MRCGP Equality and Diversity: reasonable adjustments

The Equality Act 2010 requires the RCGP to make reasonable adjustments where a candidate, who is disabled within the meaning of the Equality Act 2010, would be at a substantial disadvantage in comparison to someone who is not disabled. The RCGP is committed to take reasonable steps to overcome that disadvantage.

• Equality Act and definition of disability: A physical or mental impairment which has a substantial and long-term (usually more than 12 months) adverse effect on someone’s ability to carry out day-to-day activities.
• SpLD is an umbrella term used to cover a range of frequently co-occurring learning difficulties or differences, most commonly: dyslexia, dyspraxia, dyscalculia and attention deficit disorder (British Dyslexia Association 2017).
• High stakes assessments: A high stakes assessment is one with significant consequences for the candidate. For example, when passing would result in a diploma or a licence to practise a profession, and lack of exam success would result in being unable to progress to the next stage of training. The AKT, RCA (and previously CSA) are high stakes assessments.
• Competence standards: A competence standard is defined as an academic, medical or other standard applied for the purpose of determining whether or not a person has a particular level of competence or ability. Reasonable adjustments primarily enable a candidate with a disability or temporary medical condition to overcome barriers that prevent them from accessing an assessment, so that they can demonstrate their knowledge and skills without affecting the competence standards.

Whether an adjustment will be considered reasonable will depend on several factors which will include, but are not limited to:

• the needs of the disabled candidate;
• the effectiveness of the adjustment;
• the cost of the adjustment; and
• the likely impact of the adjustment upon the candidate and other candidates.

An adjustment will not be approved if it:

• involves unreasonable costs to the awarding body;
• involves unreasonable timeframes; or
• affects the security and integrity of the assessment.

This is because the adjustment is not 'reasonable'.

Any requests for reasonable adjustments have to be agreed before an examination. Your request for reasonable adjustments will be dealt with by the examinations team, advised by the RCGP Disability Lead as necessary. In complex cases it is possible that the Chief Examiner and an expert advisory group may also be involved in the decision-making. Candidates will be informed by email whether or not adjustments to assessment procedures will be made to meet their needs and of the nature of these adjustments.

Appeals against decisions made in relation to reasonable adjustments should be addressed to the Chief Examiner and sent to exams.accoms@rcgp.org.uk.

Reasonable adjustments can be made to the AKT procedures where necessary to meet the needs of individuals who are disabled as defined by the Equality Act 2010.

Candidates who wish to request reasonable adjustments to be made to assist them when taking the AKT must inform the RCGP as soon as the application window opens. An AKT request for reasonable adjustment form (RA1) must be completed for each examination diet even if previous reasonable adjustments have been granted. The completed form should be emailed to the exams team: exams.accoms@rcgp.org.uk

The request for reasonable adjustments form must be accompanied by supporting evidence. This supporting information needs to specifically address the issue of what reasonable adjustments might be appropriate for you. It is not acceptable to simply list your diagnosis but rather you need to explain how this would potentially impact on your performance in the examination. You will find online Information for disability assessors (Applied Knowledge Test) that you should share with the person undertaking your disability assessment before they compile their report. If you declare that you have existing reasonable adjustments in the workplace, then we will likely need to seek confirmatory evidence of these from your educational supervisor.

For candidates with specific learning difficulties (e.g. dyslexia, dyspraxia and dyscalculia) a suitable diagnostic assessment report, conducted post-16 years of age, by a chartered or educational psychologist or a specialist teacher assessor with a current practising certificate (PATOSS) must be provided. Please see section ‘Information for disability assessors – AKT’ for more information.

For candidates with other impairments/disabling medical conditions a letter or report will normally be required from their GP/consultant or other qualified specialist as approved by the RCGP. This should include a description of how a candidate’s ability to perform the AKT assessment is likely to be affected and details of any special arrangements that have been made to accommodate the candidate in their current and/or past work environment.

If you require additional time because of a disability or special need, please book an afternoon session with Pearson VUE. Please book your exam sitting early and do not wait for confirmation of your request for reasonable adjustment.

Information and evidence about a candidate’s disability and requirement for reasonable adjustments will be treated as sensitive personal information. It will be kept confidential and only passed to those who need to know. In some cases, this may include the decision makers (in the case of an appeal) and examiners.

