5. Returning to training

5.1. When there has been a significant time away from, or gap in training, a GP registrar may request that previous GP training contribute to CCT.  This is usually following either resignation or release from training or extended absence during training and includes but is not limited to periods of statutory leave, OOP, or periods without an NTN.

5.2. For any previous GP training to contribute to a new programme following a gap in training of 12 months or more, the following principles provide guidance which is underpinned by GMC and Gold Guide positions and should be used to support Deanery colleagues in their decision making.

• The most recent medical practice is within the last five years.
• At least six months of previous GP training was completed.
• ARCP forms are presented as evidence of previous training, or an ESR when there may not have been an ARCP panel.

5.3. For gaps of up to two years:

• An assessment of previous ARCP forms and Training Portfolio should be completed by the Deanery before the doctor returns to training to agree how much longer is needed to complete the requirements for CCT.
• The decision should be recorded in the Educator Notes and on the next ARCP form.
• Where the gap is more than one year or absence occurs within the last 3 months of training, guidance on prolonged absence (4.16/4.17) should be considered with sufficient time back in training for capabilities to be demonstrated and assessed.

5.4. For gaps longer than two years but less than five years:

• A supported return to training (SRTT) period should be arranged to review capabilities and learning needs before training resumes.
• The SRTT period should be decided by the Deanery. This would usually be at least three months and would not contribute to training.
• An ARCP panel should take place at the end of the SRTT to determine the appropriate entry point to resume training.
• The latest entry point should be the start of ST3.

5.5. For gaps of five years or more:

• Previous training should not contribute.
• Training will recommence at the start of ST1.

5.6. The period back in training or of experience outside of training to reset the permitted gap must be at least two months (wte). There must be evidence of learning within this period with no interruptions of more than one calendar week.

5.7. A doctor returning with any experience other than previous UK approved GP training must follow the Combined Training process.

5.8. A period of SRTT should not normally count as training and should be clearly labelled on the post list in the Training Portfolio. If a decision is made in agreement with the GP registrar that a phased or supported return should count as training time, this should be made contemporaneously with the reasons stated in an Educator Note, or on the relevant ARCP form.

5.9. Specialty training posts and programmes are not normally available to any doctor who has previously relinquished or been released (Outcome 4) or removed from that training post/programme. It is unlikely that they will be supported in returning to training unless there are exceptional circumstances.

Previously released from training

5.10. Eligibility - The criteria used to decide whether a GP registrar who was released from training, should be supported back into training are included in the Guidance for Applicants on the National Recruitment Office website:

14.1 Support for Reapplication to Specialty - If you have previously resigned or been removed from a GP training programme, you’ll need to provide full details of the resignation, release or removal. This must be provided on the Support for Reapplication to a Specialty Training Programme form and approved by both the Head of School or Training Programme Director and Postgraduate Dean in the region where training was previously undertaken. This evidence should be emailed to the confidential email address of your first preference region at the point of application. Any applications from excluded GP registrars without submitted evidence will not progress any further in the recruitment process.

5.11. The Person Spec states that:

Applicants must not have previously resigned, been removed from, or relinquished a post or programme, except under extraordinary circumstances and on the production of evidence of satisfactory outcome from appropriate remediation.

5.12. Exceptional circumstances may be defined as a demonstrated change in circumstances, which can be shown on the ability to train at that time and may include severe personal illness or family caring responsibility incompatible with continuing to train. Applicants will only be considered if they provide a ‘support for reapplication to a specialty training programme’ form signed by both the Training Programme Director / Head of School and the Postgraduate Dean in the Local Office / Deanery that the training took place. No other evidence will be accepted.

5.13. Whilst it is difficult to define ‘exceptional circumstances’, it should be accepted that this must have been something that directly and specifically affected the GP registrar’s ability to train at the time. An exceptional circumstance is not something that could have been dealt with and managed at the time and should be able to be evidenced as justifiably exceptional.

5.14. A GP registrar who was not successful in their first training programme especially after numerous fair attempts at each exam and periods of remediation, should not be supported back into training.

Re-entering a training programme

5.15. When a GP registrar approaches the Deanery for support to re-enter a training programme, the Deanery should inform the GPSA team before the doctor makes an application, to ensure accurate advice is provided and confirm the number of available exam attempts.

5.16 Where a GP registrar is permitted to return to GP training, an appropriate, supported and bespoke training programme based on the specific needs of the GP registrar must be developed by the Deanery.

5.17. If the doctor is supported back into training, a decision should be reached on whether it is appropriate for any previous GP training to contribute to the overall training programme referring to points 5.1 to 5.8.

5.18. An ARCP form from the previous training programme is expected. If there is an ESR for a previous period of training but no ARCP form, an ARCP panel may be arranged at the discretion of the Deanery to which the returning GP registrar has applied to review the previous period of training and decide whether any of it could contribute towards the new programme.

5.19. The new programme will be constructed depending on capacity in the Deanery and previously completed posts should ideally not be repeated.

5.20. For doctors who have previously been in a GP training programme before 2 August 2023, the MRCGP regulations allow for a maximum of four attempts at each of the AKT and CSA/RCA. A fifth attempt is permitted in exceptional circumstances.

5.21. Where limited exam attempts remain for a GP registrar who wishes to return to GP training after a period out of training, the pressure on the GP registrar and likelihood of success must be considered when discussing the advisability of returning to GP training.

5.22. If all fair attempts have been exhausted, no further attempts will be permitted even in the case where a GP registrar enters a new training programme. Only GP registrars who enter GP speciality training for the first time on or after 2 August 2023 are permitted a maximum of six attempts at the examinations.

5.23. Passes in MRCGP assessments are valid for a maximum of seven years in line with GMC requirements and MRCGP regulations. This applies whether or not a GP registrar has started a new training programme or re-joined a programme after a period out of training. The GMC has approved RCGP examination regulations as outlined above.

5.24. The number of examination attempts permitted is determined by the date a GP registrar joined a GP training programme for the first time and does not reset in a new training programme.

5.25. If a GP registrar is suspended by the GMC, under fitness to practice procedures, it is likely that the NTN will be removed. The Gold Guide (external PDF) makes provision and sets out the requirements for the GP registrar to request that the Postgraduate Dean restores the training number if the Interim Orders Tribunal (IOT) decision is revoked, and GMC registration reinstated.

5.26. If the NTN is withdrawn, the GP registrar can appeal to have it restored. If the appeal is successful, the GP registrar can re-enter training at the point at which they left if the period out of training does not exceed two years. They do not need to re-apply to the training programme. The period the GP registrar was not in training should be treated like an Out of Programme post. If the GP registrar is out of training for two years or more, they must reapply to training and cannot re-enter where they left. In this situation the same guidance for resignation applies and an ARCP panel must determine how much if any previous time can count.

5.27. If after a period of suspension, a doctor wishes to return to training, they must re-apply and must have the support of the Postgraduate Dean (PGD) in the locality where the training was previously undertaken. Applications will only be considered on a case-by-case basis if a GP registrar provides a ‘Support for Reapplication to a Specialty Training Programme’ form and with review of the individual circumstances by the relevant PGD. There must be close consultation between the Deanery and the GPSA team to try to ensure no issues arise at a later date. There is currently no appeal of decisions by the PGD not to support a reapplication, but Deaneries may choose to have a local process for review of the decision.