The Portfolio Pathway (formerly CEGPR route): Resources for applicants 

Before you begin to prepare your application, we strongly recommend that you carefully read and refer to the following resources:

Specialty Specific Guidance (SSG) for General Practice

• The SSG provides guidance on the kind of evidence we expect to see in a Portfolio Pathway CEGPR application.
• Don't overlook the helpful links and templates found on the last page.

GP Curriculum

• Your application is assessed against the standards set out in the UK GP training curriculum.
• Together with the SSG, this is an essential read.

Frequently Asked Questions

• Questions you may have on the application process.
• How to present your evidence, and how to evidence training and qualifications.

Guidance on the RCGP website including:

• The PDF guide (PDF file, 124 KB)
• Exemplars - Case studies and Significant Event Analyses
• The other Mini Guides in this series.

This guidance applies to applicants who are making a standard application for CEGPR via the Portfolio Pathway, not a streamlined application.

Regardless of when you completed your training, we strongly suggest you provide as much information about it as possible.

To evidence your training, you should include:

• Your family medicine / general practice qualification certificate.

• A copy of the curriculum or syllabus that was in place when you undertook your training.
  • Alternatively, a letter from your training provider describing the content and structure.

• Evidence of formal periodic assessment during your training.
  • A letter from your training provider describing the in-training and exit assessments in your programme.
  • In addition, you could consider presenting the following:
    • case based discussion
    • resident milestone evaluation
    • logbook
    • mini clinical evaluation exercise (or consultation observation tool)
    • external clinical teaching visit report
    • supervisor evaluation report

• Evidence of rotations you have completed as part of your training, including the specialty and length of each post.
  • For example, this could be a transcript or a letter from your training provider.

• Examinations taken during your training including exam results.
  • If details of the examination(s) are not found in the curriculum, we suggest you obtain a letter from your training provider, giving details of the format and content of any examinations you have sat.

The quality of your evidence will determine whether your application is successful, so it is well worth taking the time to select and present your evidence carefully.

• A very large bundle of evidence is not necessarily helpful.
  • The quality of your evidence is more important than the number of pages.
  • As a guide, we recommend that your evidence should not exceed 800 pages.

• Try to provide a variety of evidence for each area of capability.

• Think about whether all the evidence you want to include is relevant.
  • Does it help to demonstrate the knowledge and capabilities required for working in general practice in the UK?
  • If it is a very long document, such as a handbook, you may want to limit your evidence to just the relevant pages.

• Evidence which shows your personal, active participation is stronger than other evidence which simply reports it.
  • For example, your own account of making changes to practice following a significant event or the practice protocol you designed will be stronger evidence than a testimonial, certificate or minutes of a meeting.

• Introduce and explain your evidence.
  • Write an introductory paragraph to help the reader understand why you have included this item.
  • Tell the reader how it relates to the curriculum capability you are demonstrating.

• Your own thoughts and reflections will always enhance an item of evidence, rather than simply a description.
• Ensure that written documents are legible and copies of documents are clear and easy to read.

More information

Watch a video of our evaluator, Dr Laurence Buckman, discussing this topic

If you have a question or want advice on evidence which might be suitable, contact our GP Specialist Applications team: gpsa@rcgp.org.uk

Personal reflection on your practice and thinking about how you can improve the care you provide are essential in an application for a CEGPR via the Portfolio Pathway.

When you read the Specialty Specific Guidance for applicants, you will see lots of suggestions to provide your personal reflections on something. For example, your reflections on your patient log; the results of your patient satisfaction survey; how your practice differs from general practice in the UK.

It is very important that you do include your written reflections as this will help to show that you are a reflective practitioner. Reflective writing develops your reflective thinking and helps you improve your practice. Through your written reflections you should aim to demonstrate:

• learning and insight into your practice
• areas you have identified for development
• understanding of the work of the general practitioner in the UK
• that you understand the changes you may need to make to adapt to general practice in the UK.

Your reflections may be longer in some areas than others. A short reflective paragraph often helps to introduce an item of evidence. It can also help to explain to evaluators assessing your application how the evidence relates to the Area of Capability. Reflections on cases, complaints and significant events are likely to be longer.

