Dr Mustafa Ibrahim GP ST3, Wolverhampton VTS, west midlands.
General practice specialty training (GPST) is the largest training in the UK (1 in 4 trainees in the UK are doing GP training).
GPST is the route to become a GP in the UK and enter the GMC GP register. The standard route for most trainees is through certificate of completion of training (CCT) which will be discussed in this document. The usual duration of the CCT is 3 years but it can be 4 years in some parts of the UK. As a fully qualified GP your job involves primarily providing the initial contact with the patients registered in your practice, providing follow up and referring them to specialist care when appropriate. The initial contact is usually via 10 minute appointments along with home visits for some patients e.g the housebound patients.
If you are a trainer, your job will also involve supervising GP registrars and foundation doctors working in general practice.
It is a run through specialty programme usually consisting of 18 month hospital rotations and 18 months general practice rotation.
The three year specialty training program for general practice also includes taking the MRCGP examination. (One written and one clinical exams)
After the CCT there are number of opportunities of doing post CCT fellowship (e.g in primary care research fellowship, acute care fellowship etc.
GPwSI (GP with special interest) is another form of post CCT qualification done through courses and proposals. There is no restricted list of what special interests a GP can do (e.g special interest in ophthalmology, dermatology, gynaecology, endocrinology etc) it depends on the local area need and the available funds by the clinical commissioning group (the body that commission primary care funds)
Applications to join a GP training program in the UK are made through the National Recruitment Office (NRO).
It is an online application via Oriel. You will need to create an account on the Oriel recruitment system before you can apply
Dates of application: like most other specialty training programs in the UK the first post starts on the first week of august. The application opens in the preceding November and closes at the beginning of December the year before (e.g for specialty training year one starting in august 2017, the first stage of application starts in November 2016 and closes by 1st December 2016. There is a plan for twice yearly uptake (posts starting in February as well as August) but details are yet to be clarified by the recruitment center.
- MBBS or equivalent medical qualification
- Full GMC registration with licence to practice, or expected to be registered before the start date (e.g just passed PLAB 2)
- Be eligible to work in the UK (If no automatic work permit, you can get a certificate of Sponsorship from the deanery to apply for tier 2 visa.
- Have evidence of either:
- current employment in a foundation programme in the UK or:
- 12 months’ experience after full GMC registration or equivalent, and evidence of achievement of foundation competences in the three years preceding the intended start date from a UK foundation programme or equivalent. (I will explain about the foundation competence later.)
- Have a driving licence that allows you to drive in the UK (don’t panic if you don’t have one, in that case you would need to write a letter confirming that you will undertake responsibility for your own transport during your training including transport for home visits whilst in general practice rotation). I personally did not have a driving licence when I applied for GP training so I did this letter and it worked.
- Advanced Life Support Certificate from the Resuscitation Council UK or equivalent (as required to complete Foundation competences) by intended start date
- Evidence of English language skill (I will explain in detail later about this).
In the application form you will be expected to demonstrate your career progression since your graduations, anything like audit, research courses etc will help. Prepare to write in the application form about why you chose to do general practice. If you have experience of working in community, mention it.
The selection is of three stages:
- Stage one: simply the online application which is via oriel as mentioned above.
- Stage two: called MSRA (Multispecialty recruitment assessment): is a written computerised exam which includes clinical questions comparative to PLAB one in its difficulty and situational judgement questions. There are overseas centres outside the UK where you can take this exam.
From 2016/2017, if you score very high in stage2 processe, you will be given ‘direct pathway’ which means you will be guaranteed a training post by-passing stage 3. If you require Tier 2 visa, you will still be offered the direct pathway but you will wait until all the UK/EU nationals are given a job. Having said that if you look at the competition ratios for GPST below, it literally means these jobs will not be saturated by the UK/EU citizens. So you will guarantee a job even with Tier2 visa if you achieved a direct pathway score. It will be a matter of time.
- Stage 3 (will be at the selection center): this consists of 2 parts in the same day:
- Part 1: is a structured 3 different consultations with role players (one acting as a patient, one acting as a colleague and one acting as a patient’s relative) these are 10 minutes consultations and all focus on communication; no history, no examination.
- Part 2: is a written part: will require some prioritisation or ranking of issues and a justification of your responses. The time allowed for the written exercise is 30 minutes
For round 1 in 2016 the highest competition ratio was in London deanery 1.8 and the lowest was in the North East deanery (only 0.7) which is good news if you want to apply for GP as it means you are very likely to get the training post if you have the minimum required criteria and scored the required minimum score in the assessment.
The certificate of sponsorship for Tier 2 visa is issued by the deanery for 3 years which means you don’t need to worry about re-applying for a new visa throughout your training.
There is no membership qualification required to apply for GP. Whilst in GP you will be required to complete the Royal College of general practitioners exams, these are 2 exams.
- Written exam: called applied knowledge test AKT, theoretical knowledge questions exam that you can either take in ST2 or ST3 year of training. Majority of trainees pass from first attempt.
- Structured exam: similar to the PACES exam in other specialties. This is called clinical skills assessment CSA exam. Again majority of GP trainees pass eventually. You can have up to 4 attempts.
To be Continued.
Usually 3 year rotation, 18 months in hospital and 18 months in general practice, the first year is usually in hospital and the last year is usually in general practice, the middle year is split in between.
Most of the time all the hospital rotations will be in the same hospital. The first 6 month of general practice rotation is in a different practice to the last year rotation but both will be in the same area.
To be confirmed.
During your training your salary will range between 28,000 to 33,000 pound a year with 45 to 50% banding (for simplicity you will go home with around 2,500 pound a month after tax). After your training your salary will jump to 75 -100 thousand pounds a year depending on the contract and number of hours. In summary, GP trainees’ salaries are comparable to their rivals in other specialties whilst GPs earn higher than hospital consultants.
To be confirmed
To be continued.
To be continued.