General Practice Specialty Training Guidance

May 2023

This guidance provides a specialty specific framework for the use of directors of postgraduate GP education, and training programme directors when planning and constructing GP training programmes. It is also a reference, rather than rules, for Local Office and Deanery (both henceforth referred to as Deaneries) administrators, GP specialty trainees and the RCGP Specialist Applications (GPSA) team.

Aside from any elements linked to legislation, it is up to deaneries to apply this guidance as they feel is most appropriate. It is intended as a helpful tool, outlining best practice and is not being imposed by the RCGP.

This guidance relates to training for a Certificate of Completion of Training (CCT) in general medical practice in all four nations of the UK and for the practice of the specialty within the NHS.

The guidance has been produced by the RCGP with support from COGPED, COPMeD and the Specialty Advisory Committee (SAC) for general practice. It has been approved by the Specialty Training Board for general practice and will be reviewed every two years or as required.

  1. Training for a CCT in general practice is three years long. Although minimum training duration is no longer dictated by legislation, (confirmed by the General Medical Council (GMC) following the UK’s departure from the EU) the programme remains at three years based on the GMC approved curriculum for general practice training (the GP Curriculum). The RCGP develops and publishes the GP Curriculum which describes the capabilities and assessments that must be delivered over the three-year period to successfully achieve a CCT.
  2. There currently remains a requirement to record the total time in GP and specialty posts and overall training time in order for the GMC to hold accurate information for the purposes of the Swiss Citizens Rights Agreement (SCRA) and to ensure that trainees are aware of the impact of not meeting the minimum EU Directive training periods (6 months each of GP and specialty and 36 months overall) should they wish to exercise their rights under the SCRA.
  3. Programmes should comply with the GMC’s Standards for Medical Education and Training – “Promoting Excellence” and associated guidance and standards on training environments and trainers, as well as the Gold Guide overseen by COPMeD. “Promoting Excellence for General Practice: Application of GMC standards to GP Specialty Training” should also be referenced.

  1. The deanery
    • To deliver and manage postgraduate general practice specialty training programmes in accordance with the GMC approved GP Curriculum.
    • To manage and supervise a trainee's educational progress and the Annual Review of Competency Progression (ARCP) process.
  2. The trainee
    • To ensure all details of training are correct and accurate on the Trainee Portfolio and on ARCP forms throughout training including recording of all absence as per this guidance.
  3. The RCGP
    • To develop and publish the GP Curriculum and ensure that it has been completed satisfactorily in making assured recommendations for CCT to the GMC.
    • To support quality management of GP specialty training programmes and the ARCP process.
    • To maintain accurate ARCP forms as records of training to substantiate review of recommendation for CCT by the GMC as part of its quality assurance processes.
    • To produce specialty specific guidance within more generically agreed frameworks.

  1. Programmes will start after successful completion of the UK Foundation Programme or confirmation of equivalent competence, and subsequent recruitment into a GP specialty training programme. Training in the UK Foundation programme or any equivalent will not contribute to GP specialty training.
  2. Applications to general practice specialty training must be made in open competition through the nationally approved recruitment process. Entry points are usually in August and February each year.
  3. Entry to GP training programmes will be at ST1 level for all programmes, except for Broad Based Training where entry is at the start of ST2.
  4. Trainees who wish to apply for Combined Training, must first apply for a place on a general practice specialty training programme. They will enter at ST1.

Section 2 - Training programmes

  1. All training leading to a CCT must be approved by the GMC which requires Deaneries to make applications for programme approval and to provide information on how programmes will, in general terms, deliver the GP Curriculum and be compliant with the GMC’s Standards for Medical Education and Training. The RCGP will be asked to endorse any new programme that is proposed by a Deanery.
  2. Applications should come from the Postgraduate Dean and be based on the recommendations of the General Practice Specialist Training Committee (STC) or its equivalent in the Deanery. The GP STC, in common with STCs in other specialties, should be responsible for the identification and development of new programmes and posts in the Deanery.
  3. The 24/12 training model (see point 27) does not differ significantly from what is currently available and has already been applied in some areas, therefore as it is not a new programme, approval of the programme as a whole is not required by the GMC.
  4. For any post where more than two sessions or one day per week are spent in any location, that site must have GMC approval if it is to count towards the award of a CCT. This is to ensure that the location meets GMC standards for training. Therefore, if a new post is developed, if the locations for more than one element already have approval, no further approval is required.
  5. If a new location or organisation (for more than two sessions per week), is to be included in a programme, the deanery should complete the automated process via GMC Connect. The College has no role in this process but may also be asked for support in assessing whether a new training location is in a setting which can provide appropriate supervision and opportunities to meet GP Curriculum requirements. The RCGP’s role is to ensure that programmes meet the criteria as described in this guidance.