Another way to think about reflection and write reflectively is to consider how you did something and why. You might ask yourself, for example, how you gained the patient’s trust and why you decided not to discuss smoking at the first consultation.

Some other ways to describe reflecting on your practice are:

• Evaluate
• Analyse
• Think critically
• Review positive and negative aspects
• Think about what else I could have done and what I learned
• Think about what I will do differently in the future

A common problem is making your writing too descriptive, only describing what you did and not including any analysis or evaluation. Always keep ‘the how and the why’ and what you have learned in mind as you write.

More information

• Watch a video of our evaluator, Professor Lyon-Maris, discussing this topic
• CEGPR reflective case studies and significant event analysis Exemplars
• Academy and COPMeD Reflective Practice Toolkit including templates and examples
• The reflective practitioner: guidance for doctors and medical students

In preparing for general practice in the UK you are expected to have some understanding of NHS general practice and to have thought about how you might need to change your practice to adapt to the UK system.

You should gain an understanding of NHS general practice by reading up on how the NHS works and how primary care is delivered in the NHS.

• Think about the similarities and differences between the healthcare system you currently work in and the NHS.
  • This could be anything from patient demographics, breadth of practice, length of consultation, workload, clinical management, record keeping, referrals, prescribing etc.
  • Some of these differences are a result of the way primary care is delivered. In some countries or areas, primary care is delivered in hospitals.
  • For example, your practice might be skewed towards acute care or you may have relatively less exposure to the care of the elderly. How might you address this?

When you have identified your learning needs, consider undertaking CPD learning and/or some clinic sessions or work shadowing.

When you are ready to put the knowledge you have gained into your application, you should apply what you learned by:

• Writing an essay / statement on what you have learned, what you would need to do (and what you may have done) to adapt to general practice in the UK.
  • Don’t be afraid to point out and discuss the differences in your healthcare system and practice compared with general practice in the UK.

• Incorporating what you have read / learned in your case studies.
  • For example, consider any differences in clinical management. If you were practising in the UK, include how (and possibly why) you think the case would be managed differently.

• Reflecting on CPD learning you have undertaken to address the learning gaps you have identified. This is in addition to presenting CPD certificates.
  • Any learning needs which are yet to be met can be included in your personal development plan.
  • Do not simply present CPD certificates of courses you have attended.

More information

Watch a video of our evaluator, Professor Lyon-Maris, discussing this topic

The role of a GP in the NHS and NICE guidelines

E-learning portals - RCGP e-learning / Red Whale / BMJ Learning

The GMC’s Welcome to UK practice and The NHS explained by The King’s Fund

YouTube videos Being a GP in the NHS / The GP as the first point of contact in the NHS / The GP consultation in UK practice / The GP looking after the whole person 

A set of detailed, reflective case studies is an essential part of your evidence and should be used to demonstrate your capabilities in several areas of the curriculum. If well written, they offer a real opportunity to showcase your skills, experience, attitudes and behaviours as a general practitioner.

Decide on a format for your case studies which should include:

• a title or case number
• a brief outline of the case and patient history
• your detailed, personal reflections including learning points
• the patient record, management plans, letters and other related documents (if you wish).

Try to choose a range of different patients and presentations as the subject of your case studies to illustrate the breadth of your practice. Some examples include infants, children and young people; older adults with multimorbidity; people with complex care needs; people with mental health needs; people with long-term conditions; pregnant women and new parents.

The types of patients you will care for in general practice in the UK are described in the curriculum. You may also find it helpful to refer to the Clinical Experience Groups used in GP training in the UK.

Your case studies should show you working in partnership with patients and providing longitudinal, family orientated, comprehensive care. They should include evidence of managing patients independently over several consultations, as well as appropriate referral to other specialists and services.

Consider whether the case studies you have chosen for your evidence in a particular area of capability are showcasing the relevant skills. For example, under Communication and Consultation, have you discussed your specific communication and consulting skills and how they were used in this case?

Be reflective:

• A common problem is making your writing too descriptive, only describing what happened and not including any analysis or evaluation of your care. Your outline of the case is likely to be the shortest part of the case study and your reflections the longest part.

Be concise:

• If adapting a case study used for another purpose take care to ensure it is not overly long. It’s likely to need some editing and rewriting to fit the requirements of your application for a CEGPR via the Portfolio Pathway.

