How to prepare for FY1

Most advice about preparing for FY1 assumes the problem is knowledge. It usually isn't. You have spent five or six years being examined on the knowledge, and the GMC has looked at the result and decided in writing that you are safe to start. What you have not done is be the person the nurse rings.

So this is how to prepare for FY1 in the way that actually helps: mostly logistics, a short list of things worth locating before you need them, and one shift in how you think about responsibility that does more than the rest put together. It also sets out the dates, the pay and the entitlements in full, because those are what people are actually searching for in July.

You start on the first Wednesday in August — in 2026, that is Wednesday 5 August. Paid shadowing is the working days immediately before it. Scotland runs slightly earlier, most boards starting shadowing in the last week of July.

You are never solely responsible for a patient

You are never solely responsible for the patient in front of you.

Nearly every version of the fear comes down to one sentence: what if it's just me, and I don't know what to do? There is always someone above you whose actual job is to help — an SHO, a registrar, a consultant. Ultimate responsibility for a patient sits with the consultant, with a hierarchy of doctors underneath them. If you are ever genuinely alone with a sick patient for more than about five minutes, something has gone wrong with the staffing rather than with you.

You will sometimes be the first person on the scene, and the first response for those few minutes is yours. That part is real. But it is a short, learnable job — recognise that someone is unwell, start the basics, call for help — and most of what follows is about making that feel survivable rather than about making you know more medicine.

What to revise before you start FY1 (almost nothing)

Very little, which is the part people find hardest to believe.

The anxiety usually arrives as I've forgotten everything, often after months away from clinical work waiting on results and start dates. It is close to universal, and mostly misplaced. Much of what has gone was never especially relevant to the day-one job, and the parts that are relevant come back fast once they attach to a real patient rather than a question stem.

It helps to know what the work is made of. When one large teaching hospital logged every out-of-hours job across a year — 32,260 of them — prescribing accounted for roughly a third, procedures about a fifth, patient reviews a little under a fifth, and taking blood about one job in nine.¹ Nobody is going to bleep you at 2am about the causes of hypercalcaemia. They are going to ask you to write up fluids, review someone whose observations have drifted, and prescribe something for pain.

So if you revise anything, revise that. Fluids. Oxygen. Analgesia. VTE prophylaxis. Insulin. The handful of antibiotics your trust actually uses, which will be in your trust's own guideline app rather than in any textbook.

Beyond that, skim the emergencies section of whichever handbook you already own, or our emergency checklists, which are built to be worked down at the bedside rather than navigated as a flowchart while someone is unwell. Skim, don't revise. The real gap is not missing facts, it is never having applied them while feeling responsible, and no amount of reading closes it.

And on reading up for your first rotation

Worth resetting the expectation here, because people spend July on the wrong thing.

Most of FY1 is not specialty medicine. It is general medicine — and often not even surgery when you are on a surgical job. Whatever the name above the ward, the FY1 role is largely the medical admin of the team, clerking, and helping manage medical problems in whoever happens to be in the beds. On a surgical ward that means the sepsis, the arrhythmia, the retention, the electrolytes and the fluids, while the surgical decisions stay with the surgeons. FY1s on surgical jobs are quite often the person in the room with the most recent acute medical experience.

Which means reading a specialty textbook cover to cover before August is close to wasted effort. Learn the shape of the team, the common admissions, and where the guidelines live. The medicine you will actually practise is the same general medicine on every rotation.

The dates, and what to do by when

Three months out: apply for GMC provisional registration. You cannot work without provisional registration with a licence to practise, and the advice is to apply at least three months ahead.² In practice this goes through fine for essentially everybody — it is a process, not a hurdle — so the only thing worth doing is applying early and glancing at the status once rather than assuming silence means trouble.

Eight weeks out: your work schedule. You are entitled to it eight weeks before a placement starts.³ It sets out your duties, hours and educational objectives, and it is the document any exception report gets measured against.

Six weeks out: your rota. The duty roster is due six weeks ahead, and changes to an existing rota also need six weeks' notice.³ If it hasn't arrived, ask — it is an entitlement, not a favour.

As soon as the rota lands: request leave. You get 27 days of annual leave on first appointment to the NHS, plus the eight public holidays.⁴ Leave in a rotation is carved up quickly, and whoever asks first gets the dates they wanted.

