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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 am writing this since I am part of this large group of British trained doctors in GP programs whose career has somehow been devastated as a result of such unfair exam.

    I have already asked Terry Kemple to challenge me since I strongly believe I could have passed this CSA exam upon my first attempt and not failing this for 5 times and every time with only one mark when I did nothing wrong. I could have passed it if my performance was marked in a fair way.

    Let me give more background about myself. I had great clinical training experience from USA, passing all the USMLE steps including CSA all on my first attempt. Then I decided to become a GP in UK and in spite of all good records during my training, this exam has put a halt on my whole career.

    My question for RCGP is that how come USA has no examiner in their CSA exam and instead they review the recorded videos for marking it in order to decrease the bias? How come there is no fair appeal system in this UK exam?

    Our group of doctors are all knowledgable and experienced ones who are currently working in different departments of NHS or Private Healthcare with excellent feedback from their patients and colleagues on a daily basis. We have all been appraised and revalidated smoothly since finishing our GP training.

    I am just hoping the reshuffling of RCGP and most importantly the new Chair, Helen Stokes can be a constructive way forward for bringing us back to GP Land not only because of supporting us but also to help the nation as we are potentially the best option to resolve this crisis of lack of GPs.

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  • Mark Smith

    Same discussions are had in other countries chaps and chapesses. As a 53 year old lifelong UK GP who never bothered to retake MRCGP back in the day, I have had to sit the Australian equivalent which is just as controversial over here due to Internationals having a much higher failure rate. But having revised with some and experienced some of the poor quality primary care by those without the FRACGP (but allowed to work as GPs at a lower pay rate) I fully endorse there needing to be language skills AND an exam such as MRCGP because those trained in other environments are sometimes rather below par. Language skills are fundamental to a GP/patient interaction, without them, care given can be lazy/wrong/dangerous etc. There have to be high standards.

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  • Took Early Retirement

    I think those who fail to become GPs should be allowed to become consultant surgeons.

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  • John, it would be nice for those doctors to become colorectal surgeons and wish for them to have you as their first client. sarcasm is not an interesting talent of doctors, unless you see yourself as a good comedian, not a Dr.
    MRCGP has created a crises which made every GP around the country crying and mourning for not having enough staff, I doubt that the 400 doctors is an actual number, this what the college has admitted, for sure it is not reflecting the truth, also GP is not a specialty , it is vocational training which creates a good gatekeeper. Then you have revalidation which can prevent further Shipman, MRCGP IS a MONEY MAKER. It is the dying cow which has been milked to the end by RCGP, I didnt get to this fact until Clare Gerada questioned the necessity of the CSA/ MRCGP exam. There is no doubt that the clinical knowledge should be assessed in an exam, but assessment of communication skills should be assessed on day to day practice rather than one day exam.
    I hope the best for the mentioned doctors ( no doctor who has worked that hard , deserves what happened to them )
    farewell for the NHS we should do our best to keep it running and ensuring our patient's safety is in good hands (doctors hand, not nurse practitioners, paramedics or pharmacists, non doubtfully some are good in what they do , but not to become doctors/GP )

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  • It is utterly inexcusable that the RCGP is advocating the use of a skill mix to include paramedics, nurses, pharmacists and physician's assistants who have not even done basic medical training - yet they are not allowing doctors who have trained in GP IN THIS COUNTRY to work in some capacity.

    It's a mad, mad world.

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  • Bottom line is that RCGP exam is a money churner. More the failures and re-attempts, more the money pouring into RCGP coffers. Let's consider this fact of life and then think of those missing the mark by one point - a colleague mentions missing it by one point twice!

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  • Doctors who fail the exam are more likely to be:

    Older and more experienced
    UK trained and of ethnic minority

    I may understand why IMGs are more likely to fail – why does experience not help in this exam?

    What is wrong with male doctors?

    Why are UK trained doctors from an ethnic minority much more likely to fail?

    Dr. Aneez Esmail’s report into the exam in 2013 concluded that even after controlling for age, sex, and performance in the applied knowledge test black and minority ethnic graduates trained in the UK were four times more likely to fail the clinical skills assessment at their first attempt than their white UK colleagues.

    If this exam was part of revalidation – it would be cancelled within a day.

    The exam has a 25% failure rate – much higher for older candidates.

    Once these doctors are not allowed to practice any longer – the public outcry from this would kill this exam once and for all.

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  • Hi
    Having decided to pursue General practice as a career I enrolled to be a GP after leaving my job as a well established hospital Doctor.I underwent the rigors of training in different specialities to help me equip to be a competent GP .i passed my AKT on my first attempt. I worked efficiently as a GP trainee in my surgery needing little help or supervision, passed my work Place based assessments and had excellent patient feed back. My only hurdle was the CSA which is basically a exam of my English behavior skills. I had little support from my own trainers who had never been exposed to the CSA and were at a loss to understand what was the CSA trying to achieve. In a exam where the actor had his own agenda and react differently to a English and a non English Doctor how can the exam be deemed fair?This controversial exam is aimed at keeping GP as a exclusive club of the privileged few who can act rather than be good doctors
    It's a shame that during such a dire crisis the RCGP seems to be in denial of its own failings. I dare say there could be nearly a 1000 doctors in limbo (RCGP in denial for some unknown reason)due to this exam fiasco.Most of these doctors had no problems passing the other fellowship exams. So why the CSA exam is in news ? There is a lot of soul searching to be done by the RCGP as this has ruined our careers ,broken families and driven us bankrupt. Having entered GP in good faith as had a passion for general practice and to contribute to the nhs ,we feel lost and let down. I hope the RCGP will open its eyes and undo the wrong for this group of doctors .When having patients seen by a physician assistant or a practice nurse is acceptable why not use these group who are already trained and passionate to serve back as GPs. There are thousands of GPs practicing without the MRCGP so why this double standards?

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  • Not only should there be accountability but also follow up from the RCGP who has shown either an inability to or otherwise an unwillingness to deal with these 400 doctors whose careers have been ruined due to a failure to recognise and /or to react !

    Do either BAPIO or the BMA have a constitutional stance to propose a viable solution or will this be another BREXIT / Junior Doctor outcome that lingers on forever as the 'institution of General Practice is falling to pieces' ?

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  • RCGP should be accountable for creating this mess?Are the GP leaders sleeping?Shame on dont have the guts to challenge RCGP

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