How to . . . become a general practitioner
BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2146 (Published 10 May 2019) Cite this as: BMJ 2019;365:l2146
General practice is a challenging, rewarding, and varied vocation that offers stability, family friendly working hours, and great career opportunities. A GP needs excellent personal skills, a broad knowledge base, and familiarity with a large number of acronyms.
To become a GP in the UK you need a minimum of three years of GP specialty training on a programme approved by the General Medical Council. This normally consists of 18 months in an approved training practice with a further 18 months in approved hospital posts. There are, however, an increasing number of four year options available.
How to apply
The GP National Recruitment Office (GPNRO) (https://gprecruitment.hee.nhs.uk) coordinates recruitment to general practice specialty training programmes for England, Northern Ireland, Scotland, and Wales. Usually, you apply in November and take part in a series of interviews and examinations throughout January. Offers are normally made in April, with training starting in August. There are some programmes that start in February with offers made in October.
All applications are made electronically through the Oriel recruitment portal. Applicants make a single application for all available GP training posts and rank their preference for regions they are prepared to work in. Information about competition ratios in previous rounds and the number of available vacancies in each region are available on the GPNRO website.
London remains the most competitive region for training posts. The targeted enhancement recruitment scheme offers financial incentives to trainees committed to working in selected locations in England, Scotland, and Wales that have been hard to recruit to for the past three years. These areas often have a good track record for education but are less popular because of their location. These posts currently attract a one off payment of £20 000.
Assessment and selection
The process of assessment and selection is through the Multi-Specialty Recruitment Assessment (MSRA)—a computer based assessment followed, in most cases, by a face-to-face assessment at a selection centre. The computer based assessment comprises a 110 minute professional dilemmas paper and a 75 minute clinical problem solving paper. Sample and practice questions for both can be found on the GPNRO website. High scoring applicants—those with a combined total score of 575—qualify for a streamlined direct route and do not need to attend a selection centre.
Applicants who are successful at the MSRA book an appointment at a selection centre where they are assessed on communication skills, empathy and sensitivity, conceptual thinking and problem solving, and professional integrity. The assessment consists of three 10 minute simulation exercises including one with a patient, one with a relative or carer, and one with a non-medical colleague. Applicants also complete a 30 minute written exercise which requires some prioritisation of problems and a justification of responses.
The results from the MSRA and the selection centre are published in the applicant’s Oriel account. The outcome is final and there is no appeal process. All applicants are then ranked in a single national list with those who qualified for the direct pathway placed above those who went through the selection centre process. Offers are then given out with applicants given 48 hours to respond.
General practice posts
GP posts are undertaken in a variety of locations under the supervision of a GP trainer. Here you will get personalised tuition from an experienced GP who has had further training as an educationalist, as well as other members of the primary healthcare team. The training will be targeted to your identified needs.
Hospital posts
The exact posts offered by different deaneries vary but the specialties available include general medicine, elderly care medicine, paediatrics, community paediatrics, obstetrics and gynaecology, psychiatry and old age psychiatry, otorhinolaryngology, accident and emergency, dermatology, ophthalmology, and palliative care. Some deaneries also have innovative programmes that combine hospital and general practice posts.
MRCGP examination
In order to become a GP and be awarded a certificate of completion of training you must pass the Membership of the Royal College of General Practitioners (MRCGP) examination which consists of three separate components: workplace based assessment (WPBA), applied knowledge test (AKT), and clinical skills assessment (CSA).
For the WPBA, GP trainees must collect evidence for the 13 areas of professional competence (www.rcgp.org.uk/training-exams/training/mrcgp-workplace-based-assessment-wpba/wpba-competence-framework.aspx). These must be recorded in a trainee ePortfolio using specially designed tools. Trainees meet with their educational supervisor every six months to review the evidence collected.
The ABK is a computer based test of three hours and 10 minutes comprising 200 questions. It is delivered three times a year at 150 testing centres. Around 80% of the questions will be on clinical medicine, 10% on critical appraisal and evidence based clinical practice, and 10% on health informatics and administrative matters. Information about the test including preparation tips can be found on the RCGP website (www.rcgp.org.uk/training-exams/mrcgp-exams-overview/mrcgp-applied-knowledge-test-akt.aspx).
The CSA is a simulation of real life consultations. Each candidate is allocated a consulting room and has 13 consultations, each lasting 10 minutes. The aim of the assessment is “to test a doctor’s ability to gather information and apply learnt understanding of disease processes and person centred care appropriately in a standardised context, make evidence based decisions, and communicate effectively with patients and colleagues.”
Academic clinical fellowships
GP training can be combined with academia through the National Institute for Health Research’s Academic Clinical Fellowships Programme. These programmes are for four years, of which about 75% is clinical and 25% academic overall, with more emphasis on academic activities in the third and four years. Trainees must demonstrate that they have outstanding potential for development as a clinical academic and applications for the posts are highly competitive. The process for recruitment to academic GP training in the UK is different in each country (https://gprecruitment.hee.nhs.uk/Recruitment/Academic).
Global Health Fellowships
Global Health Fellowships allow GP trainees to work overseas in a resource poor rural South African or Ugandan community for 12 months as part of a four year global health and general practice training programme. The scheme is run through Africa Health Placements (https://ahp.org.za) and are recruited to locally by individual Health Education England offices and deaneries.