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The North West Foundation School is home to 1,100 foundation trainees employed at 12 hospital trusts. Despite oversubscription to the Foundation Programme every year since 2011, University Hospitals of Morecambe Bay Foundation Trust (UHMBFT) has struggled to fill foundation training posts relying on locum doctors to sustain service provision. We did a study to explore the reasons for this and identify possible solutions. Final year medical students at Lancaster University and foundation doctors based at UHMBFT and Central Manchester Foundation Trust were invited to complete a structured questionnaire and then attend a focus group to expand on their answers. Location was identified as the single biggest factor affecting where foundation applicants applied to, followed by perceived reputation of the hospital trust and job track. Participants identified free/heavily subsidised accommodation or the offer of additional qualifications in leadership or teaching as the main incentives that would have a positive effect on applications to geographically undesirable trusts. These incentives would need to be well publicised, particularly on foundation school websites, UK Foundation Programme websites and trust websites. Overall these efforts should lead to savings in recruitment costs, a reduction in vacant training posts and thus a decreased reliance on locum doctors, culminating in improved patient care.

Factors influencing recruitment and retention of foundation doctors in geographically unpopular locations