We Did document have also been produced to showcase and promote the work that this review has undertaken:

HEE will work with Foundation Schools to identify opportunities to enhance support to doctors with specific needs including wider use of supportive placements

A selection of resources from across the regional offices has been collated and brought together to assist foundation trainees in finding the support they need as they work through the foundation programme and beyond.

Further resources should be sent to the Lead HEE FSD for inclusion.

These resources can be accessed through the e-learning for health hub, ‘HEE Foundation Programme (for doctors)’.

Each Foundation School has a number of initiatives individual to their area, trainees should contact their local office for full details. Some examples of these include;

- In Peninsula where there is a workshop arranged in conjunction with local trusts to support their initiatives and develop further good practice for foundation trainees, particularly IMG trainees in the South West.

- In the East of England, there is a series of Welcome Webinars for all trainees to attend if they choose to, it include signposting information for local support networks, plus additional Supporting Diversity training for supervisors to help them support new trainees. There is also a bespoke induction and additional shadowing for international medical graduates. Further resources are being developed.

- The North West are producing an enhanced induction course in collaboration with the GP school.

- The Yorkshire and Humber region have additional induction days for overseas trainees which includes orientation to working in the UK, the prescribing and employment guidelines. As well as reverse mentoring from IMG trainees to senior HEE staff to cover areas such as differential attainment and institutional racism. There are other courses specific to IMG trainees in Yorks and Humber around interpersonal skills and an understanding of uniformed approach across specialities.

Foundation School Directors can be found here.


The Foundation Programme Review heard that a high-quality, supportive environment with strong supervision ensures the safety of both doctors and patients and guarantees the highest standards of training. Such an environment also improves the recruitment and retention of doctors, and improves the wellbeing of all healthcare staff working on those wards. Although many individuals are involved in the development of a foundation doctor, the educational and clinical supervisor play key roles in terms of guidance and support. It is important to ensure that they are trained to identify and meet the needs of those going through this level of medical training.

Recommendation 12 holds that local education providers must ensure that foundation supervisors are valued and have appropriate training and skills and specific time allocated for their roles.

Appreciating that online learning is accessible to all and sets a consistent message, HEE has worked with e-Learning for Healthcare to review the existing supervisor modules available to foundation educational and clinical supervisors. The updated modules appropriate to foundation training are now available on e-Learning for Healthcare.

The Foundation Programme Review heard that some foundation doctors felt uncomfortable reaching out to senior colleagues for advice relating to what they perceived to be routine matters. The use of trainees as mentors or part of a 'buddying' programme was recommended by the review so that FY1 doctors can be supported by doctors closer to them in their training journey . Being a near-peer supporter will help more senior trainees to develop the skills and experience needed to become a clinical or educational supervisor later in their career. Working with the Academy of Medical Royal Colleges (the Academy), HEE established a working group to explore and develop setting up a scheme whereby trainees support foundation doctors.

The term ‘near-peer support’ was coined as it reflected the themes of the scheme of both buddying and mentoring. Where Local Education Providers (LEPs) already have a strong existing framework for mentoring, buddying or near-peer support, they can continue with these arrangements. However, if there is no defined framework available, LEPs are advised to adopt the Near-Peer Support Framework to ensure all foundation doctors have adequate access to near-peer support opportunities.

The scheme is underpinned by the following principles:

- The Foundation Charter lists as an expected standard that Trusts/ LEPs must facilitate a near peer support network. Successful existing schemes can continue and need not be replaced. Where no such scheme exists, the template provided here should be implemented.

- Foundation doctors should have access to support from a trainee more senior than themselves, but not one who is too distant (hence ‘near-peer’), who better understands the challenges faced during the foundation years.

- The scheme would be available to all foundation doctors. Participation would not be mandatory, but they would be asked to ‘opt-out’ if they do not wish to participate to encourage take-up.

- Trainees who wish to take part as near-peer supporters will need the support of their educational supervisor (ES). Trainees with an Annual Review of Competency Progression (ARCP) outcome 3, 4 or 5 are not advised to take part, to enable them to focus on their own progression.

Full information is available on the Academy’s website:

Near Peer Support Terms

Near Peer Support Implementation Guide

Near Peer Support Proforma

YouTube video about near peer support for foundation programme doctors

Health Education England (HEE) rolled out self -development time for foundation doctors in August 2020 in order to further support health and wellbeing.

Over the course of the Foundation Programme Review, we heard that foundation doctors are often unable to find time within the working week for essential non-clinical activities such as working on their ePortfolio, meeting with supervisors and developing skills in teaching and QI.

Recommendation #14 of the review is to ensure all foundation doctors have time formally included in their work schedules for non-clinical professional activities and that this would be called ‘self-development time’.

In August 2020, all English trusts with foundation doctors were required to include self-development time in the work schedules of foundation year two (FY2) and then if possible for foundation year one (FY1) doctors. FY2 doctors were required to have a minimum of two hours per week self-development time. FY1 doctors were to have a minimum of one hour although not mandatory. After evaluating the first year of this scheme listening to feedback from trainees themselves and the system it has been determined that from August 2021 all FY1 and FY2 doctors will have a minimum of 2 hours on average per week of SDT time. The implementation of this has been planned with the wellbeing of doctors in mind, but also with the demands that are being placed upon service provision in mind.

The attached documents explain the intended uses of self-development time in more detail and also cover many of the questions frequently asked by foundation trainees and their supervisors about this time.

We would like to thank NHS Employers for working closely with HEE on implementing this recommendation.

 - Self-development time - FAQs for trainees and supervisors
 - Intended uses of self-development time
 - Self-development time background information

Self-development time case studies: 

 - The Royal Surrey NHS Trust
 - Brighton and Sussex University Hospitals NHS Trust

YouTube video, giving a brief overview of Self-development time (SDT) with some do's and don'ts

If you have any further questions or comments regarding self-development time, please get in touch with us at merp@hee.nhs.uk

In 2018–2019 the HEE Foundation Programme Review heard evidence from a wide range of stakeholders, including foundation doctors, about the difficulties faced by those entering foundation training from medical school. A number of recommendations were made and this pack outlines progress and contains practical information to assist with implementation.

Supporting Trainers, Supporting Doctors, Supporting Patients: progress since the postgraduate medical foundation programme review. This document also contains information regarding the Foundation Quality Charter.