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GPs go forth

'We propose an alternative to MRCGP exams process'

A group have GP trainers have written to the RCGP about their concerns around the delay to training programmes

We write with grave concern about the uncertainty around the future of some GP registrars (GPRs) due to the current Covid-19 pandemic. We appreciate some helpful guidance released by the college (RCGP) around ARCP progression and an update on the discussion around the applied knowledge test (AKT) and clinical skills assessment (CSA) examinations.

However, the GPRs are understandably very concerned about their future due to the cancellation of the AKT and CSA examinations due to the pandemic. We share their anxieties as the situation creates huge challenges for many GPRs and their families.

It is impractical to hold these examinations in the near future due to obvious reasons.

We anticipate that primary care will face immense pressures to deal with the continued state of the pandemic in varying degrees of severity as we deal with both Covid-19 and non-Covid-19 illness, suspended referrals, and delayed presentations in addition to its immense toll on the mental health of our patients. Hence, we must be as prepared as possible and realise that capacity of primary care is going to be under unprecedented strain.

During the current crisis, we have seen a very practical and realistic approach by many regulatory organisations such as GMC and CQC as well as UK medical schools to allow consolidation of the workforce. Hence, there is a clear precedent to take a pragmatic approach to the future of these GPRs to allow them to progress to qualification.

Also, we understand that there is another cohort of more than 500 GPRs previously not able to progress to CCT, some of whom have already been allowed to re-enter training. Their future is also in doubt. This will also be a great opportunity to allow these GPRs to be provided with an alternative so that they can contribute to looking after our patients and the wider NHS.

We propose that an alternative format in form of work-place based assessments and GPRs’ reports be urgently rolled out to allow these trainees to enter into the primary care workforce – a format similar to the summative assessment used in the past. These assessments along with their standardised supervisor reports can give sufficient objective information to the panels to make an appropriate judgement. A significant majority of the current trainers are a product of that system and proudly provide safe care to our patients.

We feel this approach will enable maximal use of the workforce whilst balancing with a previously well tested and validated system. Any format will have its pros and cons including the current format. However, the current need is of a safe and practical approach.

Exceptional circumstances demand exceptional solutions as other NHS organisations have quickly shown.

An alternative format to the current format of the MRCGP has been called for a while and our proposed approach can be reviewed to form a basis for this in future.

Hence, we urgently request the college to take a lead to implement this approach to bolster the primary care with nearly 2,000 GPs.

We very much look forward to a positive response.

Yours sincerely,

(A group of GP trainers with names in alphabetical order)

Dr. Keith Birrell

Dr. Girish Chawla

Dr. Ranjita Choudhury

Dr. Stephen Dellar

Dr. Dhirendra Garg

Dr. Shilpa Garud

Dr. Varun Kaura

Dr. Ankur Khandelwal

Dr. Palani Krishnamoorthy

Dr. Savitri Laloo

Dr. Andy Lindop

Dr. Rajiv Mansingh

Dr. Alexandra Milne

Dr. Liz Moylett

Dr. Nasir Nabi

Dr. Uma Narayanan

Dr. Vidya Parajulie

Dr. Amith Paul

Dr. Hemant Rana

Dr. Harish Rao

Dr. Nitish Sahoo

Dr. Sanjaya Samarasekera

Dr. Kamal Sidhu

Dr. Pawanjit Singh

Dr. Rishika Sinha

Dr. Nick Timlin

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Readers' comments (13)

  • OR - use some of the 100s+ GP locums who are currently idle to cover trainers and examiners to crack on with the examinations in a socially distant way?

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  • I have been training for 15 years now with a mix of strong and weaker trainees.
    If a Trainee has been progressing well throughout their full training scheme and are coming to the end of ST 3 I have no problem them being waved through.
    Those on an extension often have a history of struggling throughout their scheme and should be expected to prove their competence and not just be waived through.
    They do however need a guaranteed funded post till they are able to prove themselves via their external assessments.
    Perhaps we could go back to submitted video consults rather than CSA.

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  • Trainees can be ready at different times to practice as independent GPs as training is multifactorial. This can be overcome with adequate supervision and time with most trainees.
    Adequate extension should allow them to progress in most cases.
    We should also be able to identify those who are not trainable very early and also be able to sign post them on an alternative career, so we don’t waste resources in training them.

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  • it would be a huge gamble for any college to just drop their income generating exams..good luck

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  • Totally agree

    Well done Nasir

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  • Please also remember those "ex-GPs" who are trying to get through the Induction & Retention Program to return to general practice. I am waiting on a Simulated Surgery exam (cancelled) before I can engage in training. Under current circumstances in-place assessment in a training practice would seem very sensible. As usual though, bureaucracy gets in the way of getting the job done.

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  • I wholeheartedly echo the comment by Steven Hopkins. I am also on the Induction & Refresher scheme for returning GPs. I am now unable to make progress because I cannot sit the MCQs assessments (the first step of this GP return process), because all the Pearson Vue Exam Centres are closed as a result of COVID-19.

    Surely, it is not beyond the realms of possibilities to allow us to sit these electronic assessments, at home or in an NHS Facility or even at the RCGP or the HEE offices? Schools and universities have all found alternative ways to deploy electronic testing.

    We are short on GPs across the country, and the backlog of health needs once the lockdown is lifted will be huge. It is totally unacceptable for NHS England to expend a great deal of energy to get retired doctors to return and not find ways to release this GP capacity, by finding an alternative route to allow this large cohort of us to return to general practice.

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  • i gave up paying into the RCGP slush fund some years ago. i never sat the MRCGP because i was a single handed, rural, dispensing GP who was on call all the time and didn't have time for this malarky. the ultimate drop in my estimation of the "college" was when they made jamie oliver - a chef for christ's sake, with no medical clue - an honorary fellow ! so a cook can, in theory, put FRCGP after his name, but i carry on paying into their bank and get nothing at all in return ! i qualified in 1976 !

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  • doctordog.

    I thought alternative was going to be a relevant examination which tests competence to work as a GP not the touchy feely current assessment that misses this aspiration widely. Not unexpected from the Mickey Mouse royal college that is the RCGP.

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