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A faulty production line

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)

  • Why on earth would you want to be labelled MRCGP knowing that you will have to pay for the title every year for the rest of your life. Is it same as having private number plates or buying a title of 'Sir'- seems insane though must concede it does make you look more knowledgeable than those who don't have that MRCGP tail behind their names. Finally, is this impotent and hopeless College actually worth it's name?

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  • Never did the MRCGP - was in training practice and offered job before did the exam so seemed pointless. Saved a considerable amount of money - Have given a lecture under the aegis of the RCGP in the past!

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  • Strikes me as odd that the RCGP don't try and gain greater buy in from the grass roots GPs by offering membership to every GP who successfully revalidates. In my day - MRCGP was the "quality" marker. however since it moved to nMRCGP as effectively the entry requirement to General Practice - all GPs who aren't members who are effectively doing the job are in theory as qualified as those newbies who just pass. If you say they aren't then what is revalidation about? are you saying a revalidated GP with 20 years experiences isn't as good as a straight out of registrar year GP? The college however with its elitist attitude still forces existing GPs to run through the MAP process. which is wordy and long and tedious. FAP i could understand and indeed I would think thats a better way of electing fellows that the mates club it is currently.

    I never finished my MRCGP as i got a partnership and didnt need it. I've been on a PEC and am now a GB member of the CCG - I also hold an academic position. Arguably I've done more for general practice locally than one of my partners who was elected an F by his mates down the road who are also Fs (for being a trainer). but I'm not eligible for membership unless I sit MAP - who has the time - reading the CCG agendas takes all mine!

    Until the college recognises good grass roots GPs and embraces them the college will be increasingly irrelevant. by bringing on all GPs - they could reduce the fee!

    I however think i know why they don't - its their club - would they still be voted to the top and hold all the plumb positions if real GPs were involved?

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  • The NHSE were trying to recruit 500 doctors from India with diploma in family medicine. Its is interesting that there are 400 doctors having done GPVTS training and failed NMRCGP who maybe more suitable for this than new doctors. I call upon BAPIO/BIDA to try negotiate the same for such doctors to work at least as salaried doctors in primary care as long as there are no performance concerns.

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  • Peter Swinyard

    It beggars belief that the government would rather that our patients had an appointment with a paramedic or a physicians' assistant than by using the talents of this group of GPs who, for whatever reason, are failing the CSA. I would rather see as a patient someone who has passed finals after a 5-6 year course, done house jobs and 3-4 years more training than a physicians assistant who has done some sort of science degree and two years training. These people must be welcomed - perhaps as staff grade GPs where they must work under supervision. But don't waste their skills, talents and enthusiasms.

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  • Couple of thoughts
    1 Any profession has to have entry criteria.
    2 These doctors maybe doctors but they shouldn't be referred to as GPs because they are not.
    3 There should be no limit to the number of times the exam can be taken.
    If doctors eventually reach the standard even if they take 10 goes and 10years, what does it matter?
    (How they do this is up to them, they may have to work as a physician assistant and pay for training out of their own pocket?)
    4 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.

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  • With regards to point 2) the headline has been changed to reflect this

  • Peter Swinyard

    I understand the comments of John Ashcroft about sitting the MRCGP exam every 5 years to uphold standards. This option was thought about and specifically excluded when revalidation was set up. There would be four probable results - [1]many GPs would pack up (you may say good riddance - but those of my generation for whom the MRCGP was optional have been learning constantly over their last 30 years but never had Multiple Diplomatosis and hated exams - do you say we are all incompetent?)[2]the Royal College would be rubbing its hands in financial glee at all the fees it would generate [3]Many GPs would say "bother this for a game of soldiers" and quit and [4] those who sat through it all would have to take vast swathes of study leave - how would we fund that and replace the bums on seats?
    No - it doesn't wash. Sorry.

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  • Why don't they all become physicians assistants and get paid a salaried rate to do everything?!

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  • GP is not a specialty its let's accept it ... A gatekeepers job to hospital.... You have to make decisions whether a person needs specialist or needs to go home, for that you need experience which these doctors had by training for three years here ..... Not exams, no exam prepares you to make a right decision..... It's just a way for RCGP to prove to themselves they are no less then other specialties.... And earn money.... Allowing MAP route to these GP trainees would not only help our dwindling GP workforce but also prevent the training of these doctors going waste.......every other specialty has option of CEGPR, so why not in GP.... Espy when we are facing such crisis of doctors....

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  • I did the exam in 2012 and I would say it was as close to testing GP competence in an exam setting as possible. There will always be "false positives" - poor doctors who pass and I'm sure many of the cohort who persistently fail would be excellent GPs but I think being passed purely based on an eportfolio or your trainers opinion might allow weaker candidates through. Doesn't stop me feel desperately sorry for the people stuck in limbo though the sums of money some have paid out are eyewatering.

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