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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 (26)

  • While I don't doubt there are some good candidates lost to the profession who struggle with the CSA, let's not be in any doubt about the motivations behind this.

    Q. How can we get more people labelled GP off the production line and seeing punters?
    A. Dilute the quality. Noctors already seeing 50% of patients out of hours, so water down the MRCGP to make it as taxing as a 50yd swimming certificate and then everyone with 2Bs at A level can start dishing out syringe drivers.

    You think the Royal colleges of Surgeons, Physicians and Anaesthetists will be following suit?

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  • Maybe a 3 month crash course of anybody wanting to be a GP - if longer duration they might not come because they might as well then be plumbers and electricians who earn twice and have time for a round of golf.
    JH gives a hoot to quality of care, his whole existence revolves round churning figures as in the Andrew Marr show where he mentioned unrealistic numbers of GPs that have come into the system and of course, bashing 'lazy GPs' - the nincompoops who won't tow the line - his line!

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  • 99% who failed CSA were IMGs- overseas drs, they only failed because they were not well known to British culture.if people can work as gps without MRCGP, when there was no exam, why cant these young more intelligent modern drs work as GPs?
    MRCGP is an exam of British culture, it doesn't make you good or best gp. Lets see how many will come back.

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  • Thrashing around in the water whilst drowning only attracts sharks.

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  • I would be very worried about any doctor who has failed the inadequate MRCGP CSA process and still wanted to work in primary care.

    We cannot have higher and lower levels of GP's, medico legally they'd be too vulnerable.

    Silly for GPC to support this without an overhaul of the exam system

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  • The indemnity will surely kill this project as surely this group will have a risk profile much higher than a normal GP.

    Surely it's a false economy when the MDU want £20k+ a year to allow them to work.

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  • Vinci Ho

    Reality bites and you have to do whatever you have to do to make up the numbers . Not politically correct , obviously. But the question is what the government has done to help you to recruit and retain ? Bear in mind it wanted to cut HEE budget in certain fashion.
    Perhaps just scrap CSA and substitute with something more sensible, could be accepted as an alternative.

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  • I am not surprised if RCGP a little cool in reception of this idea - they need to keep monopoly of exam fees, as annual registration fees are going down as people stop renewing.
    I agree it would be unfair to let failed trainees be exposed to the risk culture of the NHS at present - MDOs would be horrifed, or make a killing!
    I am surprised anyone is even thinking about this when we have such low numbers of would-be trainees due to low status and low morale, and low pay, and those we have are held back or have their training unfairly extended by schemes wanting to shore up the shortages of hospital junior doctors by making VTS trainees repeat jobs unecesarily to fill rotas for 3 years.
    We also still have the ridiculous situation where competent british-trained, british or commonwealth doctors, including those with GP qualifications equal to (or actual) MRCGP,are not allowed to work as GPs in britain because they are not 'europeans', and possibly the sooner we leave Brexit the better!

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  • How can you ''maintain standards'' whilst at the same time allowing people who have failed the entry examination to fully qualify anyway. Either change the CSA to make it easier to pass or get rid of it completely...what's the point of spending literally thousands of pounds to pass it when it turns out that you don't actually need it to become a GP

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  • I have been told recently by one of my trainee coĺleague that there are doctors practising as acute medicine consultants without MRCP.
    I was surprised how can GMC allow this when it stands for patient safety?

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