Please refer to sections ‘Remote specific learning difficulty (SpLD) assessments during COVID-19’ and the ‘FAQ’s on reasonable adjustments for AKT’ for further information.

Reasonable adjustments can be made to the RCA procedures where necessary to meet the needs of individuals who are disabled as defined by the Equality Act 2010.

In the RCA the trainee submits 13 self-selected consultation recordings which have been carried out within their usual work environment. The duration of the consultation can be more than 10 minutes but only the first 10 minutes are assessed (excluding the consent taking process) to reflect the standard time allocated for NHS GP’s across the UK. Extensions to the 10-minute assessment time, for common SpLD such as Dyslexia alone, are not usually eligible to be considered for a reasonable adjustment. The trainee has no time restrictions on reading the case details or related knowledge information in advance of carrying out the consultation. The College may, on rare occasions, grant an extension to assessment time if the candidate has significant speech, hearing or communication difficulties.

It is not the responsibility of the RCGP to make reasonable adjustments for other disabilities affecting candidates in their workplace. Candidates should liaise with the GP training practice or their employers about adjustments.

Candidates who wish to request reasonable adjustments to be made to assist them when taking the RCA must inform the RCGP as soon as the application window opens. An RCA Request for Reasonable Adjustment Form must be completed for each examination diet even if previous Reasonable Adjustments have been granted.

The Request for Reasonable Adjustments form must be accompanied by supporting evidence. This supporting information needs to specifically address the issue of what reasonable adjustments might be appropriate for you. It is not acceptable to simply list your diagnosis but rather you need to explain how this would potentially impact on your performance in the entire RCA assessment process. You will find a document entitled Recorded Consultation Assessment – Information for Disability Assessors that you should share with the person undertaking your disability assessment before they compile their report. If you declare that you have existing reasonable adjustments in the workplace then we may seek confirmatory evidence of these from your educational supervisor.

For candidates with Specific Learning Difficulties (e.g. dyslexia, dyspraxia and dyscalculia) a suitable diagnostic assessment report, conducted post-16 years of age, by a Chartered or Educational Psychologist or a Specialist Teacher Assessor with a Current Practising Certificate (PATOSS) must be provided. Please see section on Information for Disability Assessors for more information about the new RCA.

For candidates with other impairments/disabling medical conditions a letter or report will normally be required from their GP/consultant or other qualified specialist as approved by the RCGP. This should include a description of how a candidate’s ability to perform the RCA assessment is likely to be affected and details of any special arrangements that have been made to accommodate the candidate in their current and/or past work environment.

The completed form should be emailed to the Exams Team: exams.accoms@rcgp.org.uk

Information and evidence about a candidate’s disability and requirement for reasonable adjustments will be treated as sensitive personal information. It will be kept confidential and only passed to those who need to know. In some cases, and by agreement with the candidate, this may include the examiners and decision makers in the case of an appeal.

Please refer to section ‘FAQ’s on Reasonable Adjustments for RCA’ for further information.

The AKT is a multiple-choice examination that tests the candidates’ application of knowledge and is normally taken prior to the Recorded Consultation Assessment (RCA). It is computer-delivered in Pearson VUE professional testing centres across the four nations. The exam contains 200 questions and the standard time allocation is 3 hours and 10 minutes.

There are a number of different formats to the questions:

• Single Best Answer (SBA)
• Extended Matching Questions (EMQ)
• Picture/Table/Chart Format
• Data interpretation
• Free text 

You can find examples of these on the Candidate AKT presentation.

Some of the questions will involve interpreting information that will be displayed in a similar format to that seen regularly in common medical journals. Some may also require simple arithmetical calculations.

Examples of common reasonable adjustments that are made:

• Access to medical items or medically necessary food/approved drinks bottle at your workstation are listed on the Pearson VUE Comfort Aid List. You will need to submit an application form if any item you need access to, is not mentioned on the Comfort Aid list
• Additional rest breaks for candidates. Please note that the clock cannot be stopped in the exam so candidates need to plan their breaks with this in mind
• Adjustable workstation
• Changing the font size and colour contrasts for candidates with visual impairments or SpLD (although this may result in the candidate having to scroll through screens to access information). Please note that if a larger computer terminal is needed to prevent scrolling of some screen displays, this may occasionally result in the candidate having to accept a different Pearson VUE test centre to their geographical first choice
• Ensuring that graphics with colour have additional labelling to help colour-blind candidates
• Orthopaedic seating
• Providing extra time for candidates with specific learning difficulties (SpLDs)
• Provision of headphones and ear plugs. Please note that noise cancelling headphones are not available
• Separate rooms are available. Please note that these are not soundproofed

Some questions that are commonly raised with regard to reasonable adjustments:

Provision of a paper version of the test

Reasonable adjustments have to be proportionate and the routine provision of paper tests is challenging, particularly as some question formats are specifically designed for computer-based delivery and marking. It should also be remembered that GPs are required to use computer-based medical records on a daily basis and so a candidate who requests a paper version would need to be able to demonstrate what adjustments had been made for them in the workplace to accommodate this.