More information

Watch a video of our evaluator, Dr Laurence Buckman, discussing this topic

CEGPR application exemplars of reflective case studies and significant event analysis

Academy and COPMeD Reflective Practice Toolkit (including templates and examples)

GP Curriculum and Clinical experience groups

A brief outline of the case and history

This patient is a 39-year-old man who returned to live in Australia after two years living in Ireland. He returned after the relationship with his partner broke up. His partner and their then four-year-old daughter remained in Ireland. He is unemployed and last held down regular employment as a hospital porter several years ago. He lives alone in rented accommodation but has family living nearby who are socially, emotionally and financially supportive. A family member often accompanies him when he attends our medical centre.

His current medical problems include:

• Chronic drug addiction (Benzodiazepines regularly and frequent use of cannabis)
• Chronic alcohol dependence
• Depression, anxiety and post-traumatic stress disorder (related to previous experience in the armed forces) - currently under specialist management with a consultant psychiatrist
• Obesity
• Asthma with frequent exacerbations
• Psoriasis

His past relevant medical problems include:

• Previous seizure induced by alcohol withdrawal resulting in head trauma with subdural haemorrhage
• Previous episode of alcoholic pancreatitis

His current social problems include:

• Social isolation
• Unemployment
• Unwanted separation from his daughter
• Previous history of doctor/prescription shopping

Personal reflections on the case

When I first met this patient, it was difficult to form a therapeutic relationship with him, partly because of his demands for prescriptions which could easily lead to confrontation. However, over the last couple of years, we have got to know each other better and a level of trust has developed. He attends frequently and prefers to see me rather than one of the other doctors in the practice.

One of the particular challenges for me has been the level to which I am willing to acquiesce to his requests for medication to help maintain the relationship. This has required delicate but firm handling to avoid any degree of collusion. We ultimately came to an agreement that has formed a kind of unwritten contract between us in that I will supply prescriptions according to the agreed plan (also known to his consultant psychiatrist) and in return for this I make sure that he has access to me personally unless I am away from the practice. Another challenge has been to remain patient and to be grateful for small improvements. Nevertheless, we have made some progress.

Since his last admission to a private hospital for detoxification nine months ago he has not touched any alcohol. His mental state has improved markedly with less depression, lower anxiety levels and better relationships with his immediate family who remain extraordinarily supportive. He recently applied for work as a delivery driver and has undertaken some voluntary work at the local day centre but has yet to secure regular employment. He no longer shops around for doctors willing to prescribe for him.

I have had to learn a lot about the management of drug addiction and alcohol dependence while managing this patient. I have also learnt a lot about myself, not least the tendency to make hasty judgements when first meeting patients based on insufficient information. Although his behaviour can be challenging, he has also had considerable adverse life experiences that resulted in a downward spiral and, but for the help he continues to receive from his family, the outcome could easily have been a lot worse.

We have also had to learn and adapt as a practice. Some of my partners still find him a little intimidating and some tend to make him feel as if he is being “told off” if he attends for a prescription. One of the issues is that he finds any disruption to his routine destabilising and this manifests itself in behaviours that are easily interpreted as aggression.

We have therefore devised an agreed plan between us such that if I am not going to be available, I try to notify him in advance so that there are no surprises. We have also agreed that if I am unexpectedly unavailable, he will be seen by one of two other doctors who know the case well enough and are willing to provide his agreed supply of medication, but no more.

One of the other key learning points for me has been the benefit of thorough record keeping, especially when detailing prescription plans. Also, it has been very helpful to make sure everyone dealing with this patient knows the plan, including a nominated pharmacist. This has been time-consuming to set up but has saved a lot of problems in the long run.

Finally, I have reflected that this patient has been extremely fortunate to have such a supportive family. Without their help, he would not have been able to be admitted to a private hospital for his alcohol detoxification and he would not have received such good care through the public system, particularly in terms of access to inpatient and outpatient specialist treatment. Although our health care system has many strengths, equality of access based on clinical need rather than the ability to pay sadly remains some way off.

A brief outline of the case and history

This patient was an 80-year-old retired company director.

I only met this patient for the first time after the death of his wife. He was grieving and part of his distress was due to his difficulty in coming to terms with his perception that his wife had been misdiagnosed (by a different doctor) with asthma when in fact it later came to light that she was suffering from lung cancer.