  1. Programmes should deliver the learning outcomes of the current training GP curriculum published by the RCGP and approved by the GMC.
  2. The GP Curriculum acts as the educational framework for the three-year specialty training programme for doctors who wish to work as GPs in the UK.

Post Definitions

Five different types of posts can form part of a GP specialty training programme:

  1. General Practice - experience purely in general practice posts based only in the GP surgery (including remote consultation).
  2. Integrated Training Post (ITP) - experience in a combination of general practice and other relevant posts including outreach posts based in the community, specialty posts usually based in hospital and integrated care. It can also include a non-specialty element such as Research or Leadership. Posts previously known as GP+ (a now obsolete label for an ITP) are included.
  3. Blended Learning Post (BLP) - an innovative training placement that integrates clinical work in general practice with a structured modular programme of curriculum-linked education and self-determined learning via electronic and online media as well as traditional face-to-face teaching.
  4. Specialty - experience purely in a formal specialty post usually based in hospital and can include any specialty time donated (when previous training or experience is brought in to combine with GP training) from previous experience.
  5. Academic - designated posts in research and academic areas (ACF or ACL) which are in addition to the GP training programme requirements. These posts do not count towards the specialty nor general practice components of the programme.

Construction

  1. The programme should include a balance of experience driven by the learning needs of the trainee and should be designed to enable the GP trainee to acquire all the capabilities necessary to practise independently to standards of safety, and capability set out in the GP Curriculum.
  2. Programmes should be constructed based on local post availability and funding and contain an appropriate balance between service and education, specialty placements, general practice, and experience in other community settings, taking into account any other previous experience.
  3. Specialty posts should be focused on the learning needed to demonstrate the required capabilities of the GP Curriculum. For example, they should allow relevant experiential learning in service environments such as outpatients or the management of chronic disease relevant to general practice.
  4. At least 12 months whole time equivalent (wte) must be spent in general practice with the final 12 months ideally all spent in general practice.
  5. Training programmes should ideally include a minimum of 18 months in general practice. In the 24/12 model (currently implemented in England and Wales) a total of 24 months should include general practice experience. This can be a combination of GP and ITP or Blended Learning posts.
  6. The remaining time can be a combination of any approved post type keeping in mind EU Directive minimum requirements for those who may wish to work in the EU or Switzerland post CCT (see point 2) and the consideration of service provision.
  7. All GP training posts must facilitate the completion of the mandatory Workplace Based Assessments (WPBAs) specified by the GP Curriculum. It is recognised there are non-patient facing, but clinically relevant specialities or posts which offer useful learning and experiences. If it is not possible to complete the WPBA requirements within these posts, then alternative arrangements need to be considered. This could for example include incorporating the post with general practice as part of an ITP. WPBA is a longitudinal assessment programme, and all trainees should be given reasonable and equitable opportunity to complete their assessments throughout training.
  8. Time spent in posts such as Leadership, Research and Commissioning which are non-clinical and are not formal specialties, will not count as specialty time where this may be needed (such as for SCRA) but can contribute to the overall three-year training programme if they are part of an ITP. A maximum of 6 months in total may be spent in posts which are non-patient facing and / or non-clinical.
  9. Deaneries must clearly show how each post within a programme will deliver aspects of the GP Curriculum and its 13 capabilities. It is particularly helpful to provide this as justification for non-specialty elements to ensure they can contribute to the training programme and for trainees to understand what is expected in terms of learning and progress.
  10. To ensure programmes are broad and balanced, training in any one specialty other than general practice should not normally last for more than six months (wte). Any previous specialty experience being donated to the GP training programme should ideally not be repeated.
  11. Training in any one non-GP post should not normally last for less than two months (wte). As engagement with the provision of evidence of learning in the Trainee Portfolio is a requirement for all trainees, for short posts to contribute, the trainee must demonstrate Trainee Portfolio evidence of learning relevant to the post, and the Trainee Portfolio should include a named Clinical Supervisor’s Report (CSR).

Integrated Training Posts

  1. These flexible and innovative posts support the 24/12 model as they are considered as general practice. Blended Learning posts should be treated and managed in the same way as ITPs.
    • Posts may include a range of different clinics relevant to general practice and where the non-GP element may not be spent in a single specialty and could be based in the community, remotely, online, or where work is undertaken by integrated teams.
    • Posts should ideally not be shorter than 4 months to ensure there is enough time spent in all elements of the post to provide sufficient opportunity for learning and documenting that learning.
    • A CSR is usually expected for each element of the post where time is spent in general practice and one other specialty. For other experience, one CSR which covers all elements of the post is acceptable. It is the responsibility of the trainee to show learning across the entirety of the post and document the full scope of learning.