Decisions are made on a case-by-case basis and, in exceptional circumstances, a paper version of the AKT may be provided and sat at the RCGP, 30 Euston Square, London.

Provision of more than 25% additional time

For specific learning difficulties, such as dyslexia, the RCGP, in line with current national practice, routinely offers an additional 25% time. This is almost always justified by the supporting professional evidence and adequate to ensure a level playing field with other candidates. The RCGP has a responsibility to ensure that candidates with a specific learning difficulty are supported and are not disadvantaged due to their disability, however it also has the responsibility of making sure that such a candidate does not receive any unfair advantage over other candidates. The standards expected of a high stakes national licensing exam such as the AKT cannot be compromised for reasons of patient safety.

In order to consider more than 25% additional time, the RCGP would need to see more supporting evidence. The RCGP must be able to clarify what impact the learning difficulty is having on day-to-day functioning and what adjustments are in place to support the candidate within their usual workplace.

We would only accept more than 25% additional time under exceptional circumstances where significant workplace adjustments have been made to accommodate the learning difficulty. Such significant additional time can make examinations last more than five hours, which some candidates could then find very tiring.

It is worth remembering that candidates often find other adjustments helpful, such as screen overlays, background colour changes and font size changes etc. These, along with the 25% additional time, are more than sufficient for the vast majority of applicants.

Provision of extra time for candidates for whom English is an additional language

This section is relevant when considering English for Speakers of other languages (ESOL). Candidates with a specific learning difficulty are entitled to additional time in the examination, provided that they submit a report from an educational/chartered psychologist or an appropriately qualified specialist teacher (PATOSS) which endorses this. This assessment needs to be in English and be undertaken post-16 years of age. If it involves a candidate for whom English is an additional language then you, as the assessor, need to include details of your experience in assessing individuals with this characteristic. If one of your recommendations is for additional time, then it needs to be clear that this is due to the candidate’s underlying disability (as defined by the Equality Act 2010) rather than the fact that English is an additional language.

Use of text-to-speech software or a Reader

The RCGP is not able to offer the use of text-to-speech software as an adjustment. This is due to practical reasons, including the use of pictures and graphs, the use of medical terminology and the security considerations of Pearson VUE centres in allowing additional software to be added to their computer systems. In exceptional circumstances the use of a reader may be available. However, this would require the candidate to demonstrate a genuine need and in this regards we would expect that they could demonstrate the regular use of an adjustment of this kind, or a comparable adaptation, within their workplace. 

The Recorded Consultation Assessment (RCA) was developed during the COVID-19 pandemic while the government’s lockdown and social distancing measures were first put in place in March 2020. These precluded the normal running of the Clinical Skills Assessment at RCGP 30 Euston Square for the foreseeable future.

The vast majority of GP/GP trainee consultations at present are either telephone or remote video consultations, and the aim of the RCA is to assess these types of consultations and any face to face consultations still taking place (likely to be undertaken with necessary PPE precautions).

Each candidate will submit 13 recorded consultations, which will comprise a variety of clinical encounters that have been selected using guidance produced by the College. The duration of each consultation may be more to than 10 minutes but only the first 10 minutes will be assessed. This reflects the fact that the standard consultation time allocated for qualified NHS GPs is 10 minutes. These consultations will have been undertaken by the candidate, either within their own GP practices or from home (if isolating or shielding).

Although the RCA is a new assessment, candidates are likely be very familiar with recording and storing consultations as part of their formative assessments. The cases submitted by candidates will be their own choice of either audio, video or face to face or any combination of the above. The recordings will be uploaded by the candidates on to a secure IT platform. Assessments will be carried out remotely by experienced RCGP examiners and results along with appropriate feedback will be given to candidates through their e- portfolio.