Whenever the forms arrive: return all of them. Occupational health, DBS or PVG, right-to-work, bank details, uniform sizes, parking. The ones that matter most are the ones that generate a login — without an IT account you cannot order a blood test, and your first morning goes on the phone to a service desk instead of on the ward.

Before August: log into your e-portfolio once. Horus in England; Turas in Scotland, Wales and Northern Ireland.⁵ Do it while it is a minor irritation rather than an overdue task.

And check your PSA is still in date. A pass is required to complete FY1, and if you passed the Prescribing Safety Assessment more than two years before starting foundation training, you have to sit it again.⁶ Anyone who intercalated, resat or took time out should check. Not having passed before you start does not stop you starting — you begin as scheduled and pick up the remediation — but finding out in July beats finding out in March.

What you actually get paid

The most commonly wrong number on the internet about this job, so here it is with a date attached.

FY1 basic pay is £41,226 from August 2026, up from £40,190 — a 6.2% uplift backdated to 1 April 2026 following the June 2026 agreement.⁷ Pages still quoting £28,000 to £35,000 are out by roughly ten thousand pounds, and people make housing decisions on that number.

That is basic. What lands in your account also reflects the enhancements for nights and weekends in your particular rota, and is reduced by tax, national insurance, student loan and automatic enrolment into the NHS pension.

Shadowing is paid separately, at the FY1 rate. Every new FY1 in the UK should receive at least four days of paid shadowing at basic FY1 salary,⁸ calculated as the annual basic divided by 261 working days.⁹ In Scotland it runs four to six days and is explicitly mandatory.¹⁰

When the money actually arrives

There is no national NHS pay date. Neither the doctors-in-training contract nor the Agenda for Change handbook contains one, because it is a clause in your individual contract of employment.¹¹ In practice English trusts cluster between the 24th and the 28th — the 25th, 27th and 28th are all common — while Scottish boards more often pay on the last Thursday of the month. Check your own contract rather than a date a friend at another trust quotes. If it falls on a weekend or bank holiday you will almost always be paid the working day before, though a few trusts move it to the Monday after instead.

You should make the August payroll rather than waiting until September. Cut-offs typically fall somewhere around the 8th to the 15th, so starting on the first Wednesday clears them with room to spare.¹² What delays new starters is not the calendar but the paperwork — pre-employment checks, GMC registration, and your payroll record existing at all.

It will be a part-month payment, and that part is national. Salary is apportioned as one twelfth of the annual figure for each calendar month, and for odd days as the monthly sum divided by the number of days in that month.¹¹ Starting on 5 August means 27 days out of 31 — roughly 87% of a month's pay. Worth budgeting for that gap rather than discovering it.

If payroll does miss you, the remedies have names. Most trusts run a supplementary payroll a week or two after the main one; some will make an advance against your first proper payslip; others will make an interim payment on request. Ask for one by name rather than waiting a month.

Send your starter checklist before you start. As a new graduate you almost certainly have no P45 for the current tax year, and the checklist is what stops you landing on an emergency tax code.¹³ If you do end up on one, HMRC can take up to 35 days to correct it once it has your details, and overpaid tax comes back as a refund.¹⁴ Check the tax code on that first payslip rather than assuming it is right.

Breaks are contractual, not a courtesy. A shift rostered for more than five hours earns a 30-minute paid break; more than nine hours earns a second; a night rostered at twelve hours or more earns a third — so up to an hour and a half overnight, which may be taken in one go. At least three-quarters of the breaks you are entitled to should actually be taken.¹⁵ The argument for taking them is not comfort; it is that tired doctors make more mistakes.

Since 4 February 2026 the exception-reporting rules have been better than they were. If you work beyond your schedule, cannot take a break, or miss the educational opportunities the schedule promised, you report it — as soon as possible and within 28 days. Where time off in lieu is needed for safety it must be given within 24 hours, and fines no longer go to the individual doctor.¹⁶ Reporting is not a complaint about your team; it is the mechanism that makes a broken rota visible to someone able to change it.