The patient came to see me because I was the GP who finally detected his wife’s cancer. She had been suffering from shortness of breath for several weeks and the treatments she had been prescribed for presumed asthma had not been helping. A chest X-ray was reported as normal so, given the persistence of the symptoms I requested a CT scan. It was the scan that ultimately revealed the true diagnosis. I referred her for specialist treatment but, sadly, not long after treatment commenced, she passed away suddenly due to pneumonia that failed to respond to treatment.

I listened to his concerns and it appeared to me that he was, amongst other things, concerned about his health. Therefore, I offered to perform a health check for him. Part of his health check included a blood test which showed impaired liver function and thrombocytopenia. I organised further liver investigations with ultrasound and CT scan, which showed evidence of hepatic cirrhosis with chronic pancreatitis and evidence of portal hypertension. Although the patient was clinically well at this point, given the serious nature of the investigation findings, I referred him for an opinion from a hepatologist.

The patient underwent gastroscopy which showed large gastric varices and the patient was referred by the hepatologist to a tertiary hospital centre for multidisciplinary team care. He was diagnosed with rapidly progressive hepatocellular carcinoma which was invading deeply into the portal vein and the inferior vena cava and therefore unamenable to treatment by surgery or radiotherapy. The cirrhosis also meant that systemic treatment with chemotherapy would pose a high risk of liver decompensation.

Therefore, the only realistic treatment available was palliation, but the patient found this very hard to accept, particularly because he still felt clinically well and of course he was still struggling to come to terms with his bereavement. I saw him in the presence of his son, listened to his concerns and understandable anxieties before discussing what the palliation might mean.

Not long later, the patient began to deteriorate rapidly with abdominal swelling combined with considerable weight loss. I arranged a review by the hepatologist to manage his ascites. I also initiated a palliative care referral. I provided my direct contact number to the patient and his son in case of emergency, but sadly the patient died soon after in the local hospice.

Personal reflections on the case

There are several points of reflection on this case:

1. It is important not to be unduly critical of colleagues when there might have been an oversight or even an error of judgement. Often we don’t have access to all the facts and we were not present when the patient consulted our colleague. Everything becomes clearer in hindsight. In this case, listening was a very important part of the management and I simply listened to his concerns regarding his perceptions about his wife’s diagnosis.
2. Responding to patients’ concerns is important. In this case, it was a response to the patient’s understated concerns about his health that prompted the investigations that uncovered his diagnosis. I might not have suggested the health checks, but I am glad I did and would do so again in a similar situation. Ultimately, this made no difference to the progression of his disease but it did help him to trust me, whereas his faith in the medical profession had diminished with his experience of his wife’s illness and subsequent death.
3. The patient was not satisfied with the explanation given by the hepatologist regarding the inability to offer more aggressive treatment. The patient felt that insufficient explanation was given during the consultation and after receiving the news that his cancer was untreatable, he felt lost and confused and there was no further follow up arranged nor was there any referral to palliative care services. Again, listening to his ideas and concerns was important and giving him time and space to express his thoughts was a key factor in developing a trusting relationship.
4. Providing a strategy, even though this fell short of offering a cure, was important. A helpful part of that strategy was the offer of follow up and a number to ring if problems arose.

Continuity of care and a clear plan can often help even in difficult situations where therapeutic options are limited.

In summary, I think there were some important learning points from this case. In terms of what not to do, it was to refrain from criticising colleagues. The importance of listening and responding to patients’ ideas, concerns and expectations is demonstrated and whilst the concern is that this can be time-consuming, it saves time in the long run. This is an area of communication skills that can always be improved on. The coordination of care by the GP is a key element of the task in such cases and the impact this can have on a successful outcome is often underestimated.

What happened - including your role?

A 5-year-old boy attended the practice nurse, accompanied by his mother, after falling off a coffee table earlier in the day.  He had initially complained of pain in his left arm and for a time did not appear to want to use his left hand. The practice nurse was unsure and asked for another opinion. My clinic was fully booked but I agreed to see the child as an extra added on at the end of the morning. By the time I saw him I concluded there was nothing to suggest a fracture and I explained that this was most likely a soft tissue injury but asked the mother to return if she had any further concerns. The management plan was essentially simple analgesia.

