Examination regulations during periods of Targeted GP Training

The Targeted GP Training (TGPT) Scheme enables specified cohorts of doctors to re-enter GP Specialty Training. They can make up to two further attempts at either the MRCGP Applied Knowledge Test (AKT) or Clinical Skills Assessment (CSA). This is where failure to pass either of these examinations has resulted in a previous ARCP Outcome 4 decision.

The scheme was open for recruitment between February 2019 and August 2021. It applies to Health Education England (HEE) and NHS Education for Scotland (NES). The standards set for TGPT candidates are the same as those exam standards for all other candidates sitting AKT or CSA in a standard training programme. Full details of the scheme and its entry criteria are available from the General Practice Recruitment Centre.

Here, you can find:

  • the recommended educational support for doctors in TGPT
  • the mandatory workplace-based assessments (WPBA)
  • the additional mandatory requirements regarding "Readiness to sit" either AKT or CSA

MRCGP examination regulations

TGPT doctors should be familiar with the most current version of the MRCGP Examination Regulations. These apply to all candidates sitting these examinations.

The regulations apply principally to those undertaking GP Specialty Training. Sections concerned with eligibility for examinations will not, of course, be relevant to those undertaking Targeted GP Training.

Eligibility to sit examinations that were not previously passed during GP Specialty Training 

Doctors on the TGPT scheme will be eligible to apply to sit the AKT or CSA. This follows receipt of a favourable Annual Review of Competence Progression (ARCP). This comes after 12 months of whole-time-equivalent targeted training.

This review will include confirmation from the trainee's first 12-month ARCP panel that there is sufficient evidence to confirm both engagement and progression. The minimum WPBA requirements for a trainee in their ST3 year of training must be met for each year that they are on the scheme. Full details of these requirements are available from Health Education England's website.

The evidence available in the trainees' ePortfolio considered at this ARCP should also include a positive recommendation in the Education Supervisor's report. This should say that the trainee is appropriately prepared for the examination.

Trainees on the TGPT scheme will need to be assessed as to their readiness to sit the exam not previously passed (CSA or AKT). Their readiness to sit any exam whose currency has elapsed due to time should also be assessed. Where readiness to sit has already been established for a trainee on the TGPT scheme, a further conversation is strongly recommended. This should be with the Education Supervisor and/or their support Training Programme Director (TPD). This should occur before making any applications to take either of the exams.

Examination passes which expire during Targeted GP Training 

The currency of all MRCGP AKT and CSA passes is seven years in line with the GMC's expectations about the currency of national professional examinations. Some doctors may find that an AKT or CSA pass obtained during GP Specialty training has become invalid whilst they are undertaking TGPT. These doctors will be required to re-sit this examination. All doctors must have exam passes in both CSA and AKT, as well as satisfactory workplace-based assessments. These must be valid at the time they are awarded a Certificate of Completion of Training (CCT).

Trainees on the TGPT scheme should also be assessed for their readiness to sit examinations whose currency has elapsed. This should be done by their educational supervisor or training programme director. Typically this is at the first interim Educational Supervisor Report (ESR). This will occur no earlier than 6 months (whole time equivalent) into the TGPT scheme. This decision on readiness to sit should be confirmed in the Interim Review documentation. It should be reviewed through the ARCP process (see the section above).

Number of attempts permitted for trainees on the TGPT scheme

A maximum of two attempts will be permitted for each of the exams. This is regardless of the number of attempts for either CSA or AKT made by the trainee previously when in GP training. No attempts are permitted for trainees out of programme.

The standards set and pass marks for attempts at either the CSA or AKT by TGPT candidates will be the same as for all other candidates sitting these examinations.

Less than Full-Time (LTFT) Trainees

The TGPT scheme length is 18 months whole-time equivalent. For LTFT trainees, all the requirements for the workplace-based assessments and the readiness-to-sit discussions advice should be considered pro rata. The sole exception is ARCPs, which can be held no less frequently than annually.

Exceptional fifth attempts

The RCGP's policy on exceptional fifth attempts at the AKT and CSA examinations is not applicable to those on the TGPT scheme.

Mitigating circumstances

The RCGP has a clear policy for considering mitigating circumstances which is applicable to all attempts at both the AKT and CSA. Mitigating circumstances must be reported. This should be to the RCGP Examinations Office or an invigilator. It should be done as soon as the circumstances arise, or as soon as possible thereafter. It should be no later than 48 hours after the examination has been sat.

Sometimes a candidate may believe that their performance was likely to be affected by mitigating circumstances arising before an assessment, for example illness. The RCGP would normally expect the candidate to withdraw from that sitting and re-sit at a later date. All candidates who present themselves for the AKT or CSA sign a declaration as part of the registration process on arrival at the examination centre. This confirms that they are fit to sit the examination.

A request for consideration of mitigating circumstances should not be considered as a default route for obtaining additional attempts at examinations.