Guide to the UK Foundation Program

The foundation program is a two-year structured program for newly qualified doctors in the UK.

It provides an environment where recent medical school graduates can develop their skills. The UK Foundation Program Office (UKFPO) is the organising body responsible for overseeing the Foundation program for all doctors. They are directly responsible for the allocation of all UK medical graduates into an FY1 training rotation. Additionally, they also manage the applications of non-UK medical graduates.

What are the recent changes to the UKFPO allocation and why?

Starting this with the 2024 cohort of medical graduates, allocation is no longer based on academic performance and situational judgement test results.

The new system relies solely upon a randomly generated computer rank via an algorithm and is known as ‘preference informed allocation.’

The application for all foundation jobs will be submitted on Oriel, the UK wide portal for post-graduate medical recruitment. The intention of these changes implemented by the UKFPO was to give as many applicants their first-choice deanery as possible.

Prioritisation of UK medical graduates

Alongside the move to Preference Informed Allocation, a further change has reshaped the process: the Medical Training (Prioritisation) Act. This affects how applicants are ranked, and — because of the timing of the legislation — pushed the 2026 foundation-school allocation back to March 2026 (it had originally been scheduled for late February).

The reform responds to rising competition for a limited number of FY1 posts. Because the rules here are still developing year to year, check the UKFPO website for exactly how prioritisation applies to your cohort.

How does the UKFPO ranking system work?

There are essentially two waves of ranking applicants must go through:

1. Autumn: rank deaneries
2. Spring:
3. 1. results of deanery rankings released
   2. rank locations and rotations
4. Summer: begin foundation year 1  

Types of Foundation Programs

There are two different types of foundation training programs you can apply for (now that separate Foundation Priority Programmes have been cut in 2026):

1. Foundation Program

The general foundation program must be applied to by all graduating medical students if they wish to continue practising medicine in the NHS. Even those applying for SFP or priority programmes must also submit an application for a general foundation rotation.

A note on Foundation Priority Programmes

Foundation Priority Programmes are intended to attract incoming doctors to areas of the UK that historically struggle to retain staff. Often, these rotations provide incentives such as a £3,500 financial bonus, post-graduate certifications, or enhanced remote and rural experience.

As of 2026, the UKFPO has scrapped the separate application and early offer process for FPPs. Priority posts are now simply rolled into the main Foundation Program vacancies. You will rank these priority posts alongside standard jobs within your allocated foundation school, and they are assigned via the main Preference Informed Allocation (PIA) system at the same time as the rest of the cohort.

2. Specialised Foundation Program

The Specialised Foundation Program (SFP) offers applicants the chance to gain experience in either medical education, management or academic research. One of your 4-month rotations will involve one of these areas rather than a clinical speciality.

Previously, the SFP ran its own competitive application that rewarded academic achievements such as publications, prizes, and presentations. That has since changed.

In England, places are now filled through a split process: roughly two-thirds of SFP posts go through the main Foundation Programme allocation using PIA (the random system), while around one-third are appointed via competitive, academically-assessed selection run by individual medical schools in the autumn.

However, the devolved nations handle this differently: Wales allocates 100% of its SFP posts via the main PIA system, while Scotland and Northern Ireland run their own local selection processes after the initial foundation school allocation. Because the exact balance and timelines vary, always check each foundation school's website.

SFP rotations can also be researched on each individual deanery's website.

5 Tips to Help Navigate the UKFPO Allocation System

Though this new system is creating more uncertainty for applicants, there are many ways you can prepare yourself over the course of the application timeline. I am an incoming FY1 who just went through this new process. Here are my top 5 tips to navigate the allocation system:

1) Keep On Top of Your Dates

While this may be obvious, it is easy to get overwhelmed as a final year medical student and forget to rank your choices. If you forget the deadline and do not rank, this can either result in your application being rejected or receiving a foundation job offer from the bottom of your list.