The child was subsequently taken to the emergency department because later that day after our clinic had closed, he complained of more pain and was tending not to use his left hand when playing or eating.

When he was assessed in the emergency department an X-ray confirmed a buckle fracture of his left distal radius. He was treated with a below-elbow cast. He made a full recovery and the cast was removed after 3 weeks. However, his mother questioned why a referral for an X-ray was not made at the first appointment.

Why did it happen?

Buckle fractures in young children are common and may present with few symptoms or signs. However, a history of functional impairment could be significant. In general, these fractures heal well and the use of a cast is mainly for comfort.

What was done well?

The notes from the original consultation do refer to the advice given to the mother to return if she had any concerns. In this sense, a “safety net” was provided. The outcome was good in that the child made a full recovery. The mother’s concerns were acknowledged, an apology was made and she was reassured by the commitment to have the event reviewed. In this way, we kept our response transparent and the mother did not pursue a formal complaint.

What could have been done differently - and who was involved in the discussion?

A discussion took place between me, the practice nurse, and one of the other partners because essentially this was a missed diagnosis. The main focus of the discussion was the clinical record made at the original consultation. Although reference was made to the likely diagnosis (soft tissue injury) and the advice to return if there were any concerns was clear, there was a lack of any record of the actual assessment made. I could not recall exactly what assessment I had made at the time. This made it difficult when explaining the sequence of events to the mother who questioned the decision not to ask for an X-ray at the initial consultation.

Regardless of the positive outcome, my clinical notes on this occasion were not at the standard I would have hoped for. In particular, there was no mention of a functional assessment and it's possible that this would have resulted in a different conclusion and management plan.

What have you and the team learnt?

The event took place on a particularly busy day in the practice, but this should not be used as an excuse. The most important learning points were:

1. Always have a high degree of suspicion when a child has experienced a fall followed by a period of time when they don’t want to use the injured limb.
2. Always make a functional assessment of an injured limb when possible.
3. Clinical notes should always include the assessment made rather than simply the conclusion.

What changes have you or the organisation made?

In this case, the outcomes were largely personal learning points for me and also for the others present at the discussion who admitted that they also might not have included any details of the assessment made, particularly if there was significant time pressure.

Although in this case the outcome was good and the diagnosis relatively minor, this case was a helpful reminder that it is essential to keep accurate and sufficiently detailed, contemporaneous clinical records.  

What happened - including your role?

A patient made a prescription request over the phone for an item (Ketone test strips) that they had not been prescribed previously. The request was passed to the practice nurse who then passed the request to me as the prescription was for an item not previously prescribed.

The prescription appeared to be reasonable and appropriate, so I signed it but did not realise that it had been issued to a different patient with the same name.

The original patient collected the prescription, but the error did not come to light until the incorrect patient was sent an invoice.

Why did it happen?

The error occurred for three main reasons.  Firstly, too many people handled the request, which increased the possibility of an error.  Secondly, the message was passed by handwritten notes rather than via the clinical system and so the message was not attached to the correct patient’s record.  Thirdly, I did not double-check the details of the patient when issuing the prescription.

Finally, the pharmacy did not double-check the identity of the patient including their date of birth when handing over the prescription.

What was done well?

When the error came to light an immediate explanation and an apology was made to both patients involved.  A meeting was convened to which a representative of the pharmacy was invited.  This was done in a spirit of improving systems to prevent this happening again, rather than in a sense of blaming any one person for the error.

What could have been done differently - and who was involved in the discussion?

The following people were involved in the discussion about this event:

• Practice Manager
• Doctor
• Practice Nurse
• Receptionist
• Pharmacist

It was recognised that there were several opportunities where, if things had been done differently, this situation could have been prevented. In this case, it was fortunate that no harm came to anyone and it was an opportunity to update our systems and procedures to make them better.

1. The practice of accepting prescription requests by phone was reviewed and this was thought to be inherently more likely to result in errors.
2. Messaging needs to be done via the clinical computer system so that messages and tasks are attached to the clinical records of the relevant patient.
3. At all stages, checks should be made to ensure the correct patient is being dealt with.

What have you and the team learnt?