Indemnity: worth sorting in your first week

As an NHS employee you are already covered for clinical negligence arising from your contracted work, through your trust's membership of the relevant state scheme — CNST in England, and the equivalents in Wales, Scotland and Northern Ireland. That satisfies both the law and the GMC's requirement to hold "appropriate and adequate insurance or indemnity".²⁵ The BMA puts it plainly: the requirement "is fulfilled through their Trust/Health Board's membership of an NHS scheme".²⁶

What that cover does not do is act for you. It indemnifies the trust rather than the doctor, and it answers negligence claims and nothing else. It does not fund your defence in a GMC fitness-to-practise investigation, a disciplinary about your clinical care, or a criminal investigation. Inquest funding does exist, but it sits at NHS Resolution's "absolute discretion", is triggered by the risk of a claim against the trust, and appoints someone to represent the trust's interests.²⁷ Nor does it reach Good Samaritan acts, cremation forms and other category 2 work, work overseas, or clinical work outside your NHS contract.²⁸

Which is why every professional body recommends joining a medical defence organisation. The BMA advises all doctors to hold MDO membership, and its own member terms say you are "strongly advised" to join one — because the BMA will not itself act for you on clinical conduct.^{26 29} The Foundation Programme's conditions of joining, which you sign, say that "personal indemnity cover is also strongly recommended".³⁰

Nobody requires it and it is not a condition of your registration, so anyone telling you that you cannot start without it is wrong. But foundation rates are nominal — free with MDDUS, £10 for the year with the MDU, and £1 to carry over an existing MPS student membership.^{31 32 33} Most people join in their first week, and it is worth doing before you need it rather than after.

About Black Wednesday

You will hear more than once that more people die on the day you start. It is worth knowing where the claim comes from, because it is repeated far more confidently than the evidence supports.

The original study looked at emergency admissions in England between 2000 and 2008 and reported around 6% higher odds of death in the changeover week — a result sitting right on the edge of significance, not significant in its own most recent years, and not significant for surgical patients once adjusted.³⁴ Since then the largest contemporary UK study, following more than sixty thousand patients to 2016, found no difference in 30-day mortality between changeover weeks and comparison weeks.³⁵

That study period also postdates the introduction of mandatory shadowing. So the thing everyone repeats about your first day describes an era that no longer exists, and it is not a verdict on you personally.

Shadowing week, and how to get something out of it

Most people get a few days of trust induction — exception reporting, Datix, a BLS refresher, IT, ID badges — then get sent to their ward to meet the team and the outgoing FY1s.

The best move is not to shadow. Flip it. Ask the current FY1 to shadow you. When something needs doing on the ward round, be the one who does it while they watch. Observing someone document a round teaches almost nothing; doing it with someone beside you to catch the mistakes teaches the job. The classic trap is watching all week and then discovering on day one that nobody has ever shown you how to order a CT — and that ordering a CT chest, abdomen and pelvis turns out to be a system you have never opened.

Some teams will nudge you towards observing, particularly a consultant-of-the-week hoping for a smooth week. Push back politely and get hands-on.

Ask to scribe the round. Ask to do the bloods. Ask to be the one who works through the jobs afterwards, with the outgoing FY1 checking.

Also know what you should not be asked to do. Shadowing is supernumerary and supervised: you should not be holding the on-call bleep, breaking bad news, or covering for an absent FY1, unless your clinical supervisor has specifically agreed to it.⁸ It is rarely said out loud, and it is hard to decline something you did not know was written down.

Find the emergency equipment before you need it. The crash trolley. The blood gas machine. How to turn the defibrillator on and what is in which drawer — different in every hospital, and probably different from whatever you practised on. Ask an FY1 to walk you through it, and if they are not confident either, ask the SHO or the registrar. Almost nobody refuses. There is an eerie moment coming, usually while the other FY1s are at lunch, when you realise you are the only doctor on the ward and everyone would look at you first. It is much better to meet that having already found where things are.

If you are rusty on procedures, say so this week. Plenty of people start having placed one or two cannulas, no NG tubes, and few or no ABGs. It is far more common than anyone admits. If there is a specific skill you are unsure of, ask someone to show you and then go and practise in the clean room. It is about to be your job, and this is the last fortnight where asking costs nothing. And when you genuinely cannot get a cannula in, the difficult ones belong to the SHO and the registrar anyway.

