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College rules out GP knowledge tests

RCGP opposes high-stakes exams to revalidate GPs, but only after heated internal debate

Knowledge tests will not form part of any new system to

recertify GPs after the RCGP said it was opposed to their


In its response to the Chief Medical Officer's review of regulation, the college said it 'does not support the introduction of routine and mandatory formal high-stakes examinations to revalidate doctors'.

But Pulse understands its final decision came after a heated debate within the college, with its chair of council Professor Mayur Lakhani believed to be in favour of formal tests.

Sir Liam Donaldson called for doctors to face comprehensive assessment against

standards set by the medical royal colleges as part of a

five-yearly recertification process in his report Good

Doctors, Safer Patients.

But he left it up to the colleges to decide how assessment would work.

The Government would now have to insist on knowledge tests for them to happen. Its

response is expected before Christmas.

The RCGP said it acknowledged the concerns of the profession about tests. But three council members said the

college had been divided over the issue.

One of the GPs said: 'The

level-headed brigade has won out over the hawks.'

The source added: 'I believe our chair, Mayur Lakhani, is very much in favour of

knowledge-based assessment.'

In a BMJ paper on revalidation published last year,

Professor Lakhani, who was

unavailable for comment,

said knowledge tests were 'the most accurate predictor of poor performance' in the MRCGP


Another RCGP council member said the college was 'torn

between being at the leading edge or responding to what [Sir Liam] Donaldson wants'.

The GP added: 'It may have seen opportunities if full blown take-up of Donaldson had come about but at the moment what they're trying to do is wait and see what the Government response will be.'

Dr Maureen Baker, RCGP honorary secretary and the

officer in charge of the college response, denied allegations of a split over the issue.

She said: 'We've always said we didn't believe a high stakes knowledge test was appropriate. Obviously it's entirely appropriate in a debating chamber for there to be pros and cons [expressed].'

GPs expressed their relief at the college's stance.

Dr Laurence Buckman, GPC deputy chair, said neither the BMA nor the GPC backed knowledge tests.

Dr Anthony Hereward, a GP in St Austell, Cornwall, said: 'I don't think it would protect the public from a rogue GP.'

The RCGP also rejected the proposals to move from the criminal to the civil standard

of proof in fitness-to-practise hearings.

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