Firstly, we were pleased that the patients responded positively to the team acting quickly once the error came to light. The apologies and explanations were accepted.  We were also pleased that the team came together constructively to discuss how things could have been done differently and how to improve our systems and processes. Several changes were made as detailed below.

What changes have you or the organisation made?

When this came to light it was a shock to me personally.  It was also a relief that this had occurred with a prescription request that was unlikely to cause harm, but it could have been much more serious.  Since then I have personally been much more thorough in checking the identity of patients.

The following changes were agreed and implemented:

1. Phone requests for prescription items are only permitted for previously prescribed items (i.e. repeat prescriptions) and only for those patients where this is agreed and documented as acceptable – this is only a small minority of patients and in all other cases prescription requests should be made online or in writing. 
2. All messages and tasks relevant to a particular patient should be done via the clinical system rather than by hand.
3. All staff to be reminded to check patients’ identities when writing or issuing prescriptions.

During my time as a general practitioner in Melbourne, I received one complaint which occurred in the first practice in which I worked for 6 months. The complaint pertained to a consultation with a lady aged 72, who attended me for the results of a CT scan for which she had been referred by another GP within the practice. She reported that she had a long history of back pain which had been getting worse, prompting her referral for CT scan. The CT scan showed osteoarthritic changes in the lumbar spine along with some spinal stenosis. On reviewing her symptoms, I checked whether she had any symptoms of cauda equina which fortunately, were absent. I suggested she attend an orthopaedic surgeon for advice regarding whether an MRI may help to further assess her situation. She was keen for referral for MRI prior to referral for an orthopaedic consultation.  

We discussed my limitations regarding interpretation of MRI and I encouraged her to speak with an orthopaedic back specialist before any referral for MRI. Unfortunately, as I was new to the area, I had to check my practice booklet to get details of local orthopaedic back specialists and gave her a referral to arrange a private appointment as this was her preference. 

The letter of complaint outlined that she felt more worried leaving the appointment than on arrival to see me. There were no complaints about her medical management, rather about the consultation itself. 

I reflected on this and felt that I could understand her anxiety. I felt that it may have been, in part, exacerbated by my own uncertainty regarding interpretation of CT scans of lumbar spines and that I was not familiar with the local orthopaedic back specialists. I wonder if I had projected some of this uncertainty onto the patient, thereby increasing her own anxiety. I was also aware of the difficulties which can arise when following up on a test result arranged by another practitioner, as there may have been certain expectations arising from the referral for the investigation. With this in mind, I spoke with my GP colleague who had made the referral. He was able to advise me that he was familiar with the lady, and he had noticed that she seemed to be anxious at times. He agreed with my suggestion that she seek an orthopaedic opinion based on the CT scan results. 

As the complaint pertained to my consultation style, I felt that I should speak with the patient and, following discussion with the practice manager, I tried to contact the patient over the telephone. Unfortunately, I was unable to contact her by phone. I spoke with the practice manager who advised that their protocol was that the practice manager would write to the patient explaining that I had tried to contact her and that I was sorry for any anxiety which I may have caused. The practice manager subsequently advised me that the patient was happy with the explanation and apology and no further action was taken by the patient. 

I feel that this situation reminded me that I need to increase my awareness of my own emotions during my consultations with patients. Whilst it is reasonable to express unfamiliarity with certain local services, I was more careful in subsequent consultations to try to avoid projecting any of my own feelings of uncertainty which may add to a patient’s own anxiety. 

A Portfolio Pathway application is made to the GMC online. The GMC reviews and prepares your evidence before passing it to the RCGP for evaluation. The RCGP has a panel of experienced clinicians who will evaluate your evidence. The panel makes a recommendation on whether an application should be approved or declined. As the regulator, the GMC makes the final decision on the application.

This depends on individual circumstances. It can often take up to six months to gather the evidence needed. 

Your evidence will be considered by a panel. We are therefore unable to provide an assessment or indication of whether the evidence you intend to submit will be sufficient for a successful application. Furthermore, the GMC, as the regulator, makes the final decision on your application.

We are happy to answer questions and advise on any aspect of the evidence suggested in the Specialty Specific Guidance. You may have alternative evidence which you would like to discuss with an Adviser. Our email is gpsa@rcgp.org.uk.