The sentences worth having ready

Every guide to starting FY1 says ask for help. Few say what the words are, and the words are most of the difficulty — not the asking, but the opening line, holding a phone, after someone senior has said "yes?" into it.

• Opening a referral or asking for an opinion. Hi, one of the FY1s on ward twelve — my team have asked me to refer a patient to you. Is now a good time? Then situation, background, assessment, recommendation, leading with the actual ask.
• Escalating someone worrying you. I'm not happy with this patient and I'd like you to come and see them. You do not need a diagnosis before making that call.
• When you have been told no once and they are still deteriorating. I understand, but they've got worse since we spoke — their NEWS is now seven and the respiratory rate is 28. Give the numbers rather than the impression.
• Asking what to document. What should I put for the impression and plan? Ask this specifically, and ask it every time you are unsure. Nobody expects an FY1 to know the impression and plan independently — you are documenting the team's decision, not making it, and the consultant would far rather be asked than read something wrong in the notes. You will ask a hundred times in your first fortnight and nobody will think anything of it.
• Handing over an unfinished job. Bed nine, still waiting on a repeat potassium, and the plan if it's above six is to call renal. The threshold is the part people leave out and the part that makes a handover usable.

What to put on your phone

You will look things up constantly, and you should. Keeping reference material to hand is standard practice in every safety-critical job, and the FY1 who looks up a paracetamol dose is doing it correctly.

You will also install about a dozen apps and use four. The four are whichever ones cover prescribing, your trust's own guidelines, phone numbers, and the emergency you are standing in front of.

Set these up now, before you have an NHS login

• BNF and BNFC — free, from the Royal Pharmaceutical Society, and works offline.¹⁷ Look everything up, including what you are sure of.
• Our app — emergency checklists and out-of-hours ward-cover scenarios, ordered by what you actually get called about rather than by specialty, plus calculators for the scores you will use daily and a bleep and phone directory for your hospital.
• iResus, from the Resuscitation Council UK — offline adult, paediatric, newborn and anaphylaxis algorithms. One caveat that matters: RCUK published Guidelines 2025 in October 2025, and iResus still carries the 2021 algorithms, so check anything time-critical against the current guideline rather than assuming it has caught up.^{18 19}
• NHS Blood Assist, from NHS Blood and Transplant — free, and the answer to the transfusion question you will be asked at 3am.²⁰

Set these up once your NHS account exists

• An NHS OpenAthens account. This is the one worth doing properly in your first week, because it is the key to a great deal else: BMJ Best Practice, the NHS Knowledge and Library Hub, the Royal Marsden Manual and the Maudsley Prescribing Guidelines all come with it.²¹ In Scotland, BMJ resources are funded for all NHS staff by NHS Education for Scotland.²²
• TOXBASE — the national poisons database, and the reference for any overdose. NHS and academic users can self-register; everyone else needs a paid quote.²³
• Your trust's own guidelines — but wait to find out how they are published. For years the stock answer was MicroGuide; that app was switched off in September 2024, when the platform was bought by Eolas Medical and trusts' content was migrated across, so most hospitals now publish through Eolas instead. Some use something else entirely, and a few still run an intranet page. This is decided by your employer rather than by you, so ask on your first day which one yours uses. Whatever it is, it overrides general advice — local antibiotic policy beats anything you read anywhere else, including here.
• Your e-portfolio, which is not really an app. Horus in England, Turas in Scotland, Wales and Northern Ireland — both browser-based, and Horus emails a six-digit code at every login, which is worth knowing before you try to do it one-handed on a ward round.⁵

Three practical things about phones on wards

Anything you might need in an emergency has to work offline. There is no signal in the basement, in the lift, or on a surprising number of wards. An app that needs a connection to open an algorithm is not an emergency app.

Your phone will be flat by mid-afternoon on a long day, because it is now a clinical tool you are using constantly. A power bank is genuinely part of the kit.

Do not photograph an ECG, a wound or a drug chart on your personal phone. NHS England has not endorsed any particular messaging tool for clinical use, and the guidance is to minimise identifiable patient information on personal devices.²⁴ Use whatever secure system your trust provides, and if there isn't one, ask what you are supposed to do rather than improvising — patient-identifiable data on a personal phone is the most easily avoided incident of your first month.

