GP Training Pay scales including GP Registrar Pay 2018 – 2019

These are the current pay scales for GP trainees in effect from October 2018 onwards. As the new junior doctor contract is being implemented in England pay scales are now very different in England compared to Wales, Scotland and Northern Ireland. In this article, Dr Mahibur Rahman looks at the current pay scales for both new and old contracts, as well as an estimate of your net pay when in GP practice based posts.

GP Training Pay Scales – New Junior Doctor Contract (England only)

payscales2018

The new contract bases pay on your stage in training: ST1, ST2 or ST3. For hospital posts, the old banding system has been replaced by a complex calculation of pay for hospital jobs which depends on multiple factors including the average number of hours worked per week, number of on calls, frequency of nights, weekend working etc. At the bottom end, some ST1 / ST2 posts with 40 hours per week, no on call commitments, no weekend or night working will have basic pay only of £37,191 (e.g. some public health posts). At the top end, a busy post in emergency medicine with 1 in 3 weekends, an average of 47 hours per week worked and with lots of regular night shifts might give a total package of around £50k.

For posts within a GP practice (when you are designated a GP registrar), there is a fixed additional payment which is £8,448 for the current year pro rata (e.g. if you do 6 months in a GP practice you get half this amount). This allowance is NOT payable when in hospital posts as part of your GP rotation.

If you are training in London, there is an additional London weighting allowance of £2,162 per year.

There is no increase in basic pay between ST1 and ST2.

GP Trainee Pay scales 2018-2019 – Scotland, Northern Ireland and Wales (old contract)

For hospital posts, total pay will depend on the banding (jobs with more on call / antisocial hours carry a higher supplement). Only the most common bands are shown here – some posts may have higher banding payments (Band 1A/2B / 2A). The GP Registrar supplement is currently fixed at 45% – this is for all posts when based in a practice, regardless of the year of  training, or the number of on call or out of hours shifts completed.

If you are entering GP training from another training post, you should start on the paypoint with basic pay that is closest to your current basic pay. E.g. if your current basic is £30,513, you will move onto the StR Min scale, with a basic pay of £30,606 and so on. You will move onto the next point on the scale on the anniversary of your increment date (this should be on your last payslip).

When you are on paypoint StR3 or higher (shown in orange above), you are entitled to an extra 5 days of annual leave – so you will get 30 days instead of 25 in addition to bank holidays. Please note that StR3 is NOT the same as being in your ST3 year. The paypoint is based on past NHS experience, NOT your year of training. For example, a doctor entering GP training straight from Foundation Year 2 will go onto the StrMin payscale during their ST1 year, then StR1 in their ST2 year, and StR2 in their ST3 year. They will have 25 days annual leave in all 3 years of the rotation (you may get 2 extra days for hospital posts). A doctor entering GP training having already completed 2 years of core medical training would start on the StR2 payscale (while in the ST1 year). They would have 25 days leave in this year. In the ST2 year, they would be on the StR3 payscale and get an additional 5 days leave, and so on. There may be slight variations to these payscales between Scotland, Northern Ireland and Wales (a few hundred pounds a year) as annual pay increases are devolved matters.

GP Registrar Salary – Net Monthly Pay – new contract (England only)

Most GP rotations now have 16-18 months in general practice. As there are a lot of costs during the latter part of your GP training, we thought it would be helpful to look at estimated NET pay (i.e. take home pay after Tax, National insurance, and NHS pension). This might help you plan and budget so you can meet the costs of sitting the MRCGP AKT Exam and MRCGP CSA Exam (about £2,000 together) as well as other final year costs such as CCT, indemnity when you qualify as a GP etc.

Payscales2018-net.jpg

GP Registrar Salary – Net Monthly Pay (old contract)

gptraining-pay-oldc

*These figures are estimated monthly take home pay net of income tax, national insurance and NHS pension. They have been rounded down to the nearest pound, and are based on a standard tax code.  As your pay may change during the tax year, the actual amount may differ.  You can get an accurate monthly calculation here (external link).

GP Registrar medical indemnity will be reimbursed less the amount they would have paid for a hospital job.

