Covid-19: changes to GP assessment should only be the beginning

The pandemic presents an opportunity to change the assessment of general practitioners for the better, says Kamal Sidhu

The recent news that GP registrars will be allowed to complete a recorded assessment as an alternative to the Clinical Skills Assessment (CSA) is a very welcome step, after the examinations were cancelled due to lockdown.¹

It reduces the uncertainty for GP registrars and recognises the impact of the pandemic on GP training and the wider primary care.

All those, including trainees, trainers, and organisations such as BAPIO and the BMA, who worked for this to happen have heaved a big sigh of relief. This is also the first time, since the new Membership of the Royal College of General Practitioners (MRCGP) exam was introduced, that an alternative to the CSA has been allowed.

Since its inception in 2007, the MRCGP has had more than its share of controversy. Perhaps now, at a time when changes are having to be made, we should consider its future.

Both the applied knowledge test (AKT) and the CSA elements of the MRCGP are an immense source of strain for most GP registrars. They consume a major part of their time and effort at the expense of more practical, generalist, clinical, and management skills that are needed for real-life general practice.

The prohibitive cost of the examination,² as well as the cost of a variety of preparation courses that have sprouted due to its high failure rate, has also been a sore point.³

Registrars often end up thousands of pounds out of pocket, and if they require more than one attempt, the financial cost itself becomes a source of anxiety and worry.

The gap in the pass rates of registrars based on their ethnicity and country of qualification had shaken the belief of many in this system including many in the training community.⁴

The existing format has also been challenged in court,⁵ the result of which was a clear directive to the RCGP to take measures to reduce the disparity in pass rates. Sadly, this has not been achieved and in fact, the gap has only widened.⁶

General practice has changed beyond recognition since the introduction of the current version of MRCGP.

In the last two months, modes of consulting have completely changed⁷ with a drastic reduction in the number of face-to-face appointments. The digitalisation of primary care has happened overnight in the light of the covid-19 pandemic.

No one knows what primary care shall look like in a year. Certainly, it will not look anything like the pre-covid era.

With this in mind, I would argue that the AKT and CSA are no longer relevant and that in the future we need different mechanisms of assessment.

We must not forget that MRCGP is an exit examination⁸ and this means the threshold for assessment must reflect the realities on the ground, both in terms of patient safety as well as patient need.

In preparation for the new post-covid world, we have an opportunity to move forward and the same applies to assessment in primary care for our future workforce.

The future format must meet four fundamental objectives; it must be fair and address the existing inequalities in achievement, it must not be cost onerous, it must not be effort onerous to the detriment of the training for the real world, and it must reflect changing face of general practice and hence, relevant and valid.

Let us build on the goodwill and the pragmatic approach of the organisations that have come together to address the current crisis. If the will is there, we have the opportunity to use this goodwill to change the current system and eliminate the continued disparities at a time when primary care needs as many foot soldiers as possible.

Kamal Sidhu is a GP principal and trainer, chair of South Durham Health CIC, and vice-chair of County Durham and Darlington LMC. He writes in personal capacity.

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