Reasonable adjustments in the form of additional consultation time will be extremely rare during the RCA and will usually be restricted to candidates who have significant speech, hearing or communication difficulties.

Candidates will choose recorded consultations which will have been carried out within their current working environment, and hence it would be expected that any reasonable adjustments required to enable their day to day work (such as special seating, aids, IT equipment and software etc.) would already be in place. Candidates will have adequate time to select their most preferred 13 consultations. Basic details of each submitted consultation will be entered in an easy to use electronic workbook. There is no expectation to read any additional paperwork while recording the consultations apart from what the candidate would otherwise do to carry out a safe consultation in their day to day practice. The RCA acknowledges that physical examinations being carried out in general practice at present are limited due to the COVID-19 restrictions. Candidates with a disability who usually need an adjustment to the conventional examination technique, additional equipment or an assistant in their day to day practice should continue with their normal practice and the RCA marking scheme will accommodate these variations. 

New SpLD assessments may be done remotely due to COVID-19 social distancing measures. This means that disability assessors may need to use remote technology instead of a face-to-face meeting and provide an ‘Evaluation of need'. The SpLD Assessment Standards Committee (SASC) has introduced minimum standards for disability assessors to follow. Remote assessments can use a more limited range of tools and may not give as accurate a diagnosis of SpLD.

SASC states assessments that can wait, should wait, but we understand this is not possible for many candidates. For this reason, we will treat remote assessment outcomes and recommendations with caution and on a case-by-case basis. We will accept preliminary findings and recommendations from remote assessments for AKT exam sittings.

For the vast majority of candidates there will be no need for a further face-to-face educational psychologist assessment. However, in some situations, assuming face-to-face assessments have safely resumed, the RCGP may request a further detailed assessment (or other supporting evidence) before a final decision on reasonable adjustments is made.

We will review this guidance throughout the COVID-19 pandemic. It may change in line with the government’s latest social distancing guidance.

Does my information get shared with anyone else?

Information and evidence about a candidate’s disability and requirement for reasonable adjustments will be treated as sensitive personal information in line with the Data Protection Act 2018. It will be kept confidential within the exams team and only passed to those who need to know. In some cases, this may include the decision makers (in the case of an appeal) and examiners. Part of your assessment may need to involve, with your consent, information from your workplace Educational Supervisor or training organisation. In such circumstances, if you do not consent to you Educational Supervisor being contacted, then the RCGP cannot guarantee that all reasonable adjustment requests will be granted.

If you are granted reasonable adjustments, such as extra time, then this will be shared with Pearson VUE for the purposes of delivering your AKT. You will be asked to indicate your consent for sharing this information on the application form.

Your submitted evidence will be securely deleted 28 days after the exam results are published.

When should I make a request for reasonable adjustments to the RCGP?

You will be expected to inform the RCGP of a disability at the time of applying to sit your AKT. You should do this as soon as the application window opens. The deadline date for submission will be on your booking confirmation email. Late submission of the application form will limit our ability to provide you with reasonable adjustments and your preferred test centre may not be available. Please ensure that any supporting evidence, including professional assessments, are completed sufficiently far in advance of your exam so that you can discuss the findings with your Educational Supervisor.

Applications for any adjustment made within less than 15 working days of the AKT, including on the day of the examination, will not be considered. We would do our best in exceptional circumstances, but, along with our partner organisation, cannot offer to guarantee implementation if late requests are received. You may need to defer your assessment date if a disability is diagnosed in the period of time between applying for and sitting the exam and you require reasonable adjustments to be made. If you are applying for additional time in your AKT examination, then please make sure that you apply for the afternoon session.

Who will fund a disability assessment?

It is your responsibility to provide the necessary information to the RCGP so that we can make an accurate assessment of your needs. In some areas the Deanery has funded dyslexia assessments for candidates, but this is not universal.

What reasonable adjustments can the RCGP and Pearson VUE testing centres provide?

Please see 'Information for disability assessors - AKT' on this webpage.

My Disability assessment report recommends more than 25% additional time for the AKT. Will this be allowed?

Please see the 'Provision of more than 25% additional time' section under 'Information for disability assessors - AKT' on this webpage. 

If I have previously been unsuccessful at an examination and then discover that I might benefit from a reasonable adjustment, such as extra time, am I entitled to an extra attempt?