Pay protection

If you are entering GP training from a training post in a different specialty, or from a non training post in a nationally recognised career grade post (e.g. consultant, specialty doctor, staff grade), then in some cases you may be entitled to pay protection of your basic pay subject to eligibility criteria. Career grade doctors moving from a local grade (e.g. trust grade, trust registrar, clinical fellow) do not get pay protection. Pay protection in the new contract is very complex – you can read an overview here, however I would recommend you contact the BMA for individual advice of your eligibility as in some cases you may be able to get some recognition of past experience on a case by case basis even if standard pay protection does not apply to you.

If you found this article helpful, please do share it with your colleagues!

For regular updates and discussion on topics related to GP training, join our GP Training Support Facebook group

GP-training-FB

Advertisements

10 tips to help you pass the MRCGP CSA

10 tips to help you pass the MRCGP CSA exam

Dr Mahibur RahmanBlutdruck

The MRCGP CSA is a challenging exam, acting as an exit exam for GP training in the UK. In this article, Dr Mahibur Rahman discusses some key tips to help you prepare for and pass the exam.

  1. Understand the basics

The exam is based on a simulated surgery consisting of 13 cases played by simulated patients. The cases will include a range of disease areas and case types, with at least 1 child health case, and at least 2 cases that will significantly test prescribing knowledge. You will have 2 minutes to read the case notes before each consultation, and exactly 10 minutes for the consultation itself. There will be a different examiner with each simulated patient, assessing the same 3 domains in every case: data gathering (history and examination), clinical management (including diagnosis, management, follow up and safety netting), and interpersonal skills (clear explanations, empathy and sensitivity and having a patient-centred approach).

Each domain is graded as either clear pass (3 marks), pass (2 marks), fail (1 mark) or clear fail (0 marks). The total score from all 13 cases determines whether you pass or fail the exam. The pass mark is adjusted each day to take account for the level of difficulty of the cases, but usually ranges from 72-78 out of 117. The total score is the only thing that determines if you pass or fail – there is no minimum score in each case. A candidate that scored 9 in several cases could get 0 in some cases and still pass i.e. you pass or fail the exam as a whole, rather than individual cases.

  1. Join a study group

Forming a study group early on in your preparation for CSA – 6-9 months prior to your exam – can help in many ways. A good number to meet for a study session is 3 – one to be the doctor, one the patient, and one to observe and provide feedback. Some candidates find that being observed makes them nervous and affects their performance – having a colleague observe and be the “examiner” can simulate some of that pressure and over time, help to overcome it. It is also easier for someone observing and making notes to give useful feedback. Agree in advance the importance of being honest and constructive when giving feedback – some registrars feel shy to say anything critical and just focus on the positives when observing others. While this might make you feel good, it won’t help you improve.

Putting yourself in the role of the examiner with a clearly defined mark scheme can also help give an insight into the importance of clearly demonstrating the criteria in the different domains.

  1. Seek feedback regularly

Try to get feedback on your consulting whenever possible. This can be through consultation observation tool (COT) assessments, joint surgeries, during out of hours (OOH) sessions and also during tutorials. Video can be a useful tool – you can watch a few recorded consultations with your trainer, but it can also be helpful to watch some of these back later yourself to pick up on things like body language and non-verbal cues from the patient. It can be helpful to get different perspectives, so ask for other doctors at your practice to observe you and give feedback.

  1. Observe how others consult

Try to do some “reverse” joint surgeries – where you sit in and observe your trainer and other team members consult. This can be a good way to pick up useful tips and good habits from experienced colleagues. You may have a doctor in the team that has a lot of women’s health experience, and may be able to tweak how you explain certain conditions based on their approach. Sitting in with the practice nurse during an asthma clinic might give you some ideas on things like demonstrating inhaler technique or discussing spirometry. Don’t feel that you have to do everything the same way your colleagues do – it is important that you consult in a way that is comfortable and natural to you. You may find that you can adapt your own style and add in what works from others.