If the GMC approves your application, your name will be entered onto the GP Register. Apart from being on the GP Register, you need to be on the Performers List to practise independently in the NHS. To be included on the Performers List you must join and complete the International Induction Programme.

Please contact the GP National Recruitment Office for more information on the programme. Once you have completed the programme, you will be approved for full inclusion on to the Performers List and can work unsupervised as a general practitioner in the NHS.

You could make a review application based on the recommendations provided. You will also have the right to appeal the GMC's decision. Please refer to the GMC website for more advice.

We consider evidence from the last five years to be more relevant than older experience and therefore this is given greater weighting when we evaluate your application. Where possible, you should still provide details of your training. This could be relevant pages or extracts of the curriculum and the required assessments, including the content of examinations, current at the time of your training.

If you are unable to provide details of your training, we suggest you provide a letter from your training provider describing the programme's content and structure.

See also Q15) and Q16).

As the MRCGP[INT] accredited qualifications are in general practice, you will be eligible to apply via the Portfolio Pathway. However, we strongly suggest that you read the GP curriculum and Specialty Specific Guidance (SSG) carefully. The curriculum on which an MRCGP[INT] accredited qualification is based is unique to the country it was developed for and is therefore different from the MRCGP curriculum in the UK. You will still need to demonstrate that you have achieved the UK curriculum standard and the 13 capabilities outlined in it.

The Portfolio Pathway is not designed for doctors who have not been successful in the CCT programme.

The Portfolio Pathway is designed primarily for doctors who have trained and worked as a general practitioner outside the UK who can show that their knowledge, skills, and experience in general practice (including examinations and assessments they have passed) are equivalent to the curriculum standard. If your evidence does not include a pass in a formal examination or qualification taken at the end of a general practice training programme, it is very unlikely that your application will be approved. To date, there have been no successful applicants through this route by doctors who did not achieve a pass in their final assessments in the CCT programme.

Your application is assessed against the curriculum learning outcomes (provided as 13 capabilities). You will need to demonstrate the 13 specific capabilities for general practice and show that you have the knowledge, skills and experience required to practise independently as a GP in the UK.

We usually expect to see around 500 to 600 pages of good quality evidence. This is just a guide. We advise against providing a large bundle (>600 pages) as it may distract the evaluators from important details you want to highlight. You should think about how the evidence you want to include in your application helps to demonstrate the required capabilities.

We do not expect applicants to provide all the evidence listed in the SSG. We advise you to read the SSG and GP curriculum carefully and try to provide a variety of evidence for each capability. The evidence suggested in the SSG is not exhaustive. You may have alternative evidence and we are happy to help if you are unsure about any part of your evidence or what to include. Where possible, you should present evidence of your personal participation in an activity and your personal reflection on it.

Guidance can be found on the GMC website.

Any questions you may have regarding this should be directed to the GMC. Please call 0161 923 6602 or email portfolio@gmc-uk.org.

If you have not been in clinical practice for the years immediately preceding your application, you may find it difficult to provide evidence to demonstrate the required currency of capabilities across the curriculum areas. The evaluators expect to see evidence that your knowledge and skills are being maintained.

You might want to consider going back into clinical general practice for a period of time to gather enough evidence for your application.

We expect to see evidence of your work as a general practitioner. It is important to demonstrate current competence with evidence of recent activity in the last five years. If you have been on maternity leave or sick leave, you should also provide evidence that you have kept up to date with general practice. Alternatively, you could return to your previous practice for a period of time to gather the evidence you need. 

Note: If you are already in the UK, you will not be able to work as a GP in the NHS without being on the GP Register.

We usually consider evidence from the five years preceding your application to be more relevant than older experience. However, even if you completed your training many years ago, we advise you to submit relevant pages or extracts of the curriculum and a letter from your training provider to explain the assessments within your training programme, including the format and content of any examinations. If a formal curriculum is not available, you should obtain a letter from the awarding body outlining the content of the training programme and details of assessments or examinations. You should also provide evidence of formal periodic assessment during your training.

If you don't have evidence of formal periodic assessment, you should provide a letter from the training provider confirming the requirements of your training, how you were assessed, and details of the training provided.

