Background

Background

Shortage of GPs
RCGP documents projected GP shortages across England. It reveals that some parts of the country will need substantial increases in the number of family doctors employed locally by 2020, to meet the growth of the population. Figures produced by the Royal College of General Practitioners (RCGP) show that certain areas of the country will need at least a 50% increase in the number of GPs working in the community over the next five years - due both to the growing population, and shortages of family doctors that already exist locally. Overall, RCGP research shows that England will need 8,000 new full time equivalent GPs. RCGP published on 05 September 2015 that more than one in 10 GP roles in England are vacant, meaning proposals for seven day working are 'unrealistic', with many practices increasingly having to rely on locum doctors to deliver patient care. The dire situation regarding the mismatch between demand and supply has been recognised by the main political parties. The Conservative party has committed to training and retaining 5,000 more GPs by 2020 - to allow it to achieve its pledge to provide patients with GP access seven days a week - from 8am to 8pm - by 2020. However, so far, the efforts to increase the number of GP’s in order to achieve this, has been unsuccessful and the proposed solution to bring and train junior doctors from abroad comprises extra time, educational and financial resources. The labour government pledged 8,000 GPs in their election campaign in 2015 again without a reference on where they are going to source the workforce from.

GMC
CEGPR (AP) applications are for the doctors who completed GP training in GMC approved training posts, but failed to pass one part of the MRCGP within programme. If a GP Specialist Trainee has not successfully completed all aspects of GP training, within programme, they will not be eligible for a CCT. They may be eligible to apply for the Certificate of Eligibility for GP Registration via the Approved Programme (CEGPR (AP)) route. The criteria for this application are that at the time of leaving training they had not passed one part of the MRCGP – either Applied Knowledge Test (AKT) OR Clinical Skills Assessment (CSA) component of the examination and that they have passed the missing part of the MRCGP within the six month period after their final day in training or unless they were given express written permission by the Chief Examiner or nominated deputy to take the examination later. The other fulfilling criteria is that their final ARCP form shows that all other aspects of the training are complete, including Workplace Based Assessment, with no outstanding actions other than to pass the AKT or the CSA. In their final Educational Supervisor’s review, all the competence areas are rated by the supervisor as either ‘competent for licensing’ or ‘excellent’. This CEGPR (AP) application must be submitted within 12 months of their final day in training.
CEGPR (CP) route- some trainees who decide to join an approved specialist-training programme have previously trained in other, non-approved posts. The LETB may decide that this has already given the doctor some of the CCT curriculum competencies. If so, they may be able to enter training at a later starting point, complete the rest of the programme and gain the remaining competencies. This is known as the ‘combined programme’.

RCGP’s stand on number of attempts currently
RCGP chief examiner Dr Pauline Foreman has commented, 'The current regulations for candidates who entered UK GP specialty training after 1 August 2010 permit a maximum of four attempts at both the AKT and CSA during training. This limitation on the number of attempts is evidence based, and the current policy has been approved by the GMC. Fifth attempt has till now being granted in ‘exceptional circumstances'’. However she has added that 'the RCGP would be receptive in principle to a change to the current regulations to allow an exceptional fifth attempt at either the AKT or CSA provided that those sitting for a fifth time have undertaken appropriate additional educational experience since their last examination failure and sufficient progress has been made to merit a further attempt. Any arrangements of this kind would of course need to be agreed collaboratively with the deaneries/LETBs as they are the bodies responsible for GP training, and the RCGP is currently working towards this aim.'
The GP Work Force Forum, though supportive of RCGP’s initiative feels that giving extra attempts does not make much difference to the outcome of the result of the CSA or AKT examination.

Court case against RCGP and GMC
Reports last year revealed significant discrepancies in the CSA pass rates of white British, BME and international graduates, which sparked allegations that the RCGP, which conducts the exam, was being racially discriminatory against BME and international candidates. In the hearing, BAPIO claimed that the requirements for membership of the RCGP, particularly the passing of the CSA, were unlawfully racially discriminatory. It was argued that the RCGP was in breach of its Public Sector Equality Duty by ‘failing and continuing to fail to undertake an Equality Impact Assessment of the requirements for membership of the RCGP’. The GMC, which BAPIO said was accountable for ensuring a fair process, also stood accused of failing to comply with its Public Sector Equality Duty under the Equality Act. However, BAPIO failed to convince judge Mr. Justice Mitting that international and BME candidates were subject to bias and at a disadvantage compared with their white UK peers.