Recording Posts

  1. All posts must be recorded and labelled clearly in the Trainee Portfolio so that there is an accurate record of training. This is a GMC requirement.
  2. For ITPs and BLPs:
    • These posts count as general practice but must be labelled correctly on the post list in the Trainee Portfolio with what was included in the post.
    • A prompt appears in the Trainee Portfolio when adding a new post to confirm if it is an ITP (which includes BLPs). If ITP is selected, post details can be added for a second specialty within the training period.
    • If an ITP or BLP includes more than two components or the experience type is not available in the drop-down list, the post description can be used to add additional information about the construction of the post, or the experience included.

Combined Training

  1. Trainees can apply to combine previous relevant experience with a GP training programme through one of two combined training pathways: the Accreditation of Transferable Capabilities (ATC) pathway and the Combined Programme (CP) pathway.
  2. A trainee applying for a combined training pathway must show that previous experience and capabilities are relevant to GP training and the capabilities required of the GP Curriculum. They must apply through the Trainee Portfolio and complete a gap analysis and capability mapping.
  3. As trainees accepted on either combined training pathway will not complete a full three-year GP CCT programme, Deaneries should consider how best to ensure, by means of careful programme construction, how the trainee will acquire all the capabilities and requirements of the GP Curriculum.
  4. Any contributing time from previous training or experience should ideally not be repeated in GP training.
  5. A minimum of two years should be spent in the GP training programme. All of this time could be in general practice posts.
  6. All trainees on a combined training pathway will be eligible for a CCT on successful completion of their training programme. Those using previous experience that was not approved UK specialty training must apply for a CCT (CP).

  1. If a trainee is training at less than full time (LTFT), the percentage of LTFT training should be no less than 50%. In exceptional circumstances this can be reduced as per GMC guidance.
  2. Time spent in academic training posts will not contribute towards CCT training requirements, Time spent in posts that combine academic and clinical activity should be carefully documented in the Trainee Portfolio to show how much of the post was in the clinical environment. An ARCP issued during an academic programme should make reference to progress in both the clinical and academic elements.
  3. If an academic trainee is also LTFT, the clinical and academic components should ideally be split 50/50. The clinical element must not fall below 20%. Any clinical component less than 50% should normally be for a maximum of a one-year period. It is recommended that at least the final month of training is completed at a minimum of 50% clinical time in general practice to allow best preparation for independent practice.

  1. Programmes and posts will be in Local Education Providers, quality managed by the Deanery as the Education Organiser. The employer may be different to the post provider, for example where there is a Lead Employer.
  2. Educational supervision throughout the programme should be provided from general practice. The Educational Supervisor is responsible for producing regular reports on trainee progression.
  3. Each placement within a programme where the trainee is not directly supervised by their Educational Supervisor should be overseen by a named and GMC approved Clinical Supervisor.
  4. Programmes should be managed by a GP Training Programme Director, appointed by the Deanery, working within an educational governance framework as set out by a Postgraduate Dean.

  1. Training for a CCT in general practice is three years long. Although minimum training duration is no longer dictated by legislation, the programme remains at three years based on the GMC approved curriculum for general practice training. The capabilities laid out in the GP Curriculum for independent practice post CCT, are designed to be best achieved over a three-year training programme. The expectation is that all trainees will complete three years of approved training.
  2. The GMC’s Time out of Training Position Statement says that absence of trainees should be monitored by Deaneries through the ARCP process. Absence of 14 working days or more in one training phase should trigger a review of whether the end of training date needs to be extended and is dependent on their acquisition of competence. (Gold Guide 9 3.183)
  3. There currently remains a requirement to record the total time in GP and specialty posts and overall training time in order for the GMC to hold accurate information for the purposes of the Swiss Citizens Rights Agreement (SCRA) and to ensure that trainees are aware of the impact of not meeting the minimum EU Directive training periods (6 months each of GP and specialty and 36 months overall) should they wish to exercise their rights under the SCRA.
  4. It is the responsibility of the Deanery to discuss SCRA requirements and the impact of not meeting these with the trainee so that they can make an informed decision.
  5. The following principles provide a framework which is underpinned by GMC and Gold Guide positions and the need for trainees to have acquired the GP Curriculum capabilities needed to make them safe and competent practitioners. It is up to the deanery to apply these as they feel is appropriate.
    • Training should be referred to in terms of phases rather than ST years.
    • The indicative time which should be spent in the training programme is 36 months (1095 days) wte and the GMC approved GP training curriculum is designed to be delivered over this period.
    • The expectation is that all trainees should aim to complete all of this time in training.
    • To support planning and the current requirements of SCRA (see points 52 and 63) some exceptional time out of training can be applied to absence. This is usually up to 14 days per training phase plus an additional 7 days in the final phase (ST3).
    • This allows for a maximum of 7 weeks or 49 days away from training which is proportionately high given the short nature of the GP training programme but is not considered to impact progression or patient safety.
    • Time away from training does not automatically result in an extension. Equally, not having to make up missed time is not an entitlement.
    • The determination on final CCT dates and whether absence should be made up is by the ARCP panel.
  6. The GMC monitors the quality and consistency of recommendations made for CCT by each College and Faculty expects to see that its guidance on training time has been followed, including:
    • The duration of a trainee’s posts all add up to the appropriate duration for the programme – with any gaps appropriately accounted for/time made up.
    • Any changes to the expected completion of training date have been accounted for and explained (due to sickness, maternity/paternity leave, part time working, periods OOP or gaining competencies at a faster rate than expected).

