Important changes to the Recorded Consultation Assessment

I hope that this finds you well. I am writing today to inform you of some important changes being made to the Recorded Consultation Assessment (RCA) from September onwards. These relate to mandatory criteria, safety netting and the submission time limit.

Changes for the RCA to take effect from the September 2021 diet

The RCA will remain in place to allow for sufficient time for development of the new MRCGP performance assessment module. We have listened to feedback from candidates, GP trainers, the wider training community and other stakeholders.

In response to this feedback, and the valuable input from MRCGP Examiners (themselves practising GPs) based on their observations of submitted consultations, we are making some changes to the RCA. These will apply from the September 2021 diet, the submission deadline for which is 30 September 2021.

It is important to note that these changes cannot be applied retrospectively, and therefore there are no grounds for appeal from candidates who were previously unsuccessful in the RCA. The changes have been developed in partnership with the Committee of GP Education Directors (COGPED) representatives and are supported by the GMC.

Maternal and reproductive health

Breast lumps (apart from those associated with the postnatal period) will no longer be considered for the mandatory criteria of maternal and reproductive health

The mandatory criterion was in place to ensure that candidates have the clinical skills to manage obstetrics and gynaecology. We have found that breast lumps score poorly as the management is a straightforward (but appropriate) referral to a fast-track clinic of a breast surgeon with no other management skills that align with the original intention of the criterion. There have also been many submissions of male breast lumps.

Clinical examination

Clinical examination will no longer be a mandatory criterion

In trying to explain to patients what examinations will be carried out in the proposed subsequent face to face consultation. Candidates appear to feel that they are required to talk to the examiner rather than the patient. Even in a video recording, the examination takes place behind a curtain. Hence, clinical examination will no longer be a mandatory criterion in the RCA. But clinical examination skills will continue to be assessed in Workplace Based Assessment.

Safety netting

The feedback statements and descriptors around safety netting will be changed to include the words 'appropriate' and 'realistic' safety netting

It has become apparent that some 'generic' safety netting by candidates such as 'phone 999' or 'go straight to A&E' can confuse and even upset patients. This clarification to the feedback statements and descriptors is intended to ensure candidates' safety netting is contextually appropriate to patients presenting complaints.

Time for RCA submissions

Increase the allowed length of time for submissions from 10 minutes to 12 minutes for all cases

An increase in allowed time for every case was one of the biggest requests from the training community. It is recognised that 'real life' consultations can extend beyond 10 minutes, especially as the challenges of COVID continue. It is hoped that this increase in time for all cases will make candidates' RCA case selection easier. Thus supporting them, their GP trainers and their practices.

As ever, please do contact the Exams Team at exams@rcgp.org.uk if you have any questions about the changes, or anything else regarding assessments.

About the writer

Dr Michael Mulholland is a GP at Unity Health, a five-site practice for 22000 patients across the Buckinghamshire and Oxfordshire border where he has practised for nearly 20 years.  

He also works for Health Education England with roles in GP training, Quality Improvement and workforce planning. Within the RCGP he has been part of the GP at Scale programme and a GP Forward View Regional Ambassador.

He was elected to the post of Vice Chair (Professional Development) in November 2018.