One note on emergency apps generally: flowchart-driven ones are less useful than they look. In a real emergency you want a checklist you can work down while someone else is doing something, not a decision tree asking you questions.

What to buy, and what not to

Less than the internet suggests, and treat any "essential kit" list that resolves to affiliate links with suspicion.

Shoes are the purchase that matters. You go from mostly sitting to standing for twelve hours, and your calves will report back by the second day. Comfortable, washable, closed. This is the one item worth real money.

Don't buy scrubs yet. Most trusts issue them now, and the issued ones are what you are expected to wear. Wait and see what your department actually does.

You will use a stethoscope less than you expect. On a ward job it comes out a handful of times a day. A serviceable one is fine.

A second SIM is the best few pounds on this list. Most phones take two. Give that number to medical staffing and the group chats, and turn it off when you leave. Finishing a run of nights knowing nobody can reach you is worth more than it sounds, and it is the single most-recommended tip among people a year ahead of you.

If nights come early, buy the blackout before you need it. Blackout blinds if you own the place; if renting, the static film that sticks straight to the glass with no adhesive makes a genuinely dark room and comes off cleanly. Add earplugs, or in-ear headphones running white noise. Housemates will not be quiet because you are asleep at 2pm.

Meal prep in whatever form you will keep up. Batch cooking on a day off, or a freezer meal service. The point is that at the end of a long shift the decision about food has already been made.

Two black pens, because they vanish. A power bank, because your phone is now a clinical tool. Cannulation kit, tourniquets and everything else clinical is single-use and supplied on the ward — you do not need to buy any of it.

Sorting your life so the job doesn't have to

The first fortnight is physically hard in a way people are not warned about. Expect a wave of anxiety, sometimes bad enough to feel physically unwell for a few days. That is a stress response, not a verdict on whether you should be doing this, and it settles as the fortnight goes on. Show up anyway.

Live as close to work as you reasonably can. Not lifestyle advice: driving home exhausted after nights is one of the genuine mortality risks of this job, and a shorter journey means fewer occasions where you have to judge whether you are safe to make it.

Use zero days to recover rather than to achieve things. They exist because of working-time limits, and the temptation is to fill them with the backlog. Work out what actually refills the tank and do that.

Start a teaching log in week one. Not a portfolio project — a note on your phone with the date and title of every teaching session. It has to go into the e-portfolio eventually, and the alternative is reconstructing a year out of old calendar invites. Our app has a logbook that exports to a spreadsheet if you want something more structured than a note.

Put the rota somewhere you will actually look. Supershift and similar keep your shifts out of your main calendar. What matters is knowing when you are working before someone asks you to swap.

What "good" looks like on day one

More achievable than most people expect, and almost none of it clinical.

Arrive in time to be set up before the consultant is. For most specialties that means somewhere around 7:30 to 8:30, roughly half an hour ahead. Not turning up unpaid at dawn — just the few minutes that separate looking lost from looking organised.

In those minutes: print the list (find out who prints it and where on your first morning, not at 08:29), take handover from the night team and mark who is sick and who is new, and find a computer and log in. The nurses have been on since seven and already know where the trouble is, so ask them. Do that much and even on day one you look like someone who knows what they are doing.

Then you round — often around 28 patients on a medical ward, frequently split into two teams. Your job is to document it, and keeping up is the hardest thing about week one. Write what is said and what is examined, and at the plan, ask what to write.

What separates a comfortable FY1 from a struggling one is talking to seniors. Not knowledge — commentary. Taking bloods from bed three now. That's done. I'll order tomorrow's bloods. A registrar who knows what you are doing can help you; one who doesn't, can't. FY1s routinely stay late finishing something a senior would gladly have taken off them, had they known about it.

If someone is unwell in your first week

Worth thinking about once before it happens.

Ward patients rarely crash out of nowhere. The usual things are falls, hypoglycaemia, chest pain, fever and possible sepsis, and fast AF with compromise. Cardiac arrests are rarer than the fear suggests — a large hospital sees roughly one a week, spread across every ward and every hour.

