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The waiting game

Fast-track training could salvage potential GPs 'lost to the profession' says GPC

Exclusive The GPC has expressed its support for Health Education England to go ahead with plans to explore an alternative route to GP qualification for trainees who have failed the MRCGP.

As revealed by Pulse last year, Health Education England has suggested struggling trainees - or doctors switching specialities - could receive personalised support to fast-track their GP training.

It invited both the RCGP, which oversees the current assessment, and the BMA to give their views on the 'fixed term targeted GP training' plans, with both parties now having supplied feedback.

The GMC has already recommended, in a recent report, that medical training in the UK 'needs radical overhaul' to become more flexible for trainees.

According to HEE, all parties need to agree for the new training option to become a reality. But Pulse understands that although the BMA is keen for the plans to go ahead, the RCGP may have severe reservations.

Under the proposals, trainees chosen for targeted training would not need to obtain a full certificate of completion of training (CCT) to practise.

They would instead use an existing equivalent qualification, the ’Certificate of Eligibilty for GP Registration’ (CEGPR), which is usually reserved for overseas doctors, and undergo a 'bespoke training programme' accounting for 'existing experience and expertise'.

HEE hopes that this would make retraining as a GP less prohibitive in terms of time and loss of income.

The GPC's response to HEE, seen by Pulse, says the proposal could be a sensible solution to the problem of doctors being 'lost to general practice'.

But, although the college would only supply a brief statement on the matter, Pulse understands the RCGP's position could be less welcoming.

GPC workforce lead Dr Krishna Kasaraneni told HEE that when a doctor has had the maximum four attempts at obtaining the MRCGP, it ‘makes sense’ to let them reapply for further training ‘to become independent practitioners in future’.

He said: 'We believe your proposal is one such solution which recognises that training should be personalised to support doctors who would otherwise be lost to general practice to demonstrate the competencies needed.’

Although he added that it was ‘important that the bar for qualifying as a GP remains at an appropriate level’.

The letter concluded: ‘With this in mind we welcome the opportunity to continue to work with you and other colleagues to progress these proposals which we hope will remove some of the barriers to enter GP training.’

Asked about the college's response to HEE, RCGP chair Professor Helen Stokes-Lampard said that a ‘very small number of trainees’ were in the position of failing a part of the MRCGP examination, and that they were already being supported by the RCGP.

She added: 'Patient safety is, and always will be, the top priority for the college - and the MRCGP assessment safeguards this by ensuring that all GPs have the clinical skills and knowledge necessary to practise independently in the UK.

'We will continue to work with the GMC, as the medical regulator, and other interested bodies, to explore any ideas that will help us to do this effectively, while ensuring that standards of patient care are not being compromised.’

Professor Simon Gregory, HEE primary care lead, told Pulse: 'We are seeking to increase flexibility while maintaining standards and also ensuring fairness.

'This requires the support of the Royal College of General Practitioners (RCGP), British Medical Association General Practitioners Committee (BMA GPC) and the General Medical Council (GMC) among a number of stakeholders.’

‘A further update on this work will be available in due course.'

Qualifications required for GP training

The RCGP administers the examinations that make up the MRCGP, which is now a pre-requisite to achieve a certificate of completion of training (CCT) and practise independently.

These include the clinical skills assessment (CSA) which was subject to high court challenge over the variation in pass rates between white and black and minority ethnic doctors – though the ruling found in the RCGP's favour.

The other components of the examination are an applied knowledge test and workplace-based assessment.

Pulse has revealed that the RCGP’s own estimates show around 400 GP trainees are stuck unable to practise because they cannot pass the final exam, and trainers say this cohort is needed by the NHS.

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

Readers' comments (28)

  • I know many GPs working without MRCGP.

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  • To Jo Smith...we had higher and lower GP trainees for years. One group submitted themselves for MRCGP the other group just did the Summative Assessment thing. This pertained at least 1995 to 2005. Nobody cared less then.

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  • don't know what other people think but the exams are not difficult so if you fail you probably don't know enough?

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  • I wonder what might happen if a nation recruited its armed forces in this manner.........

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  • I can't understand what the fuss is about!!...When all other specialties have the option of alternative route(a.k.a Article 14) to achieve certification and have the option of specialty doctor....why is RCGP and all people here being so pedantic..l believe a patient would any day like to see A DOCTOR then a nurse practitioner!!!!!!In this time of crisis in General practice RCGP needs to explore all avenues to provide patient care....If such acute and high intensity hospital specialities can allow other routes why cant RCGP.....TBH.....when GP is just a gatekeepers job.

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  • 4:32
    Patients are seeing nurse practitioners.

    RCGP knows being a GP is not as attractive as being an orthopaedic surgeon but how does it show its importance?.By setting hard rules for the doctors by saying patient safety.At the same time RCGP turns a blind eye towards nurse practitioners as well as physician assistants who are practising without MRCGP.
    I would prefer to see a doctor not a noctor.
    This is all clever tactics to keep their control over the current GPs and GP trainees.

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  • gatekeeper turned poacher .

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  • Once you got your MRCGP, you've got to pay for the rest of your career to add that tail. Worth it? Think not considering there may already be an obesity problem among RCGP leaders.

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  • I completed 38 years of general practice very happily without being a member of the RCGP and very proud not to have been one. How did it ever become a pre-requisite anyway??

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  • Never done the MRCGP, although I could pass it standing on my head so to speak. I have avoided all contact with this odious self serving organisation and I too am proud of this.

    This is from someone who does far far more medical education yearly than required

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