All junior doctors in England will be forced to undertake at least four months’ community placement during their first two years in the NHS, to better prepare them for the future of service delivery, it has been announced.

However Health Education England, announcing the change, also warned it posed potential risks to provider trusts, including the loss of funding and increased workload on remaining staff.

Currently there are approximately 15,400 doctors registered on the foundation programme in the UK, which covers the first two years working in the NHS. Only 5 per cent of doctors complete a community placement in their first year, and 55 per cent in their second year.

HEE’s Broadening the Foundation Programme report says this should increase to 80 per cent by 2015 and to 100 per cent by 2017 for doctors in England.

A consequence will be less availability of junior doctors to staff hospital care. The report warns that surgery and hospital medicine posts are likely to be most affected.

It states there will be “significant challenges” for providers to ensure education, patient care and junior doctors’ workloads are protected.

The report was written for HEE by Buckinghamshire Healthcare Trust chief executive Ann Eden. She told HSJ doctors needed to be prepared for their careers in which more services would be provided in the community.

“The old barriers are blurring as we become more integrated around the needs of the patients and this change will give an opportunity to expose junior doctors to environments and career paths they may not have even thought about,” she said.

Ms Eden accepted there were risks to acute services. She said: “This is a fundamental change but one that must be managed in a pretty pragmatic way. We need to be very careful during the transition that where there are hard pressed areas. We absolutely recognise that and [won’t] take [staff] from those areas.”

The changes come as the government prepares to introduce a previously announced tariff system for post-graduate medical trainee education next month, which will ultimately see hospital providers lose 50 per cent of the salary support they currently receive for foundation year one doctors. It is unclear how much they will be funded for F1 trainees based in the community.

However, the shift of trainee doctor time out of hospital is likely to compound financial and workforce pressures created by the tariff change. These are being brought in gradually to address historic variation in the funding of medical education and training.

More junior doctors than jobs

It was confirmed this week that the foundation programme for junior doctors was oversubscribed for the fourth consecutive year.

Some 235 doctors were not allocated a job in the NHS and were put on a reserved list. The other 7,114 doctors were matched to jobs.

Health Education England chief executive Ian Cumming has previously warned the NHS can’t continue funding annual increases in medical trainees.