Remedial Trainees for whom CSAresult will not be available by end of remedial contract.

Trainees who have not achieved a pass in CSA by the end of normal training are usually awarded additional training time by an ARCP panel in accordance with the Gold Guide. It is unusual for trainees to be awarded longer than 6 months remediation unless there are exceptional circumstances.

Trainees require to have achieved a pass in all 3 components (CSA, AKT and WPBA) within training to gain MRCGP and hence a CCT.

Trainees awarded an extension to training are required to apply for the first available diet of the examination.

An exam taken ‘out of programme’ (where the trainee retains their NTN) can count towards a CCT but an exam take ‘out of training’ (where the NTN has been removed) cannot. Trainees in this situation need to apply for a CEGPR (approved programme) if eligible.

As regards ARCP outcome, following advice from GMC and RCGP Certification Unit, the actual CSA sitting date is the deciding factor rather than the result issue date.

  1. If a trainee sits the CSA before the end of extension contract date this will be regarded as sitting the exam within training and the trainee can be awarded a CCT if a pass is obtained. If the result will not be available until after the end of training date, the trainee should be awarded an outcome 5 and placed out of programme while awaiting the result. In this situation the trainee retains their NTN and is considered to be in training. When the result is available an ARCP should be held and the appropriate outcome awarded (outcome 6 if passes and also passed AKT and WPBA, outcome 4 if released from training, or, in special circumstances, an outcome 3 if further extension granted.)
  1. If a trainee has not been able to sit the CSA before the end of extension contract date then the CSA would be considered to have been taken out of training. The panel is likely to award an outcome 4 at this stage. If the exam is sat out of training and the candidate is successful then a CEGPR - AP (approved programme) is the appropriate route.
  1. If in (2) above and an appeal is lodged, and the CSA passed while waiting for the appeal to take place, this can be considered by the appeal panel who may overturn the outcome 4 and consider the award of an alternative outcome.
  1. Again as in (2) above, if an appeal is lodged and the outcome 4 is upheld by the panel, or the trainee withdraws form the appeals process, and the CSA subsequently passed, CEGPR- AP is the appropriate route.

If the GPST fails the CSA again and has already passed all other components of the MRCGP, and they have not exceeded their 4 attempt limit, and have not already sat the exam out of training, they could be eligible to apply to sit the exam one more time out of training. A statement of fact requires to be submitted to the RCGP from the Deanery to allow this to occur.

This policy is in agreement with the RCGP examination regulations which state:

6.2 The AKT and CSA components of the MRCGP should be taken and

passed during the three year training programme. Further attempts will be

allowed during periods of extended training authorised by a deanery

subject to this not exceeding the limit of four attempts permitted (see

Regulations 6.6 and 6.11 below). At the discretion of the RCGP and

deanery, and in exceptional circumstances only, one attempt at the AKT

and CSA will normally be permitted in the six month period immediately

following exit from training without receiving a CCT. Those obtaining

passes after they have exited training will not be eligible for a CCT and

must apply instead for a Certificate of Eligibility for GP Registration

(CEGPR) under Article 11 of the Order.

Consideration should be given to ARCP panel dates to allow these to take place as late as possible towards the completion of contract date.

The certification unit advise that extensions should be planned around exam dates.

This should allow most trainees to proceed via CCT route rather than CEGPR.

Trainees who require to be placed OOP to meet these arrangements will need to formally apply to their respective Dean for approval.

When a trainee is awarded an outcome 4, the NTN is removed from immediate effect and hence the trainee is removed from the performers list and cannot work in the practice. The practice where the GPST is placed will require prior notification that an outcome 4 may be awarded to plan service provision.

Contractual Implications:

NHS Education for Scotland acts as employer for GPSTs when in a General Practice post.

Human Resources will require prior notification of a potential outcome 4 award and hence removal of NTN, as this will result in termination of the contract of employment under the ‘some other substantial reason’ category.

Depending on the current contract end date, HR may require to arrange a separate formal meeting with a trainee. At this meeting HR will explain that the contract is being terminated for some other substantial reason (as above). The trainee should be advised that there is a right of appeal against the termination of the contract. HR will advise the GPST that he/she will receive 1 month's payment in lieu of notice if appropriate.