No, you will not be able to rely on testimonials from colleagues; primary evidence which shows your personal participation in an activity and where you have included your personal reflection on it will carry most weight. Testimonials from colleagues can be used to support and corroborate your direct participation in an activity. The SSG provides details of the evidence which we consider helpful.

The evaluators must decide whether your knowledge, skills, and experience meet the curriculum standard. We do not expect the training programme or assessments you have undertaken to be identical to the ones in the UK. 

We are aware that annual appraisals may not be a requirement in some countries. However, it is possible to provide elements of an appraisal even in the absence of a formal appraisal process.

The GMC website describes the various components which make up an appraisal portfolio in the UK. These include:

• Continuing professional development
• Quality improvement activity
• Significant event analyses
• Patient feedback
• Colleague feedback
• Compliments and complaints

The submission of these will provide strong evidence that you are likely to engage well with appraisal and performance review in the UK.

There are numerous e-learning courses and reading material available online. For example, e-Lfh, BMJ Learning, and RCGP Learning. Some applicants choose to take the RCGP's GP Self-test. The GMC has a self-assessment tool. You may want to look at NICE guidelines and discuss some of the differences between your current practice and what is expected in the UK. This could also be helpful when you reflect on your case studies. You should include reflections on your learning. Many successful applicants research the context of NHS general practice, consider the differences and similarities with their own healthcare setting, and tailor their learning to preparing for work as a GP in the UK. Online courses and reading could help you identify gaps in your knowledge and present an opportunity to do more learning or could form part of your learning goals in your Personal Development Plan (PDP).

We expect to see evidence of you managing the full range of patients and conditions expected in UK general practice, dealing with unselected problems in patients of all ages and coordinating care with other professionals in primary and secondary care. If your current practice is skewed towards a particular patient group or population, it may be difficult to gather evidence needed for a successful application.

You may have worked in an urban setting in previous roles and may wish to include evidence from that time, although evidence which is more than five years old usually carries less weight. You should reflect on the similarities and differences between your current practice and UK general practice. If you identify gaps in your knowledge, you should think about how these could be addressed (for example, via CPD learning).

You may write case studies from memory. The management plan for those patients and letters you wrote to other agencies and professionals could be reproduced as Word documents. If you are unable to present referral letters, you may wish to present a summary of the referral and your reflections on it. You would need to add a note to these explaining they’re reproduced from memory as you no longer have access to patient records.  

If you are unable to provide formal patient feedback, letters of appreciation from patients can be included. You could also ask your employer or appraiser to report on the feedback received from patients. 

If you are unable to obtain multi-source feedback (MSF), you could provide letters from close colleagues commenting on your performance. If you have had appraisal or performance reviews, you could include evidence of these.

No, your curriculum and family medicine certificate will not be sufficient evidence. The Specialty Specific Guidance carefully sets out how you can present evidence to demonstrate the 13 specific capabilities for general practice. 

You can gather evidence as soon as you complete training, or it may be good to start organising this during the final six months of your programme. Some applicants lose access to patient notes once they leave training so it might be helpful to gather some evidence while you can. Otherwise, you could choose to gather the evidence for your application once you are practising independently as a family physician or general practitioner.  

Case studies form an important part of your application. Our resources for applicants include mini guides (reflection and case studies) and case studies exemplars. At the end of each mini guide, a short video by one of our evaluators highlights many of the things we would like to see in your cases. You can also refer to the Academy of Medical Royal Colleges reports and guidance for information and templates. 

While part of your case study will include an outline of the case, the case study should demonstrate your ability to think critically.

A complete list of resources is provided on the final page of the Specialty Specific Guidance. 

Yes, it is important to present a PDP. We suggest you use the template provided in the Specialty Specific Guidance. It is important that you identify your learning needs and develop your PDP around these. Some of your objectives should relate to general practice in the UK and recognise knowledge and skills you may need to develop for your role in NHS general practice. 

Your PDP will help to show that you are thinking about how general practice in the UK may differ from your current practice and how you intend to adapt to general practice in the UK. 

No, we do not expect applicants to present their research projects, thesis, or dissertation. The exception would be if it relates to quality improvement.

If you wish to include a project report or published article, we suggest you include a summary of it. There is no need to include full length reports or articles, especially if they are lengthy. The evidence you present should focus on your clinical work as a general practitioner.