Combined training

1. Apply to GP training through the GP National Recruitment Office (GPNRO) and select the “ATCF” or “CCT (CP)” option on your application

• You must ensure you understand what these pathways entail and be confident that you are eligible before selecting either option and you should select only one option.
• It is not possible to apply for these pathways once you have commenced the training programme.

2. Register with the RCGP at least one month before your training programme commences. This will give you access to the Trainee Portfolio.
3. Your HEE office or deanery will invite you to upload your CV to the Trainee Portfolio for review. You should discuss your previous experience with them at the earliest opportunity so they can confirm if you are eligible to apply, plan your GP training programme and confirm what evidence you will need to provide to support your application.
4. If you are eligible to apply for combined training, you will be invited to complete the online application in the Trainee Portfolio.
5. You should complete and submit the application within one month of your HEE or deanery team inviting you to apply.
6. Your HEE or deanery assessment team will review your evidence and consult the RCGP to determine how much of your previous experience may contribute towards your GP training programme.
7. The final decision on how many months your previous experience can contribute towards the three-year programme will be made around six months (full time equivalent) into your ST1 phase by an ARCP panel.

More information can be found in the applicant guide to applying for combined training.

You must include the following evidence in your application.

Curriculum vitae (CV)

An up-to-date CV with details of all training, posts and experience within the last five years.

Annual reviews of competence progression (ARCPs)

The most recent ARCP outcome forms from your previous specialty training programme which must document at least 12 months full-time equivalent of training.

Acceptable format for ARCP evidence

• A PDF version of the original ARCP/s (downloaded directly from a training portfolio)
• A scanned image of a paper ARCP
• Screenshots from an online training portfolio can only be accepted if it is clear from the image/s that you are signed in to your own portfolio and the whole form is captured.

We are unable to accept photos of ARCPs, or ARCPs copied into a word processing programme, e.g. Word.

If your ARCP form covers less than 12 months of clinical training time or you have been working less than full time or as an academic trainee, you should provide additional ARCP/s to ensure a minimum 12 months FTE approved clinical training is clearly documented.

If your ARCP form/s from your previous training programme carry an outcome 2, 3, 4 or N22, it is essential that you provide an explanatory statement in the field provided and reflect on how any issues identified will be addressed in the GP training programme.

You must include the following evidence in your application.

Curriculum vitae (CV)

An up-to-date CV with details of all training, posts and experience within the last five years.

Statements of employment

A letter from your medical staffing team or supervisor for each post included in your application. Job offer letters or contracts of employment as confirmation of employment are not acceptable. The letter must include:

• your full name
• your grade
• the specialty
• the precise dates of your employment, whole or part time
• If the post was completed part time, as a locum doctor or in an academic role, the letter must also include confirmation of your average weekly clinical hours.

Job or post descriptions

A job description for each post you would like considered towards your application.

If a job description is not available, you may write an account of your duties which should be signed by your clinical supervisor.

Appraisal documentation

Recent appraisal documentation and evidence collected to support your appraisal that may be relevant to your application.

References or end of post reports

This may include references written by your supervisor. If your application includes training in another UK specialty training programme, you should include your ARCP (Annual Review of Competence Progression) outcome forms.

If you have other evidence of review of your performance and progress in post, this may also be useful to include.

You must include the following evidence in your application. All evidence must be presented in English.

Curriculum vitae (CV)

An up-to-date CV with details of all training, posts and experience within the last five years.

Summary or index of posts and evidence

A list of the posts you are putting forward clearly stating the documents you have submitted for each one.

Job or post descriptions

A job description for each post you would like considered towards your application.

If a job description is not available, you may write an account of your duties which should be signed by your clinical supervisor.

If your post was part of a formal training programme

You must provide a letter from your programme director or training provider describing:

• the programme structure
• the programme content
• any assessments you completed as part of the programme.

If your post was in general practice

You should provide information about your role and the healthcare context in a statement describing:

• the setting
• your role and responsibilities
• how your work was supervised
• the primary care team
• your work with other teams and services
• your daily case load
• your case mix or patient population

Visit our website to read exemplars of reflective case studies.

To help with this, you may wish to include your reflections on cases you managed while working in general practice outside the UK. Visit our website to read exemplars of reflective case studies.

A statement signed by your clinical supervisor for each post to be considered.

The statement must include:

• your full name
• your grade
• the specialty
• the precise dates of your employment, whole or part time (including average weekly hours)
• details of your performance and progress in the role
• your clinical supervisor's signature

Evaluations or reviews of performance

These might include reports and evaluations completed by your supervisor or visiting assessor and workplace-based assessments.

Testimonials and reference letters

These should include details of your role and level of responsibility in the post(s) you are presenting. A maximum of three letters is recommended.

To support the capability mapping, you should include 2 to 3 pieces of evidence which demonstrate your skills and performance in each capability.