  1. Prepare for challenging cases

It is important identify areas you find challenging and actively prepare for them. If you find it difficult to take sexual health history because you get embarrassed when asking sensitive but important questions relating to risk factors for sexually transmitted infections, you should practise this until you can do it confidently. If you do not see many women with gynaecological issues, you could go through important areas of the history and examination in a tutorial or with your study group. Equally, if you have not treated many patients with testicular problems, or erectile dysfunction, you should revise the key parts of the history, examination and management. Try going through the CSA case checklist in the MPS MRCGP Study Guide and go over any areas that you are not confident in. Practise telephone consultations as it can be challenging taking a history when you do not have some of the non-verbal cues that we rely on in clinic.

  1. Learn to manage your time effectively

You have 2 minutes to read the case notes, and exactly 10 minutes to get through each case. Candidates that regularly struggle to complete cases will often get a low score for the management domain, as they may not have had time to discuss treatment options, or to talk about follow up and safety netting. Try to get comfortable with getting through your consultation in 10-12 minutes the month before sitting the exam. You may still be on 15 minute slots, but try to use the last few minutes to type up your notes. It is very difficult for a candidate who regularly needs 16-17 minutes per case in surgery to suddenly shave several minutes from their consulting time in the exam.

  1. Remember all 3 domains are marked in every case

A common myth about the CSA is that it is all about communication skills. While good communication is an essential part of being a good GP, this is only a third of the marks in each case – the other two thirds relate to clinical areas.

Data gathering is about history and examination – it is important to be able to take a focused, systematic history. If you spend too long on the history by asking vague or irrelevant general questions you may find that you get a poor mark for data gathering, and also run out of time and get a poor score for the clinical management domain. Candidates often lose marks in this domain by failing to ask about relevant red flag symptoms to exclude rarer but serious conditions, or forgetting to request an essential examination.

There is a lot to cover in the management domain to get a clear pass – you need to allow enough time to go through the diagnosis, discuss management options, cover other important risks, and to discuss follow up and safety netting. This will usually take 3-4 minutes to cover well. You can also lose marks if your proposed management plan is not in line with current evidence – a good knowledge of current guidelines is very important.

In the interpersonal domain, you may lose marks if you do not build a good rapport, or take on board the patient’s agenda. Work on being able to explain investigations, diagnoses and results in clear, concise language without using technical jargon. Pay attention to both verbal and non-verbal cues – it is important to explore them as there may be an important symptom or issue that will only come out when the cue is explored.

  1. It’s not enough to know it, to get marks you have to show it

Examiners can only mark observed behaviours, so it is important to demonstrate your knowledge and skills clearly in each domain. For example, in the clinical management domain for a case of newly diagnosed Stage 2 hypertension in a 50 year old, a candidate that informed the patient that they would be “starting a once daily tablet for your blood pressure” would not get the marks for correct management. A candidate that wrote a prescription for lisinopril 10mg once daily for 28 days, would. Similarly, a patient with a transient ischaemic attack (TIA) with high risk of stroke needs to be seen within 24 hours by a specialist according to the current guidelines. A candidate that did not make the timeframe clear may not get the marks. For example, saying “I will arrange for the specialists to see you urgently” is unclear in this situation – as a 2 week referral is urgent, but not appropriate for a patient at high risk of stroke. Making it clear that you would arrange for the specialists to see the patient “within the next 24 hours” would be much better.

  1. Treat the exam like a regular clinic

Treat the CSA as a regular 13 patient clinic, with the benefit of a break halfway through, and without having to write up any notes on the computer. Do not do any acting – the only person doing any role play should be the simulated patient. You should be doing the same things you would do with a similar case in real life. Some candidates make up false options that they would never offer in real life or pretend to write a prescription rather than using the sample prescription on the table. This looks awkward and unnatural, and can be embarrassing when the patient points out that there is nothing there! Imagine the examiner is not there – do not look at them, talk to them, or try to engage them in any way – they are there to mark the case, not to influence the outcome. You should focus on the patient, and give them your full attention – just as you would in surgery. If you think there is a relevant examination, you should ask the patient if you can examine, rather than asking the examiner. If you would offer a chaperone for an examination in real life, offer one in the exam. Getting regular practice in your study group or in a joint surgery can help you get used to consulting with an observer in a way that does not affect your focus on the patient.

