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400 potential new GPs trapped in MRCGP limbo as GP leaders call for reform

Exclusive The RCGP has estimated that around 400 doctors are stuck in limbo after repeated failures to pass its MRCGP exam, prompting GP leaders to call for the college to ‘look again’ at the exam.

The figures were revealed in minutes seen by Pulse of a meeting between the college and campaigners working on behalf of many of these doctors.

They have been in talks around potential alternative routes to registration, such as further training and an alternative licensing assessment.

GP leaders – including the former RCGP chair – have called on the RCGP to look at reforming the training process.

But the RCGP has said that developing an alternative assessment model would not be cost effective and would require an overhaul of the current regulatory framework.

It follows the row over the differential pass rates between white and black and minority ethnic doctors taking the CSA, which led to the college undergoing a judicial review.

The court ruled the MRCGP was lawful but urged the RCGP to take action around the number of BME doctors and international medical graduates failing the exam.

Candidates are given four attempts to pass the exam, after which they are barred from taking it again - unless there are exceptional circumstances.

GP Dr Narveshwar Sinha has been working on behalf of around 100 of these doctors, and minutes from his meeting with the college seen by Pulse, discuss the number of doctors ‘who have not attained the MRCGP’ - which the college estimates as ‘possibly around 400.’

Dr Sinha has been calling for these trainees to have further supported training time before undertaking an alternative assessment to the MRCGP.

However the RCGP has said many of these doctors already have difficulty providing robust evidence of their clinical skills and knowledge for the existing ‘equivalence’ routes to registration, such as the Certificate of Eligibilty for GP Registration (CEGPR).

The college’s minutes state: ‘CEGPR is generally not intended for doctors who had not managed to attain MRCGP and that it is usually for already trained and experienced GPs from abroad.’

But Dr Sinha told Pulse: ‘These 400-500 doctors who are already here, why don’t we use them rather than struggling to find doctors from Europe, or India or wherever else?’

This comes after Pulse revealed NHS England was in talks with recruiters about a ‘pipeline’ of nearly 600 European GPs, who could come to the UK in the next three years as part of GP Forward View commitments to recruit 500 GPs from overseas.

RCGP chief examiner, Dr Pauline Foreman told Pulse while the College was sympathetic to the problem faced by the GPs Dr Sinha represents, they couldn’t reasonably overhaul the exam.

Dr Foreman said: We explained to Dr Sinha that his proposal is not deliverable within the current legal regulatory framework, and that many of the changes required to enable it are not within the remit of the College.

She added ‘it would not be reasonable or proportionate’ for the College to develop a new licensing exam ‘for the small group of doctors who are unable to reach the standards’.

But former RCGP chair Dr Clare Gerada told Pulse she agreed the GPs could help the workforce crisis, and - while she didn’t think the CSA was discriminatory - the ‘whole process of working in the NHS disadvantages overseas doctors.’

Dr Gerada said: ‘I do think we should look again at alternative routes to MRCGP. Not letting people in who are not good enough, absolutely not. But we should be looking at alternative spaces where these GPs can work.’

Dr Krishna Kasaraneni, chair of the GPC’s education, training and workforce subcommittee, said: 'We’re set on the mindset that an exam proves somebody’s competence, the exam proves you can perform in that exam. Certain aspects overlap with competence, but because they’ve passed an exam doesn’t make them a good GP, and failing doesn’t make you a bad GP.'

'What we need to be able to do is to train GPs in an atmosphere where they get proper training in general practice from day one, rather than identifying problems when they’ve failed the exam a few times.'

Readers' comments (41)

  • the best way to deepen the already severe recruitment is to introduce an MRCGP exam every 5 yars. It will add another way to quicken the demise of general practice as we know it. God forbid anyone who thinks so has any power to have this approved.

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  • This NMRCGP is another form of 'harrasement' in my opinion.

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  • In secondary care they have staff grade Dr's those Dr's did not pass higher qualification or did not attempt to do so but they are doing marvellous job.Why you have to pass MRCGP to do marvellous job ?patients don't look at your qualifications when they enter your clinic they look at your smiley face and watch your attitude towards them.Some Dr's In RCGP are paranoid.

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  • It seems reasonable to have an exam but is the MRCGP really teaching what we need? The CSA, in particular, seems to be failing good candidates and as I recall was more an exam in British social etiquette than medical competence.

    General practice is becoming more complex each year and we need diverse doctors that bring differing skill to the practice mix. The current exam does little to teach business skills, medical law and management - the stuff that keeps practices safe and functional. It's time to reform the MRCGP but I'm in agreement that allowing staff grade GPs without this qualification would be far better than leaving patients without access to primary care physicians.

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  • Good suggestions above. Like those posters I went straight into a partnership from VTS and then never had the time or the inclination to do MRCGP. After 25 years in the job and having jumped all the hoops for revalidation it seems an irrelevance to me now.
    PS let's hope that Hunt gets reshuffled soon! Might stop me from retiring

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  • 'Trapped in MRCGP limbo'!
    Sounds like a one way ticket to Hell!

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  • Having recently sat the CSA I must say it really wasn't that difficult. It did just feel like a normal morning surgery. I think if you can't pass after 4 attempts with some pretty extensive coaching and support they perhaps that candidate should consider an alternative career. Having a recruitment crisis doesn't mean we should be lowering standards. You can't even get a training number in surgery without MRCS never mind finish it.

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  • i have to disagree with John Ashcroft when he says

    anonymous 10.50 makes a valid and an uncomfortable point even if he didn't intent to... Re validation is not an appropriate way to ensure that those who are GPs are upto standard. The only way is to sit the MRCGP exam. I suggest every 5years and this includes those coming from abroad. especially now there is Brexit

    1. what are we doing revalidation for then? if the RCGP thinks its a waste of time say so and lets be shot of it.
    2. or why don't they campaign for the revalidation process to be more robust (more like MAP) and a pass means RCGP membership

    i seem to recall they've just watered it down?

    3 its arrogant to state that the nMRCGP is the perfect test to assess GPs in practice with experience and real case loads. its not reflective of the patients i see or deal with after 20 years in practice and doesnt allow the fact that i can ask colleagues/ consultants for help if needed rather than having to sort the case in 15 mins.

    4 there is no comment about the RCGP wanting to broaden its membership. its a bunch of arrogant GPs who think they are better than the rest of us - though i suspect few of them do anything like full time work.

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  • Agree with most of John Ashcrofts points.
    Sadly every profession has trainees that do not make the grade. This applies to all medical specialties including general practice equally as it does in accountancy or the legal fraternity.

    The 400 gps are not qualified hence are failing trainees, not gps. Why they are failing is likely to be varied in reason and severity however if they have had the additional 6 months of funded support beyond their standard st training we must be honest with them and say are will not be gps. Simply having a desire and experience of attempting to do the job does not make a good general physician,( which in essence is what we have become).

    Self funded training might be an option but this 400 reservoir of doctors should not be considered as 400 gps being held back from practicing due to red tape. They have not crossed the required line to do so.

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  • Dear RCGP why are you so afraid to VIDEO the CSA exam regardless of so much pressure to do so? I wonder why you are so afraid of transparency? IS THERE MUCH TO HIDE?
    One examiner per station, no evidence to challenge the examiner’s decision. Repeated high failure rate of one group of candidates of protected characteristics despite being selected by a competitive process for VTS training. Progression through multiple ARCPs over the years until the CSA exam. High stake exam yet no fair appeal process. It is astonishing this kind of things can happen in a country like United Kingdom where justice and fairness believed to be championed! Where is justice and fairness in case of MRCGP exam?
    -LWT

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