  1. Calculation of time in training is made using calendar days (wte) and so it follows that any absence and subsequent adjustments to training time are also calculated in calendar days.

Application

  • The ARCP panel should make the decision on whether absence should be made up in line with this guidance and amend the CCT date accordingly on an ongoing basis.
  • A maximum of 49 days of exceptional time out of training can be applied across the full duration of the training programme without having to be made up. This is usually:
    • 14 days per training phase
    • An additional 7 days in the final phase of training (ST3)
  • Short periods of exceptional time out of training might be subsumed within an extension or additional training time (ATT) awarded following an ARCP Outcome 3.

  1. It is important that absence is recorded accurately to:
    • Ensure a standard and consistent approach and fairness to all trainees.
    • Confirm eligibility for SCRA.
    • Make absence evident to both Deaneries and the RCGP GPSA team, and so reduce queries.
    • Improve efficiency.
  2. The Gold Guide and the GMC Time Out of Training statement outline that it is the responsibility of the trainee to report absences to the Deanery, and the responsibility of the Deanery to administrate and record these absences. ARCP panels must take all absence into consideration and record their decision-making clearly.

Application

  1. It is the responsibility of the trainee to be honest and open and to act with integrity (as per the GMC’s Good Medical Practice).
    • Trainees must record all absence contemporaneously and in calendar days.
    • This should be done upon return to work and added to the absence recording tool in the Trainee Portfolio.
    • In addition, trainees must declare all absence on their Form R / SOAR, or via the agreed Deanery process before each ARCP panel. This is all in addition to reporting absence to an employer.
  2. The total number of days absent since the last review must be added to the box on the ARCP form by the panel stating the cumulative total of all periods of absence in this review period.
    • If absence is declared after the ARCP panel, this should be added to the total on the next ARCP form.
    • The total should include any exceptional time out of training.
  3. Absences of 30 consecutive days or more should be recorded on the Trainee Portfolio by the administrator as a stage of training, including if that absence has prior approval or is for statutory reasons.
    • If the absence is taken during a post that the doctor then returns to it should be documented in date order.
    • All entries should run chronologically and concurrently with no overlapping dates.
  4. If unplanned absence is taken after an Outcome 6 has been issued, it is the trainee’s responsibility to notify the Deanery and their employer. The Deanery should notify the GPSA team as soon as possible.
    • There is no requirement for the CCT date to change, or a recommendation for CCT withdrawn unless the requirements for SCRA may be impacted.
    • The Outcome 6 will stand as a robust record that all mandatory requirements for CCT have already been met if the trainee accepts any shortfall in meeting SCRA requirements.
    • If the CCT has already been issued, then it is too late to make any changes and withdraw it.
  5. Although the EU Directive does not apply in the UK, if the minimum requirements relating to GP training (6 months specialty. 6 months general practice and 36 months overall - allowing for absence as described in this guidance) are not met, there may be implications including SCRA, for the trainee should they wish to work outside of the UK post CCT. The deanery has a responsibility to make the trainee aware of this and record the agreed outcome of the discussion as an Educator note or on the final ARCP form.
  6. If a trainee has a supported, phased return to work, this period should not normally count towards training time. The period that is not counting towards training time should be clearly labelled as such on the post list in the Trainee Portfolio.  However, if a decision is made in agreement with the trainee that a phased return to work should count towards training time, this should be made contemporaneously and should normally be at least 50% wte.  Ideally, the reasons for this decision should be stated in an Educator Note, or on the relevant ARCP form.