  1. Focus only on the case at hand

In an exam with 13 cases, it is quite normal to have 1 or 2 cases that either don’t go as well as you would have liked, or that include a rare or high challenge presentation. Remember that a bad performance in any case can be compensated by doing well in others. Just do your best to listen carefully to the patient, try to be safe, and to communicate clearly. At the end of the case, take a deep breath, clear your mind and go into the next case with a positive attitude – otherwise 1 poor case can go on to affect how you score on the next few and have a much bigger impact on your overall score.

Summary

The MRCGP CSA is a challenging exam with a significant failure rate. To pass, you need to demonstrate that you have the skills and knowledge to practise safely without supervision – from taking a structured history and focused examination to being up-to-date with your management. You need to show that you can communicate clearly and effectively with the patient, and engage them appropriately. Finally, you need to be able to manage your time well to get through everything in 10 minutes.

I hope these tips are helpful in your preparation and wish you every success with the exam.

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He has been the medical director of Emedica since 2005 and has taught over 24,000 delegates including those preparing for GP entry exams, MRCGP and on GP careers. He teaches an intensive 1 day MRCGP CSA preparation course in London and Birmingham that includes key theory and high yield topics, exam technique as well as plenty of practise with professional role players in CSA exam conditions. 

Useful links and further reading:

MRCGP Exam Preparation: A revision guide for the AKT and CSA – MPS (includes CSA topic checklist)

Emedica MRCGP CSA Preparation course

Emedica MRCGP CSA Online package – video lectures, high scoring consultations + 65 CSA cases to practise (5 full CSA exam circuits)

Salaried GP Contracts – FAQs

When taking up a salaried GP post, it is important to discuss and negotiate key areas in your contract and agree a job plan. In this article, Dr Mahibur Rahman explores some frequently asked questions about salaried GP contracts.

When should I ask for a contract?

Employers have to give you a written statement covering the main conditions of employment within 2 months of the start of your employment – however, it would be sensible to see this before you agree a start date, and to discuss and negotiate anything that is unclear. If you are a member of the BMA, they have a contract checking service which you can use to get a second opinion on your contract or help with discussions with the employing practice.

What are important areas in the contract to discuss?

A lot of job adverts are unclear with regards to the actual contract or terms of employment. It is important to discuss and clarify the following:

  • Pay – many jobs have no mention of the pay in the advert! You may also wish to discuss when your pay or package will be reviewed (there are no automatic pay rises once you are qualified!).
  • Job plan, including realistic hours or work – if you are expecting to work 9 hours a day, and end up working 12-13 hours most days, the pay that you agreed might not seem so attractive
  • Extended hours, evening or weekend working requirements
  • Leave entitlement – annual leave, CPD / study leave, maternity, sick leave
  • Indemnity cover – will the practice pay or do you have to cover yourself (this can be a significant cost)
  • Recognition of past NHS experience

It can take some time to negotiate and discuss all the important areas, but this is really important as it can have a big impact once you are in post, and you may find it more difficult to make changes after you start.

What is a job plan?

A job plan should outline the details of your role. It could include areas such as:

  • Usual hours of work – including any extended hours
  • Usual number of patients per clinic (morning / afternoon)
  • Time allocated for administration
  • Allocation of home visits
  • Duty doctor or on call doctor sessions – frequency, duties
  • Meetings that you are expected to attend
  • Time allocated for CPD

It is important to agree a job plan before starting, so that both you and the practice are clear regarding the expected hours and workload. If your workload is significantly different or changes after you start, the job plan will be a useful reference point to highlight this. In some cases, this may be helpful to negotiate additional pay or time off in lieu, or to allow you to work more in line with the agreed job plan.

ContractWhat is the BMA model contract?

The model contract sets out standard areas of the contract for a salaried GP that should be offered as a minimum by GMS, and PCO practices. It also applied to PMS practices in England since 2015. It includes the following areas:

  • Pay – the minimum annual salary for a full time post (9 sessions) is £56,525 – many posts advertise pay per session and the bottom end of the BMA scale equates to just £6,280 per session per year. The top end of the scale equates to just under £9,500 per session per year, although some practices may offer more than this.
  • Working hours – full time (9 sessions) is considered 37.5 hours – additional hours should be paid or time of in lieu offered – this is based on a session being 4 hours and 10 minutes
  • Paid CPD time – 4 hours per week paid CPD (1 in 9 sessions)
  • Annual leave – 30 days annual leave + 10 bank holidays / statutory days (effectively 32 days annual leave + 8 bank holidays)
  • Maternity leave – subject to qualification, 8 weeks full pay, 14 weeks half pay, 17 weeks SMP or MA, 13 weeks unpaid leave
  • Sick pay – based on continuous NHS service, up to 6 months full pay + 6 months half pay
  • NHS continuous service – all past continuous service to be recognised (not just employment with the current practice)

What does the term salaried GP cover?