In order to maximise your chances of going where you want, remember your deadlines! A few important resources you can use for staying on top of these dates include:

• The UKFPO website: Usually they upload all the important dates in the summer preceding your application
• Oriel: You will receive emails from Oriel reminding you to register for an account prior to the application deadline (don’t forget to check your junk mail)
• Your Medical school: The clinical leads and admin team at your medical school will assist with navigating through each deadline

2) Research Each Foundation School Early and Thoroughly

Heading into my final year of medical school, I only knew about the deanery where I did my clinical placements. There are 18 foundation schools you must rank on Oriel. Based on the new randomly generated ranking, there is a possibility you will not get your preferred deanery and therefore, each foundation school must be carefully ranked and researched. Some tools I would suggest for this include:

• Messly: Start here. This site has well-written summaries of each foundation school, their competition ratios, and even individual hospital ratings.
• Individual foundation school websites: Once you have a good understanding of the different deaneries, look at each trust’s website. You will find deanery-specific, well-written information, e.g., specific priority program rotations, hospital accommodation options, and other important benefits.
• Fellow Doctors: If you have friends who were the year above you in medical school or have become friendly with an FY1 during your placement, ask their opinion. There is no better person to ask than someone who is experiencing first-hand what it is like working within a specific foundation school.

3) Do Not Try to Outsmart the Algorithm

There remains very little information on how this algorithm operates, and applicants do not have control over what number they receive. It is impossible to predict how high your number is, and therefore you should not base your rankings off of that.

Simply rank your deaneries and your rotations based on where you want to be, not where you think you might be able to get. One of the benefits of this new system is that everyone has a fair chance of getting where they want, including the more competitive deaneries such as London and the Northwest.

However, I do advise expecting the unexpected. I was certain I would get my first choice or second choice, (North-West deanery and Scotland). I did not look into any other deaneries

That assumption was naïve, as I ended up with my 6^th choice deanery. Within that deanery I got my 400^th ranked job and am about to undergo foundation training in a town I had never heard of before.

Be optimistic and expect the unexpected!

4) Use Free Tools to Help Rank Rotations

Once you have been allocated a deanery, you must then rank the rotations in that region. Some deaneries have a two-step approach where you first rank the different regions, then the rotations. Other foundation schools require you to rank every foundation rotation within that region.

It is tedious and challenging to navigate this process on Oriel. Thankfully, there are multiple different options to help rank your choices in an organised and carefully throughout manner, such as free foundation rankers available online.

I found Messly and Medibuddy the most useful. These tools:

• have all the available jobs on Oriel integrated into their software
• will rank all available foundation posts based on all your preferences
• provide the job codes so you can easily find the job on Oriel, then drag it into your rankings.

Many students also used Excel to help organise all the different jobs for ranking. You are able to download a CSVchoice file from Oriel and then arrange it however you would like to. Overall, these options helped applicants organise the jobs available in their deanery.

When ranking, consider these factors:

1. Location:

Some foundation jobs will have you located in one hospital for the whole 2 years, while others will require you to move around. Additionally, some deaneries cover massive areas, with multiple large cities to choose from.

2. Hospital:

Some doctors want to be based at a large tertiary centre where they can experience rare pathology, while others prefer smaller DGH hospitals with more opportunity for one-on-one teaching.

,

As you only have 6 x 4-month rotations across FY1 and FY2, it is impossible to experience every speciality. If you are focused on experiencing a specific specialty such as plastic surgery or A+E, you will have to rank rotations with these higher up. The same applies for specialities which you're less interested in.

5) Stay positive

There is a lot of doom and gloom around the NHS and the foundation program at present. While this new system for outgoing medical graduates creates a lot of uncertainty, remember that there will be a community of FY1’s and FY2’s who are all in the same boat.

You are all competent, and you will all be able to apply your hard-earned knowledge in any deanery. As soon as you find out which deanery and hospital you will be in, you will most likely be added to numerous different chat groups with your future colleagues.

I highly recommend reaching out to people on these chats. Everyone I have interacted with so far going to my hospital has been lovely and shares the same nervous excitement I am currently feeling!

Summary

So in summary

• remember key dates
• research every foundation school
• don’t try to outwit the algorithm!
• use free tools to help rank
• stay positive!

Good luck!