  1. The deanery should be aware of trainees who may have planned leave (such as parental or planned sick leave) beginning close to their CCT date and should try to monitor them closely to ensure that the deanery is aware of any changes to training as early as possible. In principle, a plan should be developed for each of these trainees, and they should be managed individually and in line with the current Gold Guide.
  2. If a trainee’s absence coincides with the end of training, and they will have completed the requirements for CCT by their planned end of training date, there is no need for them to return as long as SCRA has been taken into consideration
    • An ARCP panel is held as normal in the 2 months before planned completion.
    • Ideally, the final ESR should be done as close to the final panel as possible so that in the event of unplanned absence when a return to training is required, it will still be in date and will not need to be redone.
    • If an Outcome 6 is issued, the trainee applies for CCT.
  3. If a trainee is required to return to training for any length of time, an Outcome 6 should not be issued prior to their absence to allow them to retain their NTN.
    • A doctor cannot return to training once they have been added to the GP register.
    • An ARCP panel held prior to the absence should award an Outcome 1 if progress is satisfactory.
    • A further review should be held after return to training within 2 calendar months of the CCT date to confirm if an Outcome 6 can be issued.
    • A new Form R / SOAR or equivalent, must be completed when the trainee returns to training with any new health issues or significant events declared.
    • A new ESR is only required if the one completed prior to the period of absence is out of date (more than 2 months of training time between ESR and panel) or the time away from clinical training is more than 12 months.
    • If there is any absence after an Outcome 6 is issued this should be managed in line with point 66.

  1. If a period of continuous absence from clinical training is 12 months or more in total (including any accrued annual leave) a period of additional training is necessary to ensure capabilities have been maintained.
    • The trainee should return to training for sufficient time to allow a new ESR to be completed and maintenance of capabilities to be assessed (up to three calendar months may be required for this).
    • An ARCP panel is held when the trainee is approaching completion of training.
    • A new ESR and contemporaneous evidence of learning should be presented to the ARCP panel - this might include log entries and WPBAs.
    • If less than three calendar months are completed on their return to training, the ARCP form must include a statement confirming that the panel is satisfied the trainee has maintained the capabilities for general practice.
    • Where a period of continuous absence from clinical training is 5 years or more in total, training time prior to the absence should not be counted towards the CCT programme and training should restart from the beginning of ST1.
    • As with all trainees, any performance issues that may occur following the award of an Outcome 6 are dealt with via the Responsible Officer for revalidation.
  2. For continuous periods of absence more than six months but less than twelve months, the deanery must be satisfied that the trainee has not lost their skills.
    • A new ESR is only required if the one completed prior to the period of absence is out of date (more than 2 months of training time between ESR and ARCP panel)
    • Contemporaneous evidence of learning should be presented to the panel even if there is no need for a new ESR - this might include log entries, WPBAs and an Educator note confirming that the trainee has maintained their capabilities.
    • The first ARCP form on return to training must review capabilities and contain a statement confirming that the trainee has maintained the capabilities for general practice.
    • If there is no sufficient evidence to support maintenance of capabilities the ARCP panel may award an extension to training.
    • Where a trainee returns to training for less than 2 weeks there may not be any new evidence for a new ARCP panel to review. If an ARCP panel was held and an Outcome 1 issued confirming all requirements for CCT were met prior to the leave and a new ESR is not required, the final ARCP should include the following statement: ‘The trainee gained all the capabilities for completion of training before the period of absence commenced however, we were unable to recommend Outcome 6 at this point in training as it was more than two months before the completion of training date’.
  3. Where training is fragmented by multiple absences in a condensed period, the trainee may not have been in training for long enough for a formal assessment to take place.
    • The first ARCP panel on return to training must review evidence of capabilities.
    • The ARCP form must contain a statement confirming that capabilities have been achieved despite the fragmented training.

Keeping in Touch (KIT) days

  1. Whilst on parental leave, a trainee may work for up to a maximum of 10 keeping in touch (KIT) days which do not have to be consecutive.
    • They are considered employed days where a trainee is paid to be in training.
    • KIT days would not normally count towards training, however if there is evidence of education attained on a KIT Day, this should contribute to the overall assessment of training.
    • It should be noted that the acquisition of evidence is not the primary intended purpose of KIT days.
    • A trainee may choose to take an exam on a KIT Day if supported by the deanery.

  1. Types of absence considered exceptional time out of training which should be declared, include:
    • Sickness absence (including for COVID)
    • Maternity leave
    • Paternity leave
    • Compassionate leave
    • Parental leave
    • Carer leave
    • Sabbaticals
    • Jury service
    • Industrial action strike
    • MoD responsibilities
    • Professional leave (work outside the requirements of the curriculum)
    • Shielding or self-isolation due to pandemic (where remote training is not possible)
    • Annual leave accrued during times of exceptional leave periods as above.
  2. The following types of leave are managed by the Deanery as they are either linked to training or are employment related. These types of leave do not count as time off from training and are therefore not included for calculation purposes:
    • Annual leave accrued from time in training
    • Study leave
    • Representation at relevant educational or trade union meetings (up to 5 days per phase of training of pre-approved leave for non-clinical roles linked to GP training).

