There have been many changes in the last few years that have impacted the process to get into GP training, as well as the structure of training. Some of these have been further disrupted by COVID-19. Dr Mahibur Rahman, Medical Director of GP training experts Emedica, looks at some of the key changes to GP specialty training entry, MRCGP, and GP training
GP specialty training entry
To be eligible for GP training, doctors need to have two years’ clinical experience and evidence of Foundation competences. There are usually three recruitment rounds each year – Round 1 and Round 1 re-advert for jobs starting in August, and Round 2 for jobs starting in February. There has been a gradual increase in the number of places available for training over the last five years, from around 4,000 places to over 4,500 places available to start training in August 2021. The fill rates have also increased, with nearly all available jobs filled in 2020 recruitment.
Applications are handled centrally by the National GP Recruitment Office, and are submitted via Oriel, the NHS specialty training recruitment portal.
Historically, applicants were shortlisted based on their scores in the Multi-Specialty Recruitment Assessment (MSRA) – an assessment consisting of a 95-minute professional dilemma paper (with 50 situational judgement questions) and a 75-minute clinical problem solving paper (with 97 clinical questions). Candidates with very low scores would be removed from the recruitment process at this stage. Candidates with very high scores (around the top 25-30%) would get a direct offer of training based on these assessments alone.
All other shortlisted candidates would need to take part in the GP selection centre (also known as the GP Stage 3 assessment), consisting of a 30-minute written prioritisation task (an essay type paper), and three different consultations with simulators – simulating a patient, a relative or carer, and a colleague. The selection centre would assess communication skills, empathy and sensitivity, professional integrity, conceptual thinking and problem solving.
Overall ranking would then be based on a combination of the scores in the MSRA and the selection centre, with job offers being made based on merit.
The coronavirus pandemic led to restrictions in terms of travel, social distancing and availability of senior doctors to take part in the selection centres, and so the recruitment process was amended to remove the selection centre assessments for 2021. The current process means that ranking and job offers are based on the results of the MSRA, with the professional dilemma and clinical papers being given equal weighting.
A more detailed explanation of the whole process including dates for the different recruitment rounds is available at gptraining.info/applying-for-gp-training
The structure of GP training in recent years has included 16-18+ months spent in GP practice-based posts (4 to 6 months in either year 1 (ST1) or year 2 (ST2) of training, and then 12 months in year 3 of training (ST3)). With changes to the GP contract, there is a plan to change the structure of GP training from August 2022 to increase exposure to posts based in a GP surgery to 24 months, with the remaining 12 months in hospital-based posts. Some areas have already started piloting this.
This change means there will be more GP registrars working in primary care, and more GP trainer time needed for supervision and tutorials. There was a proposal for GP trainees starting training from 2021 onwards to be offered a two-year fellowship after getting their Certificate of Completion of Training (CCT). These are optional, but it is hoped that most doctors would take them up. These posts would allow doctors to have ongoing mentorship, and protected time for continuing professional development, when they are newly qualified GPs. Implementation of this scheme, and availability of post-CCT fellowship posts, may be impacted by the pandemic.
Membership of the Royal College of General Practitioners (MRCGP) consists of three parts that are done during the three years of GP training. These are: ongoing Workplace Based Assessments (WPBA) throughout all years of training; the MRCGP Applied Knowledge Test (AKT), which can be taken in ST2 or ST3; and the Clinical Skills Assessment (CSA), which can only be taken after starting the ST3 year. The pandemic has also impacted the AKT and CSA examinations. The AKT in April 2020 was cancelled, with additional examinations held in the summer as a replacement.
The bigger change was to the CSA – as it was not feasible to run this assessment safely, it was replaced temporarily with the Recorded Consultation Assessment (RCA). This new assessment is based on submitting 13 recorded consultations – these can be audio, remote video, videos of face-to-face consultations, or a mixture – and this better reflects how we are working in primary care at the moment. Each consultation is assessed by two RCGP examiners to assess competence in data gathering (history and examination), clinical management (correct diagnosis, being up-to-date, safe management) and interpersonal skills.
Registrars preparing for the RCA will need recording equipment and, for face-to-face consultations, the practice team may be involved in getting consent to record consultations from patients. The RCGP has not yet announced when or whether the CSA will restart, but has stated that registrars will be given at least six months’ notice before any change, to allow adequate time for preparation. It is likely that the CSA will be adapted to include more consultations involving remote consulting, to better reflect the reality of current general practice.
GP training is changing, with more trainees entering training, and more time being spent in primary care during training. Getting more exposure to working in the GP setting during training should help better equip trainees for the reality of life as a qualified GP, and also help get more benefit from hospital posts. With reduced hospital posts, trainees may need to seek out CPD opportunities to get exposure to rotations and specialties that will help when seeing patients as a GP.
Some of the changes implemented due to the pandemic may lead to different ways of working in the future, with more consultations done remotely, and specific training will be needed to manage the additional challenges this brings. The MRCGP assessments may change to reflect the changes being seen in the way general practice is being delivered.
Some practices may need to consider making additional consulting rooms available to host multiple registrars at different stages of training, and more GP trainer capacity will be needed to supervise them. Post-CCT fellowship posts may help new GPs develop their skills and confidence in both clinical and non-clinical aspects of being a GP, as well as offering stability and mentorship.