It includes all of the following job titles as well as salaried GPs (this list is not exhaustive):

  • Salaried GP who undertakes special interest work (a GPwSI)
  • GP retainer
  • GP assistant / associate
  • Flexible Career Scheme GP
  • Returner scheme GP
  • Salaried GP employed to work out-of-hours via a PCO

I have a job offer from a PMS / APMS practice. The contract they have offered me has much less paid sick leave / maternity / annual leave / CPD compared to the BMA model contract. What can I do?

The model contract applies to GMS practices, and practices that are directly run by Primary Care Organisations (like Health Boards). PMS practices in England should also offer it for new contracts after June 2015.  PMS practices outside England and APMS practices are not obliged to offer the BMA model contract, although some may offer some or all parts of it as an aid to recruitment. If you are not happy with any part of the offer, it is important to discuss and negotiate with the practice before accepting. Some doctors will be happy to have less paid CPD time in exchange for more annual leave or higher pay. Most areas of a contract are negotiable – hopefully you can come to an agreement that is mutually satisfactory. If you cannot, then there is no obligation to accept an offer that you feel is not adequate – you could look for another post.

There is a lot of variation in contracts offered to salaried GPs between practices, even in the same area. Each practice will have their own way of working and as a newly qualified GP, you may be unfamiliar with negotiating and discussing areas like pay – GP registrars have a standardised contract and the pay scales are nationally agreed. You may find it helpful to discuss any offer with an experienced colleague to get their advice.

Dr Mahibur Rahman is the medical director of Emedica. He teaches on the Emedica Life after CCT: GP Survival Skills course which includes sessions on salaried GP contracts, partnerships and succeeding as a GP locum. It also includes practical advice and demonstrations on how to negotiate contracts. You can see more details at http://courses.emedica.co.uk/acatalog/RCGP_MRCGP_CCT_GP_Careers.html 

Workplace Based Assessment (WPBA) as part of the MRCGP in GP training

Workplace based assessment (WPBA) is one of the 3 components of the MRCGP exam. In this article, Dr Mahibur Rahman provides an overview of WPBA – what it covers, how to gather evidence for it, and when you need to complete certain milestones.

What is WPBA?

WPBA is a continuous assessment process throughout the 3 years of GP training. It is designed to support development through feedback on various competences both in hospital and GP posts.

It is based around 13 areas of professional competence:

  1. Communication and consultation skills – use of recognised consultation techniques to communicate effectively with patients
  2. Practising holistically – using physical, social and psychological context to provide holistic care
  3. Data gathering and interpretation – effective history taking, choice of examinations, investigations and their interpretation
  4. Making a diagnosis and making decisions – a conscious, structured approach to decision making
  5. Clinical management – recognition and management of common medical conditions in primary care
  6. Managing medical complexity and promoting health – aspects of care beyond managing straightforward problems, including management of co-morbidity, uncertainty, risk and focusing on health and well-being rather than just illness
  7. Organisation, management and leadership – understanding the use of computer systems in practice, change management, and the development of organisational and clinical leadership skills
  8. Working with colleagues and in teams – effective team working and the importance of the multi-disciplinary team
  9. Community orientation – management of the health and social care of the practice population and local community
  10. Maintaining performance, learning and teaching – maintaining performance and effective CPD
  11. Maintaining an ethical approach to practice – practising ethically, with professional integrity and a respect for diversity
  12. Fitness to practise – the doctor’s awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk, and taking action to protect patients
  13. Clinical examination and procedural skills – competent physical examination of the patient with accurate interpretation of physical signs and the safe practice of procedural skills

These competences are assessed in different ways throughout training, the idea being that you should achieve the standard expected of a qualified GP in all of them before you complete training.