If a senior is already there, let them lead and be a useful pair of hands. If you are alone, two questions: is this patient sick, and have I done this before? If it is beyond you, put out a 2222 call early. Help takes a few minutes, and those minutes are yours to spend on the basics: work through A to E, get a gas, oxygen if they need it, fluids if they are shocked, pads on if there is an arrhythmia.

That is genuinely the whole expectation. A registrar arriving to find the patient on oxygen, fluids running, someone attempting a gas and the crash trolley nearby has found an FY1 doing the job well. Nobody is expecting you to recall the refractory hyperkalaemia algorithm. The job is to identify that someone is unwell, initiate the safe basics, and escalate.

Questions people actually ask

These are the questions new FY1s actually asked — and voted up — in our webinars, in their own words.

What is expected of us during shadowing week? Are we supposed to be working normally, but with another FY1 alongside? The single most-asked question, and the answer is: work as normally as you can. Ask to scribe the round, do the bloods, do the jobs, with the outgoing FY1 watching. Some teams will nudge you towards observing — push back politely. The week is only worth what you actually do in it.

What should I make sure to ask about during induction, to make the week count? Where the crash trolley is and what is in which drawer. Where the blood gas machine is. How to turn the defibrillator on. How the ward orders a scan and who prints the list. Which guideline app your trust uses. None of it is clinical, all of it is the stuff that makes day one workable, and nobody volunteers it.

My first shift is a night. Is that allowed? It happens, and many trusts do not permit it, though it appears not to be flatly against policy. Either way, flag it and ask specifically what extra support is in place — some trusts roster additional registrars whose job that night is to support the new FY1s, which is the mitigation to ask for. An FY1 should not be carrying significant responsibility on a first-ever shift.

Should I shadow a night during shadowing week? If it would reduce the anxiety, yes, but you do not need the whole night. Nights are busy from about half eight to one and quieter afterwards; staying until midnight to see how handover and the bleeps work is plenty.

Any advice for starting in general surgery? The surgeons round fast and then leave for theatre, and the medical management is largely yours. Most of what you will actually deal with is medical: sepsis, arrhythmias, retention, blocked catheters, fluids and pain. Genuinely surgical problems — a drain putting out too much blood, peritonitis — go straight to the surgical senior, and you are not expected to make those calls.

How do I know what is within my competence? You define it, and if you are unsure, ask. Nobody senior worth working for thinks less of an FY1 for asking about a paracetamol prescription. Look it up in the BNF, and if still unsure, ask. When you genuinely do not know whether you are allowed to do something, don't, until you have asked.

How do I organise an audit or QIP for a specialty I am not rotating through? Easier than it sounds. Every FY1 in the trust turns up to the weekly protected teaching, so you will be in a room with the surgical FY1s most weeks. Ask who their consultants are and email them. Almost nobody turns down an offer of help with a QIP.

What is the portfolio actually like? Not worth stressing about in the first fortnight, but worth one habit from week one: keep a record of every teaching session you attend, even as a note on your phone. It has to go into the e-portfolio eventually, and reconstructing a year of it from old calendar invites is genuinely miserable.

I haven't touched medicine since April and I get sudden bursts of anxiety about how little I remember. Extremely common, and a normal response to an abnormal situation — medical training does not give you enough exposure to real responsibility, so the anxiety is reasonable rather than a warning sign. Most of what has gone is not what the day-one job asks of you, and the rest returns quickly once it attaches to a patient. July confidence is also a poor predictor of September steadiness: a room of new FY1s is a room of people all quietly assuming everyone else has it together.

It gets better, astonishingly fast

The version of you dreading the first Wednesday and the version who finds week six unremarkable are the same person, about three weeks apart. Most people do not notice it happening; the improvement is easier to see looking backwards than forwards. It might take six months to feel genuinely comfortable, or twelve, and it arrives with experience rather than with preparation — which is the honest reason this page is mostly about shoes, SIM cards and where the crash trolley lives.

The hard part is already done. You got in, you passed finals, and the GMC has decided in writing that you are safe to start. Every doctor you will work with began on a first Wednesday in August feeling roughly the way you do now.

Pay, entitlements and start dates were checked in July 2026. The pay figure and the exact August date change each year; everything else here changes rarely.