If you are unfortunate enough to be unsuccessful at your AKT and are subsequently diagnosed with a disability (such as a specific learning difficulty) then you will be entitled to reasonable adjustments for any future attempts. However, your unsuccessful attempt(s) will still stand.

So, if you are unsuccessful in an examination and feel that your performance may have been impaired by an underlying disability you are strongly advised to seek further advice after an initial attempt rather than waiting until you have been unsuccessful at the examination a number of times.

What reasonable adjustments do/do not require approval?

Prior approval needed:

• Additional time for rest breaks for candidates
• Additional time for candidates with SpLD
• Adjustable workstation. Subject to availability.
• Changes to font size and colour
• Disabled parking. Recommendation to check with test centre prior to the exam day.
• Enlarged terminal display. Subject to availability.
• Orthopaedic seating
• Overlay. Overlays must be supplied by the candidate and will be visually inspected by staff during the test centre check-in process.  Overlays should lie flat against the screen (kept in place by static) or in a frame that sits on the top of the monitor.  Monitors in most UK test centres are 24” flat screen. It is recommended to take a non-damaging adhesive, such as ‘Blu-tack’ in case you do not have the appropriate size overlay.
• Separate room (quieter but not soundproofed). Subject to availability..
• Wheelchair access. Subject to availability.

Prior approval not needed:

• Headphones/Earplugs. Only headphones/earplugs supplied by the test centre are permitted for use.
• Items on Pearson Vue Comfort Aid List. Items will be visually inspected by staff at check in.
• Screen magnification. Click to enlarge links are provided where relevant.

How will my application for Reasonable Adjustments be dealt with?

Your request for reasonable adjustments will be dealt with by a small team within the Examinations Department who may seek the advice of the RCGP Disability Lead. In some cases, this may include the decision makers (in the case of an appeal) and examiners. Part of your assessment may need to involve, with your consent, information from your workplace Educational Supervisor or training organisation. In such circumstances, if you do not consent to you Educational Supervisor being contacted, then the RCGP cannot guarantee that all reasonable adjustment requests will be granted. We will keep the information you give us confidential and store it in accordance with the General Data Protection Regulation 2016 and the Data Protection Act 2018.

Does my information get shared with anyone else?

If you are granted reasonable adjustments, then this will be shared with the senior examination management team for the RCA. It is up to you whether you would like the individual examiners to know the underlying reason for your reasonable adjustments. You will be asked to indicate this on your application form for reasonable adjustments.

When should I make a request for Reasonable Adjustments to the RCGP?

You will be expected to inform the RCGP of a disability and request reasonable adjustments at the time of applying to sit your RCA. You should do this as soon as the application window opens. Late submission of the request form may limit our ability to provide you with reasonable adjustments.

If you are subsequently diagnosed with a disability in the period of time between applying for and submitting the RCA recordings, you will need to inform the RCGP as soon as it is practical to do so. If you need to have reasonable adjustments made in the workplace to enable you to produce your recorded consultations, you may need to defer your assessment date until these adjustments are in place.

Who will fund a disability assessment?

It is your responsibility to provide the necessary information to the RCGP so that we can make an accurate assessment of your needs. In some areas the Local Education Provider has funded dyslexia assessments, but this is not universal.

What reasonable adjustments can the RCGP provide?

Please see 'Information for disability assessors - RCA' on this webpage. 

What if I am shielding or working from home due to my disability?

Due to the current COVID-19 pandemic many GP consultations are currently being undertaken by telephone or remote video consultation. All 13 cases submitted can be remote consultations. There is no stipulation that any have to be done face to face. Examinations cannot be performed remotely but, as in day to day general practice during the pandemic, any examination deemed necessary should be described and explained to a patient as part of gaining their consent and to enable the time subsequently spent face to face to be minimised. This explanation will be taken into account in assessing your consultation. Any reasonable adjustment required to enable you to work from home should have already been discussed with your employer or training practice. 

If I have previously been unsuccessful at an examination and then discover that I might benefit from a reasonable adjustment, such as extra time, am I entitled to an extra attempt?

If you are unfortunate enough to fail your RCA and are subsequently diagnosed with a disability (usually a specific learning difficulty) then you will be entitled to reasonable adjustments for any future attempts. However, your unsuccessful attempt(s) will still stand.

So, if you are unsuccessful in an examination and feel that your performance may have been impaired by an underlying disability you are strongly advised to seek further advice after an initial failure rather than waiting until you have failed the examination a number of times.