'We propose an alternative to MRCGP exams process'

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