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LMCs reject introduction of 'intermediate' grade for GPs who fail MRCGP exam

GPs threw out a proposal to introduce a new ‘intermediate’ grade for failed trainees in a hotly debated motion on the first day of the annual LMC’s Conference.

The motion - proposed by Dr Andrew Paterson from Hampshire and Isle of Wight LMC as a way to fill gaps in the GP workforce - was overwhelmingly rejected by conference after GPs warned it would create a ‘two-tier’ system and would be ‘dangerous and divisive’.

Dr Paterson urged for the new intermediate grade to keep trainees who failed the MRCGP in general practice ‘so that they may enjoy a safe and fulfiling career in a supervised capacity and their training time and effort is not wasted’.

Some GPs were sympathetic to the plight of GP trainees who they believed had proved themselves good and safe doctors, but repeatedly failed a part of the MRCGP.

Dr Peter Wiliams, from Derbyshire LMC, described the case of a registrar at his practice who ‘passed his AKT easily’ and who his partners felt ‘was an outstanding doctor’ but who he said ‘got stage fright in front of actors and failed his CSA five times’.

‘In my day, he’d have done a video and passed, but unfortunately he failed,’ said Dr Williams. ‘The system isn’t working and we’re not retaining some of the doctors we should be retaining - whether we should have a subgrade in general practice or need to examine differently I can’t be sure, but what I do know is we need to keep these people working in general practice.’

However, Dr Simon Minkoff from Hertfordshire warned delegates creating an intermediate grade would be ‘dangerous’, ‘set back UK general practice decades’ and ‘create ‘a two-tier post-code lottery of those practices wholly staffed by fully trained GPs and those not’ that would result in a ‘loss of patient trust and erosion of respect for the profession’.

It follows a long legal battle around the fairness of the Clinical Skills Assessment component of the MRCGP exam, after an international doctors group pointed to huge discrepancies in the number of international medical graduates failing the exam.

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Readers' comments (13)

  • Nonsense proposition. Let the DoH deal with recruitment crisis...stop trying to be everything.

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  • But its ok for primary care to be run by nurses, pharmacists and physician assistants. I despair

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  • I agree that this intermediate grade would have detrimental effect on prospective GPs. Most IMG would end up that way by failing CSA and RCGP rather than giving further support will ask the trainee to join intermediate grade and be exploited.

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  • don't think ' intermediate grade ' is the best option.

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  • how 'bout just making the exam fairer to begin with or is that too obvious ?

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  • Let all those current GPs who have not taken AKT and CSA sit for the exam, and those who cannot pass the test could be labelled as Staff Grades.

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  • I don't think intermediate grade will give GPs enough motivation for work. All focus should be on making role playing CSA fairer. CSA puts one group of doctors in a significant disadvantage. To work as an independent doctor, you need good clinical skills otherwise you may burn out soon. I failed CSA by 2 points, but passed AKT with very good mark. My WPBA was very good as well. I am currently enjoying working in A&E and sorting out GPs referrals. My A&E colleagues few times mentioned that what was wrong with RCGP for failing me in CSA. Some of A&E consultants mentioned to me that they were cruel to me for not allowing me to become a GP. Even some of the mentioned that RCGP is a looser for not qualifying me as a GP, but A&E is a winner for having me. Anyway, I feel sorry for tax payers money spent on my training.

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  • So the MRCGP makes you a safer doctor then?

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  • I pay tribute to Dr Andrew Paterson and Dr Peter Wiliams for their courage and common human decency to come out and address an issue, the masses conveniently and cowardly swept under the carpet since the judicial review. Dr.Paterson and Dr.Williams are not the only educators know about this injustice from their own experience yet other educators do not seem to have convictions in their souls as strong as Dr.Paterson and Dr.Williams to be altruistic or stand up to the injustice.
    However, I do not think an intermediate grade would do any good for those demoralised , broken cohort of IMG doctors to work in an environment constantly haunt them and remind them of the injustice they had to endure by simply choosing General Practice as their career. When a post graduate exam consistently has a >95% pass rate for a cohort of individuals based on their protected characteristic, anyone with an intact cerebral cortex can decide how robust that exam could be.
    Majority of the IMG doctors who had to endure this injustice are high achievers and people with resilience. They are the people who were willing to take a challenge by leaving behind the known and embraced the unknown. Majority of the GP trainers know it, hospital consultants know it, even your GP trainee colleagues know it. I think they would be better off choosing a speciality where they will be treated with dignity and appreciation. It is never too late to be trained in another speciality where some of the skills can be transferable like A&E.

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  • " Make the exam process Fair " and abolish this Flawed system.

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