Qualifying as a GP in the NHS

 

Qualifying as a doctor in the UK:

The first step to becoming a qualified medical practitioner in the UK is completing a medicine degree from an accredited UK medical school, or a GMC (general medical council)-approved medical school abroad. This will normally take 5 years but can take 4 years for postgraduate entry students and 6 years for students who choose to complete an intercalated degree during their studies.

After achieving a medical degree, junior doctors gain a ‘provisional’ GMC registration with licence to practise and are entered into the medical register. This provisional registration only allows them to enter and complete the first year of their 2-year Foundation Programme, the next step to achieving the medical qualifications to become a doctor in the NHS.

After completing year one of the foundation programme (FY1), junior doctors are awarded full GMC registration with licence to practise. After completing FY2, trainees may apply for either core medical training, or in some cases, such as General Practice, directly for their specialty training.

The Core Medical Training (CMT) programme is the first stage of specialty training for most physicians who plan on training in one of the medical sub-specialties. It usually has a duration of 2 years, and to successfully finish CMT, trainees must gain their Membership of the Royal College of Physicians (MRCP) UK qualifications by passing a 3-part knowledge-based assessment.

Once trainees complete their CMT they apply for entry directly into 3^rd year of specialty training (ST3). There are some specialties in which trainees can take the ‘direct route’ and enter specialty training at ST1. Once trainees complete their specialty training and acquire their Certificate of Completion of Training they may practice as specialty doctors.

Specialty doctors who take up consultant posts in their specialty are also awarded a specialist registration alongside with the full GMC registration with licence to practice. Trainees who complete the GP specialty training programme are added to the GP register, allowing them to work as qualified GPs.

 

The GMC list of registered practitioners:

The medical register is a list of all registered doctors in the UK. The register is easily accessible online, and it shows what type of registration a doctor holds, their training, and other useful information. Patients, employers, or other doctors can check the GMC medical register to verify the registration information of any practicing physician in the UK.

There are 4 types of registration: provisional registration, full registration, specialist registration and GP registration. Provisional registration is awarded upon entry to FY1 and only allows trainees to practice within their foundation programme, while full registration is awarded in FY2, and all doctors practicing in the UK will need a full GMC registration.

A specialist registration is awarded to doctors taking up consultant posts in a medical or surgical specialty in the UK, with the exception of locum doctors. And finally, all GPs other than GP trainees must hold a GP registration, including locum GPs, who also need to be on the GP performers list. 

 

Becoming a GP in the UK: applying for GP training:

There are several routes through which you can become a GP, and which one you take depends on what previous training or qualifications you have. Firstly, a common route to becoming a GP is applying for GP specialty training immediately after completing the UK Foundation programme.

Applicants for GP training submit a single application to all available GP training posts across the UK. All applicants partake in an assessment and selection process, which consists of the Multi-Specialty Recruitment Assessment (MSRA) and a face-to-face assessment at a Selection Centre. Applicants who score highly on the MSRA can skip the face-to-face assessment and are offered a training post directly. When assigning a training post to successful applicants, both their performance and their stated preferences are taken into consideration.

Secondly, you may also enter GP training if you have been training for another specialty but decided you would like to transfer to general practice. This is done via the Accreditation of Transferrable Capabilities Framework (ACTF). To qualify for this framework, you must:

• Be transferring from a GMC-approved specialty training programme
• Have completed a minimum of 12 months in a relevant GMC approved specialty training programme
• Have a valid National Training Number (NTN) at the time of transfer or have been in a GMC approved specialty training programme within the 5 years preceding the planned start date of the GP training

Lastly, another way to enter GP training is through the CCT Combined Programme (CCT CP). This programme enables trainees to combine one year of previous relevant experience above Foundation level or equivalent, both in the UK or relevant experience overseas, with the UK GP training programme.

To apply for the CCT CP route, you must first apply for the standard 3-year training programme and within the application, you should indicate that you would like to be considered for the CCT CP.

 

GP training pathway and gaining GP qualifications:

Once you successfully complete the application and assessment process, you will be allocated a GP training post and begin your GP training. This usually consists of 18 months in hospital posts, and 18 months in an approved GP practice post in your deanery and under a senior GP’s supervision.

All posts are accredited and GMC-approved. The hospital specialties available during the hospital placements include General Internal Medicine, Paediatrics, Elderly Care, Obstetrics/Gynaecology, and more similar specialties. Some deaneries also offer Academic Fellowship posts, and Global Health Fellowship posts.

To acquire the Certificate of Completion of Training (CCT) at the end of their training programme, trainees must successfully sit the Membership of The Royal College of General Practitioners (MRCGP) examinations: the Applied Knowledge Test (AKT) and Clinical Skills Assessment (CSA).

Additionally, trainees will undergo Workplace Based Assessments (WBPAs) throughout their training which they must also pass to obtain their CCT. The trainees’ progress is also monitored annually by the Annual Review of Competency Progress (ARCP) panel.

Once trainees have passed their WBPAs, obtained their MRCGP UK qualifications, and received a successful outcome on their last ARCP report, they receive their CCT and may apply to join the GP register.

 

Joining the GP register:

Upon completion of their GP specialist training, newly qualified GPs should apply to join the GP register. How you apply depends on when and where you completed your GP training programme.

If you are submitting your application within 12 months of completing a CCT training programme/ GP training programme, you may apply for a Certificate of Eligibility for GP Registration: Approved Programme route (CEGPR (AP)). To join the GP register, you also need to join a Performers List and Induction or Returner Scheme.

However, if your last day of GP training was over 12 months ago, you must apply through the standard CEGPR route. Doctors who have trained and worked as GPs overseas and want to start practicing in the UK, and doctors who are combining their training in the CCT programme with other relevant training and experience will also use the standard CEGPR route.

Once your name is on the GP register, you are also eligible to become a member of the Royal College of General Practitioners (RCGP).

Doctors should not work in general practice before their CEGPR (AP) is issues, and their name is included in the GP register. 

 

Resources for aspiring GPs:

• The Royal College of General Practitioners (RCGP) website
• The GMC website
• GP Training Support website (https://gptraining.info/)

 

References:

1. The RCGP. Qualifying as a GP in the NHS. Available from: https://www.rcgp.org.uk/training-exams/discover-general-practice/qualifying-as-a-gp-in-the-nhs.aspx (accessed Aug 2021)
2. The GMC UK. Becoming a doctor in the UK. Available from: https://www.gmc-uk.org/education/becoming-a-doctor-in-the-uk (accessed Aug 2021)
3. The RCGP. Steps to practise as a GP in the UK. Pdf. Available from: https://www.rcgp.org.uk/-/media/Files/GP-training-and-exams/GP-register-training-materials/RCGP-steps-to-practise-as-a-GP-in-the-UK-2019.ashx?la=en (accessed Aug 2021)
4. Health Education England NHS. The GP training programme. Available from: https://gprecruitment.hee.nhs.uk/recruitment/training (accessed Aug 2021)
5. British Council. Membership of the Royal College of General Practitioners. Available from: https://www.britishcouncil.in/exam/professional-university/medical/membership-royal-college-general-practitioners (accessed Aug 2021)