  1. Where a trainee is unable to train or work remotely and there is no evidence of educational activity
    • The training clock stops, and the time is treated as time out of training.
    • These periods should be recorded as absence or time out of training as outlined in Section 3 of this guidance.

  1. Where remote patient consultation is not possible, but there is evidence of learning linked to the GP specialty training curriculum
    • The ARCP panel should consider any documented learning and how this has supported educational attainment and achievement in capability.
    • It is reasonable for up to three months of this time to contribute to training.
      • Longer than this when working remotely with no patient contact, would likely not benefit the trainee nor provide opportunity for additional GP Curriculum linked educational attainment.
      • The decision on how long should contribute lies with the ARCP panel.
    • In order to provide reassurance to the RCGP and GMC, a comment must be added to the ARCP form to confirm that this period has been reviewed and how much of it can contribute to training requirements.

  1. Where redeployment to another approved training post is required
    • This post should be treated as any other within the usual guidelines for CCT and programme construction.
    • These periods should be noted on the ARCP form, and a “redeployed” post description added to any impacted posts.

  1. Where remote patient consultation is possible but face-to-face physical patient contact is not
    • A discussion should be held with the Postgraduate Dean.
    • The usual expectations on engagement with the Trainee Portfolio, and evidence of learning apply. The following criteria are relevant:
      • All WPBA and curriculum requirements must be met before a trainee can be competent for licensing and issued an Outcome 6.
      • There should be evidence of capability in all relevant areas of the curriculum according to their specific definitions.
      • Capability should be assessed independently from the mode of consultation undertaken.
      • For CCT, achievement in ‘Communication and Consultation’ requires evidence of capability in all recognised consultation techniques, including physical face-to face in the same room.
      • For CCT, to demonstrate competence in other capabilities including Clinical Management, Clinical Examination and Procedural Skills, Working with colleagues and in teams and Organisation Management and Leadership it would be expected that the trainee would require a period of time physically in the practice.
    • Please refer to WPBA guidance for:
      • details on which elements normally require physical patient contact and are expected to be completed with the trainee in the same room as the patient.
      • when, in exceptional circumstances it is appropriate for suitable compensatory evidence to be considered.

  1. Trainees will be subject to a national assessment programme defined by the RCGP and approved by the GMC. This includes Workplace Based Assessment (WPBA), the Applied Knowledge Test (AKT) and the Recorded Consultation Assessment (RCA) or equivalent.
  2. GP trainee appraisal is annual and via the ARCP process. ARCP panels should not normally take place more than two calendar months before the end of the period under review. ESRs should have been completed within the two calendar months preceding the ARCP panel date.
  3. The ARCP panel should review the full period of training since the last ARCP panel. A decision can then be made on overall progression and learning based on all the evidence presented. In doing this, a satisfactory outcome can only be issued if the full pro rata WPBA requirements for the period under review have been met.
  4. Occasionally there is no evidence of learning, often when a post is unexpectedly cut short. Where this is the case, the Educational Supervisor should raise this with the trainee at their next review (whether year end or interim) and ask that they provide an explanation of the circumstances in a Learning Log and their reflections on what was learned. The Educational Supervisor can then review and comment.
  5. When reviewing evidence of learning, particularly for short posts (usually less than two months), an ARCP panel has three options:
    • If overall progress is satisfactory, and there is sufficient evidence, the period can count
    • If there is insufficient evidence and overall progress is not satisfactory, the period cannot count
    • If more information is required, an Outcome 5 could be issued.

    A standard statement should be added to the comments section of the ARCP form confirming the short post was considered and whether this period of training should count towards training time or not.

    A similar approach should be taken with any trainee who does not regularly upload evidence to their Trainee Portfolio and early referral to Trainee Support Services should be considered.

