Update on fees for the SCA examination

Publication date: 03 May 2023

We are now in a position to confirm the Simulated Consultation Assessment (SCA) examination fee and would like to ensure that all members understand the way in which the fee has been agreed.

Since the MRCGP became mandatory for clinical practice in the UK in 2007, the RCGP has made a commitment to trainees that it will take a full cost recovery approach to the MRCGP examination fee. It will not use the examination to generate a profit to fund other activities. We understand the financial pressures that many GPs experience during their training.

This means that all costs related to running the examination, both direct and indirect, are included in the examination fee. The Charity Commission requires the College to report on costs annually, but it is not possible to guarantee a break-even position at the end of each financial year. This is because there can be a great deal of variability around the number of trainees taking the examination each year. The College therefore works to the principle that over a three-year period, the examination should be cost-neutral, and fees are adjusted accordingly to be fair to trainees taking the examination throughout that period.

Direct costs are related to running the examination event that trainees are attending (e.g., case writing, examiners, staff, IT platforms, role-players). Indirect costs relate to other aspects of the examination and training (e.g., Workplace Based Assessment, examination governance etc) and to the attributable general costs for the College to support staff and operate an examinations team.

All these variables have been considered in setting the Simulated Consultation Assessment fee for 2023-24, at £1,180.

It is important to remember that examination fees are a tax-deductible expense via each trainee's tax returns. See further information on claiming a tax rebate on training fees (including a step-by-step guide).

The examination fee breakdown

Each examination module will incur costs which are quite different to each other. The direct costs which apply to the SCA examination are:

Compared to the RCA examination, the SCA has a lower cost for examiner marking and QA, but substantially higher combined cost for role-players, examiner training, and other costs.

Made with Flourish

Examiner marking and QA

The clinical skills component of the MRCGP is examiner marked. Examiners are working GPs and we currently have a panel of examiners in excess of 250. Unlike other specialities, examiners are not provided by Trusts and therefore require remuneration to cover the costs of time out of practice. The costs of marking in the CSA and the SCA are similar and reflect the standardised OSCE model in practice. The examining costs were much higher in the RCA where cases were double marked due to them being selected by candidates and therefore unstandardised. This accounted for over 50% of the fee in the RCA.

As requested by the UK's Statutory Educational Bodies, candidates will no longer need to travel to London to sit the SCA. This will significantly reduce the inconvenience and cost for most candidates while also reducing the examination's carbon footprint by 4.5 times. This also means that the remote OSCE model delivered in GP practices will no longer require examiners to travel to examine or incur accommodation costs at 30 Euston Square as they did for the CSA. This offers significant cost reductions in the SCA compared to the CSA.

Examiner training

To ensure the quality of examiners it is critical that the College appropriately trains and quality assures its examiners each year. These costs remain stable across each type of examination but in the SCA, where trainees no longer meet regularly face to face, we have provided additional training throughout the year. Training and quality assurance not only covers the application of marking schemes, but also the key Equality, Diversity, and Inclusivity training.

Role-players

In the SCA, as in the CSA, the roles of patients are portrayed by highly skilled role-players. The reliability of the examination is critical to the quality of each role-player. Significant investment is therefore made into their training and quality assurance, as well as the fees to the agencies. There were very minimal role-player costs in the RCA (to support training materials), but these have now returned for the SCA. These costs are higher than the CSA due to market rates, and an increase in the numbers of trainees taking the examination.

Examination venue

The SCA, like the RCA, offers the benefit that it is a remote examination, and we no longer have to provide an examination test centre which contributed as a significant cost in the CSA. The examination will now take place in local GP surgeries which not only reduces this component of the fee, but also means trainees no longer must pay additional funds to travel to and stay in London. This is also a benefit to the practice who no longer have to release trainees from practice for as long.

IT provider and delivery

The RCA and the SCA have seen a significant increase in the costs to develop and deliver the IT platform on which the examination will be conducted. This was a much lower cost for the CSA where the RCGP developed the platform themselves over time with an IT provider. Market rates have increased significantly, and we have worked very hard to ensure that as a charity we are paying fair rates to keep the trainee fee manageable. The IT platform covers all remote invigilation costs.

Assessment materials

The SCA is a standardised examination and will rely on a large bank of cases being written and maintained to the appropriate quality. This was never a cost for the RCA where consultations were recorded with real life patients. This is a standard cost for all examinations, and for the SCA we have developed cases using economies of scale and adapting existing cases where possible from the CSA.

Other

To ensure the highest levels of test reliability, the RCGP pay for expert psychometric advice and services. Not only do the psychometric teams ensure we provide an examination which is always as reliable and valid as it can be, but also help us to set the fairest pass marks for trainees. Psychometric fees are small and relatively stable, but market rates have increased in recent years. We also employ groups of clinical GPs, examiners and educationalists who contribute to the continual quality and development of the MRCGP.

We have worked hard throughout the design of the assessment to ensure that costs to trainees (including travel costs) are minimised as much as possible. This is of course while balancing the need to provide the highest levels of reliability and validity required for a high-stakes national GP licensing examination.

We hope this gives you a thorough explanation of the changes that will be happening later in the year. We look forward to supporting you through the MRCGP examinations and then as qualified members of the College across your long and flourishing GP career.

About the writers

This update was written by the RCGP examinations team.