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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)

  • I never sat the MRCGP as Summative assessment was the entry criteria when I was a trainee. I never felt the need, nor do I now, 20 years later, despite my workplace paying those with the MRCGP more than those without, despite there being no actual evidence that they are actually any better. As for the comment that the MRCGP should have elements of business and management, well, no. Not all of us work in NHS Practices.

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  • RCGP (Royal College of General Practitioners) should be renamed as ROYAL COLLEGE OF SPEECH AND LANGUAGE. RCGP is not testing the clinical abilities of doctors but some useless communication skills which will in no way save the life of any patient.

    Everyone knows that CSA examiners are all GP Trainers. In my opinion I feel that the GP trainers are to be blamed for this fiasco, because for various reasons ( eg increasing administrative work load, working part-time, becoming port-folio GPs etc) the trainers themselves end up having so poor clinical knowledge that the only way they can show that they are somewhat superior to the trainee doctors is in their ability to communicate with the patients.

    In most situations, when a GP trainee approaches a trainer and asks them a simple straightforward question about any clinical issue, they give bull s**t responses like - where do you think you will find the answers (with the lame excuse that this will encourage self-directed learning) but they themselves cannot admit to the fact that their clinical knowledge is no better than that of the trainee.

    Good communication skills do not save patients lives (except in some rare incidents where in patients completely misunderstand the advice given by a doctor) but poor clinical knowledge definitely does. Also just being able to communicate well does no make one a caring doctor.

    Patients would rather prefer to be treated by a doctor who has sound clinical knowledge even though they may not be having some exceptional communication skills.

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  • I am one of the unsuccessful doctor who fall into this group. I failed CSA exam by narrow margin of one mark on two occasions. My aspirations of becoming a GP was put to a halt in spite of having excellent patients and colleague feedback and Supervisor support. Would getting a mark less make me any less competent than someone getting a mark more? Would it not be appropriate in such circumstances to look at overall training and assessments before ruining someone’s career? Sad part of it is that we cannot even challenge the results.
    We are not asking to reduce the standard of training, it is about making sure doctors with potential of becoming a good GP are not lost in the process.

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  • What makes a good doctor!? The trainers do not know where to find the right answer, they only pretend........God bless

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  • Truely agree with @3.36pm.... I also failed by one mark.... And unlike other specialities .. Nothing to show for three years worth of training... No way to prove yourself.... No way to show that money spent on my training was well worth it.... And all other specialities happy to employ me except the one l spent three years in training, gaining experience, building doctor patient relationship. So sad all that has been ignored by RCGP, except Dr Terry Kemple, who has been so supportive and empathetic to our case, yet his hands are tied by RCGP. I have high hopes that Dr Lampard will revolutionise the college and put patient care and NHS above all the beaurocracy and rigid rules.A patient wants to see A doctor , who can help mitigate his problems, he does not care whether he has MRCGP, he wants to see A doctor , not nurse or physician assistant, yet with all the crisis of GPs, the patient is being denied this basic facility, and not least helped by the attitude of the college ... Denying doctors like me a chance to prove ourselves and help us and patients.

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  • Just goes to show how desperate things must be in India for these candidates to continue knocking on the RCGP's doors inspite of failing repeatedly and spending all that money in the process.

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  • When Dr Clare Gerada says ‘whole process of working in the NHS disadvantages overseas doctors.’ my heart sinks. I got my MBBS overseas. I think she is right. Could this be due to communication difficulties of overseas qualified doctors or due to patients' bias towards them?

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  • @5.06pm..... Wrong just goes to show how desperate the things are in UK that it's going knocking on India's door requesting its mere diploma holders, who are nothing extraordinary to come and work in UK as GPs...so much for ''high standards''...... History is proof that it has always been UK which has gone knocking on other countries door begging for doctors to come and join its sparse army of doctors...... In a country where sadly more often then not people prefer to drop out of school and be couch potato...being drip fed by the state benefit system ......no one really wants to work ... Let alone be a doctor..... Working under rules of people like Hunt.... Being exploited and paid mearge wages..... I don't'' wonder''...... I know things are desperate in UK/NHS

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  • I find it highly suspicious that so many of these doctors are failing marginally/by one mark. It brings into question the authenticity of these exams, raising an issue of probity against the college.

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  • Passing exams simply proves that you can... pass exams. Don't forget that there are other groups of people who can get discriminated against by the exam system - principally those who find the exam process itself terrifying, however good a doctor they are - and it's made worse if they feel that the current exam is their last but one chance to get into the job they've always wanted.
    There's a simple answer to all of this - remove the 'four failures and you're out' rule; and recognise that things need to be amended for those who are exam-phobic

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