  6. If a post is interrupted by a period of statutory leave where the trainee returns to the same post at the same location with the same supervisor, the evidence for the post should be considered in its entirety when considering whether any of the post should count.
  7. ESR's should have been completed within the two calendar months preceding the ARCP panel date. When the ESR has been undertaken outside of this timeframe, a comment should be added to the ARCP form to confirm that there has been no change since the ESR, and the panel are reassured in making a decision based on progress and the evidence presented.
  8. Trainees are expected to revalidate with the GMC immediately following the award of a CCT by the GMC. Evidence collected within their Trainee Portfolio for WPBA will be used to assist in the appraisal and revalidation process. The evidence is equivalent to but different from that normally collected by post-CCT GPs undergoing annual appraisal and revalidation. Additional evidence, which falls outside the requirements of the GP Curriculum, should not normally be required for trainee appraisal and revalidation purposes.
  9. Where causes for concern have been highlighted in a final ARCP, relating to revalidation, this should not stop the recommendation for CCT being made if all training and educational requirements for CCT have been met.

  1. Unless the named Clinical Supervisor is also the Educational Supervisor, the Clinical Supervisor should complete an assessment of the trainee’s performance from a clinical perspective (Clinical Supervisor Report - CSR) on completion of that placement or at other appropriate times as per the current WPBA guidance.
  2. The GP Educational Supervisor should review and report on the educational progress of the trainee every six calendar months and when required for additional ARCP panels, by completing an ESR. In the final educational review, the Educational Supervisor must make a declaration whether, in their opinion, the GP trainee has acquired all the capabilities as set out in the GP Curriculum necessary to be awarded a CCT.
  3. The portfolio of assessments, ESRs and other evidence should be reviewed by an ARCP panel of the Deanery in line with GMC and Gold Guide requirements. The panel is responsible for ensuring that all the mandatory evidence has been provided and then making a judgement about the trainee’s progress before recommending one of the outcomes described in the Gold Guide.
  4. The ARCP form is the historical record of training which must be true and accurate. This is the expectation of the GMC. The trainee must check that the details of their training are accurate and correct in the Trainee Portfolio and therefore also on their ARCP form before they sign it. The panel chair also has a responsibility to ensure that details on the ARCP form are correct before they sign it.
  5. The RCGP Specialist Applications (GPSA) team will review all ARCP forms to ensure that all requirements for CCT will be met by the end of training. They will liaise with Deanery staff, providing support and guidance.
  6. The RCGP is responsible for making the final recommendation for CCT to the GMC where the trainee has met the capabilities and requirements of the GP Curriculum, including successful completion of the tripos for MRCGP. This recommendation will be based on the information on the final ARCP form. Award of the CCT permits the holder to apply to join the GMC’s GP register.

Section 6 - Exit from and return to training

  1. Trainees resign from training for a variety of reasons including when an inter-deanery transfer was applied for but not granted. Sometimes, a doctor will reapply for GP training and if successful, begin training again. In such cases the trainee may progress to CCT at the discretion of the Deanery, and the previous GP training could count in line with the following principles:
    • Resigned from training within the last 5 years.
    • Must not have been out of UK medical practice (as defined by the GMC) for more than two consecutive calendar years.
    • At least one calendar year of continuous time must have been spent in clinical GP training posts (not OOP) within the last five years.
    • There was satisfactory progress in the previous training programme.
    • The period of training that could be “counted” in these circumstances is that covered by an ARCP form. An ARCP form from the previous training programme is expected. If there is an ESR for a previous period of training but no ARCP form, an ARCP panel may be arranged at the discretion of the deanery to which the returning trainee has applied to review the previous period of training and decide whether any of it could contribute towards the new programme.
    • Trainees should complete at least 12 months training (wte) in the new deanery.
    • The new programme will be constructed depending on capacity in the deanery and previously completed posts should ideally not be repeated.

  1. When an ARCP Outcome 4 is issued, the reasons for this and the options available to the trainee should be clearly documented.
    • The final ARCP form must clearly note which capabilities have and have not been met and that an Outcome 4 usually means it is unlikely the trainee will be able to go on to have a career in general practice.
    • Details of the reason for the Outcome 4 should be specific and should also be included in communications with the trainee following the issue of the Outcome 4.
    • The ARCP form must also include any information on mitigating circumstances.
    • Appropriate career advice should be offered to the trainee.
      • This often means having to have a difficult conversation. However, this is in the best interests of the trainee who may need to be told that the Outcome 4 means they are unlikely to be suitable for a career in general practice.
      • The Gold Guide states that the trainee ‘may wish to seek further advice from the Postgraduate Dean (PGD) or their current employer about future career options’.
      • The suggestion of applying for a Certificate of Eligibility for GP Registration (CEGPR) should not be offered as it is not likely to be successful in these circumstances.
    • The appeal process should be discussed with the trainee.