• You should only include evidence from and reflect on the posts being reviewed as part of your application. Please do not include evidence from other roles, or from your Foundation or GP training programme.
• All evidence should be provided in PDF format and uploaded to your application in the Trainee Portfolio.
• Evidence of assessments from previous training should be downloaded directly from your training portfolio and referenced against the appropriate capability.
• Your evidence should be relevant to the linked capability and might include:
  • Workplace-based assessments
  • Case studies and reflection
  • Multi-Source Feedback (MSF)
  • Patient feedback
  • CSRs, testimonials or references
  • Evidence of appraisal
  • Significant or learning event analysis
  • Evidence of quality improvement or audit
  • Reflection or feedback on teaching delivered
  • Certificates of courses attended
  • Evidence of relevant exam passes or qualifications
• You should select specific pieces of evidence for each capability and avoid attaching a large training portfolio as evidence against a capability. If you are unable to extract specific pieces of evidence to upload, you must reference specific assessments or pages within the portfolio that demonstrate your performance within the capability.
• Some pieces of evidence may be relevant to more than one capability so you can link evidence to more than one section if appropriate. However, try to avoid using the same piece of evidence several times to ensure a broad range of evidence is provided.
• Some capabilities may be more difficult to develop in non-primary care placements so you may not be able to provide evidence for all 13 capabilities. Where you cannot provide evidence to support a capability, reflection is still required to support the development of a learning plan once you begin your training.

Example 1: This is an example of an excellent entry, where using the suggested template enabled reflection in a particular capability.

Capability: Communication and consultation skills

1. How previous experience has helped you develop skills within the capability and how your chosen evidence demonstrates this.

In my role as locum doctor, I communicated with patients and their relatives on a daily basis and had many experiences throughout the year interacting with patients where factors made communication challenging, for example with patients who were under the influence of drugs and alcohol, patients with psychosis and patients who didn’t speak English as a first language. Many of these interactions were in A&E where I had to make a safe assessment, investigate as appropriate and make a robust management plan in a time-limited setting. I became familiar working with the use of translators.

2. How this experience is transferable to general practice.

The experience I have gained is transferrable to GP training because in General Practice it is important to get to know a diverse group of patients, their beliefs and their social situations, and develop rapport and working relationships with them. It is important to be able to provide clear explanations to patients, to gauge their understanding, and to be able to break difficult news. Though it is much less likely to be an emergency, situations where I will need to break difficult news will be frequent – for example telling someone they have a lifelong chronic condition such as COPD or heart failure. I will also need to discuss the future and anticipatory care plans with patients and their families.

3. Gaps in skills or knowledge and how you will address them during your general practice training

• Develop knowledge of recognised consultation skills and gain experience using these in my practice.
• Develop knowledge of recognised consultation frameworks to structure my consultations through reading about the theory, and develop skills in practice with feedback on my performance from my supervisor.
• Develop skills in telephone triage and consultations, if necessary, using telephone translation – by shadowing colleagues and attending RCGP workshop on telephone consultation skills.

Example 2: This is an example of an entry that is unlikely to be approved for combined training.
It is a narrative statement with little reflection and no justification of how the experience is transferable to general practice. There is also no learning plan or identification of gaps in knowledge.

Capability: Communication and consultation skills

As part of my role, I must escalate certain patients to the attention of more senior colleagues. This happens on almost a daily basis and because we are often very busy and under time pressure. It is important to communicate information in a concise manner. I use the SBAR technique to do this which is a framework for discussing patients with colleagues. I have received positive feedback about my communication with patients from both patients and colleagues. I am empathetic to patients and listen to what they have to say and their concerns, thus gaining their trust. My explanations are simple, and I make the patient feel part of the decision-making process and as a result.

Example 3: This is an example of an entry with insufficient reflection to be accepted for combined training. The entry is very brief and is a statement rather than providing any reflection.

Capability: Clinical management

I have worked autonomously managing patients in clinic and on the wards. This will help me to manage patients in GP.

Example 4: Although there is reflection in this entry, it is less relevant to GP so would be a borderline submission. If there had been reference to the RCGP descriptors and a focus on skills rather than specific conditions this would have improved the submission. A learning plan has also not been included.

Capability: Data gathering and interpretation

My experience as a surgeon in different countries has enabled me to develop a strong ability in data gathering and interpretation, understanding different cultural backgrounds and beliefs. I have been able to effectively assess the urgency of care based on symptoms, patient history, and physical examination, and to accurately diagnose the patient. My experience in triaging and assessing patients for urgent care has been a valuable skill that I can apply to my new career as a GP. In my current role as a GP, I will be able to provide a more comprehensive assessment of a patient's condition and be able to accurately determine which patients require immediate care as those with the acute abdomen (appendicitis /cholecystitis /diverticulitis / pancreatitis) and which can wait for the follow-up. Working as a colorectal surgeon will enable me to interpret the patient's symptoms and deal with different colorectal cases as haemorrhoids, fissure, fistula, colonic polyps, IBD, and being aware and comfortable with when to refer to secondary care and when to consider 2WW referral.
These skills and experience will continue to serve me well in the future.