  1. If a trainee is suspended by the GMC, under fitness to practice procedures, it is likely that the NTN will be removed (GG9: 3.99 vi). The Gold Guide makes provision and sets out the requirements for the trainee to request that the Postgraduate Dean restores the training number if the Interim Orders Tribunal (IOT) decision is revoked, and GMC registration reinstated (GG9: 3.106 i).
  2. If the NTN is withdrawn, the trainee can appeal to have it restored (GG9: 4.169 – 4.175). If the appeal is successful, the trainee can re-enter training at the point at which they left if the period out of training does not exceed two years (GG9: 1.15 ii). They do not need to re-apply to the training programme. The period the trainee was not in training should be treated like an Out of Programme post. If the trainee is out of training for two years or more, they must reapply to training and cannot re-enter where they left. In this situation the same guidance for resignation applies and an ARCP panel must determine how much if any previous time can count.
  3. If after a period of suspension, a doctor wishes to return to training, they must re-apply, and must have the support of the Postgraduate Dean (PGD) in the locality where the training was previously undertaken. Applications will only be considered on a case-by-case basis if a trainee provides a ‘Support for Reapplication to a Specialty Training Programme’ form and with review of the individual circumstances by the relevant PGD. There must be close consultation between the deanery and the GPSA team to try to ensure no issues arise at a later date. There is currently no appeal of decisions by the PGD not to support a reapplication, but deaneries may choose to have a local process for review of the decision.
  4. If the doctor is supported back into training, the GPSA team should be notified, and a decision reached on whether it is appropriate for any previous GP training to contribute to the overall training programme and confirmation of how many exam attempts remain.

  1. Specialty training posts and programmes are not normally available to any doctor who has previously relinquished or been released (Outcome 4) or removed from that training post/programme. It is unlikely that they will be supported in returning to training.

  2. Eligibility

    The criteria used to decide whether a trainee who was released from training, should be supported back into training are included in the Guidance for Applicants on the National Recruitment Office website:

    14.1 Support for Reapplication to Specialty If you have previously resigned or been removed from a GP training programme, you’ll need to provide full details of the resignation, release or removal. This must be provided on the Support for Reapplication to a Specialty Training Programme form and approved by both the Head of School or Training Programme Director and Postgraduate Dean in the region where training was previously undertaken. This evidence should be emailed to the confidential email address of your first preference region at the point of application. Any applications from excluded trainees without submitted evidence will not progress any further in the recruitment process.

  3. The Person Spec states that:

    Applicants must not have previously resigned, been removed from, or relinquished a post or programme, except under extraordinary circumstances and on the production of evidence of satisfactory outcome from appropriate remediation.

    Exceptional circumstances may be defined as a demonstrated change in circumstances, which can be shown on the ability to train at that time and may include severe personal illness or family caring responsibility incompatible with continuing to train. Applicants will only be considered if they provide a ‘support for reapplication to a specialty training programme’ form signed by both the Training Programme Director / Head of School and the Postgraduate Dean in the HEE Local Office / Deanery that the training took place. No other evidence will be accepted.

  4. Whilst it is difficult to define ‘exceptional circumstances’, it should be accepted that this must have been something that directly and specifically affected the trainee’s ability to train at the time. An exceptional circumstance is not something that could have been dealt with and managed at the time and should be able to be evidenced as justifiably exceptional.
  5. Exam attempts and period of validity

    For doctors who have previously been in a GP training programme before 2 August 2023, the MRCGP regulations allow for a maximum of 4 attempts at each of the AKT and CSA/RCA. A fifth attempt is permitted in exceptional circumstances. If all attempts have been exhausted, no further attempts will be permitted even in the case where a trainee enters a new training programme. Only trainees who enter GP Speciality training for the first time on or after 2 August 2023 are permitted a maximum of six attempts at the examinations.

    Passes in MRCGP assessments are valid for a maximum of seven years in line with GMC requirements and MRCGP regulations. This applies whether or not a trainee has started a new training programme or re-joined a programme after a period out of training.

    The GMC has approved RCGP examination regulations as outlined above.

  6. Summary
    • A trainee who was not successful in their first training programme especially after numerous attempts at each exam and periods of remediation, should not be supported back into training.
    • The number of examination attempts permitted is determined by the date a trainee joined a GP training programme for the first time and does not reset in a new training programme.
    • Where limited exam attempts remain, for a trainee who wishes to return to GP training after a period out of training, the pressure on the trainee and likelihood of success must be considered when discussing the advisability of returning to GP training.
    • When a trainee approaches the Deanery for support to re-enter a training programme, the Deanery should inform the GPSA team before the doctor makes an application, to ensure accurate advice is provided and confirm the number of remaining exam attempts.
    • Where a trainee is permitted to return to GP training, an appropriate, supported and bespoke training programme based on the specific needs of the trainee must be developed by the deanery, and the GPSA team consulted.
    • Additional guidance on returning to practice is provided by the AoMRC.