How do I meet the requirements for WPBA?

You will need to gather evidence that you have achieved the competences using various tools. Some are used only in the GP setting, some only in hospital while others can be used in both settings. The tools are:

Tool Hospital GP
Case-based Discussion (CbD)

A structured interview assessing professional judgement in clinical cases – based around real cases you have seen.

Consultation Observation Tool (COT)

A review of patient consultations by your trainer – either video recordings or direct observation in a joint clinic.

Multi-Source Feedback (MSF)

Collection and reflection on feedback from colleagues on your clinical and professional skills. This is from clinicians only in hospital, and both clinicians and non-clinicians when in GP.

Patient Satisfaction Questionnaire (PSQ)

Feedback from at least 40 patients on your empathy and relationship building skills during consultations.

Clinical Examination and Procedural Skills (CEPS)

Assessment of various clinical examination skills and competence in performing key procedures – this includes intimate examinations.

Clinical Evaluation Exercise (MiniCEX)

Assessment of clinical skills, attitudes and behaviours in a secondary care setting – based on direct observation of your interaction with a patient for around 15 minutes.

Clinical Supervisors Report (CSR)

A short, structured report from your clinical supervisor looking at the competences in 4 clusters: relationship, diagnostics, management and professionalism. This is usually completed for each hospital post, although it can be used in GP posts.

(☑)
Learning Log

This is your personal learning record and should be used to reflect regularly on learning experiences. These can be linked to relevant curriculum headings.

Personal Development Plan (PDP)

This is used to allow you to demonstrate that you can assess your learning needs and plan actions to meet them. Items in the plan should be reviewed with evidence to demonstrate that you have achieved them.

Are there a minimum number of assessments I need to complete?

You will usually meet your educational supervisor every 6 months for a review of your progress. You will be asked to complete a self-assessment prior to each meeting. The guidance of how often each tool should be used is shown below – remember that the quality of entries and assessments is as important as the quantity. Some doctors will need to do more than the minimum to reach a suitable standard. The minimum evidence given here is based on a 3 year rotation with 18 months in hospital and 18 months in practice for a full time trainee.

Year of training Minimum evidence
GP ST1

Prior to 12 month review

6 x mini-CEX (if in secondary care) / 6 x COT (if in primary care)
6 x CbD
2 x MSF (each with a minimum of 5 replies from clinicians plus 5 non-clinicians if in primary care)
1 x PSQ (if in primary care)
CEPS as appropriate
1 x CSR from each hospital post
GP ST2

Prior to 24 month review

6 x mini-CEX (if in secondary care) / 6 x COT (if in primary care)
6 x CbD
1 x PSQ (if in primary care and not already completed in ST1)
CEPS as appropriate
1 x CSR from each hospital post
GP ST3

Minimum prior to 36 month review

12 x CbD
12 x COT
2 x MSF (each with 5 clinicians and 5 non-clinicians)
1 x PSQ

Less than full time trainees, and those on 4 year rotations (including academic trainees) have different requirements – you can read more about this here: http://www.rcgp.org.uk/training-exams/mrcgp-workplace-based-assessment-wpba/less-than-full-time-trainees.aspx

Summary

WPBA is an important component of the MRCGP, and alongside the MRCGP AKT and CSA, assessed readiness for independent practice as a GP. It also offers a way to record your learning, gain feedback on areas to improve and to provide evidence of your achievements. It is important to keep on top of the different learning tools and gather the necessary evidence in a timely manner so you can successfully progress through training.

Further reading:

RCGP WPBA overview: http://www.rcgp.org.uk/training-exams/mrcgp-workplace-based-assessment-wpba.aspx

GP Training Payscales including GP Registrar Pay 2016 – 2017

These are the current payscales for GP trainees in effect from August 2016 onwards. Current trainees will start to be moved to the new junior doctor contract from October 2016 onwards – we will publish an update if this is implemented, once full details are available.  For hospital posts, total pay will depend on the banding (jobs with more on call / antisocial hours carry a higher supplement). The GP Registrar supplement is currently fixed at 45% – this is for all posts when based in a practice, regardless of the year of  training, or the number of on call or out of hours shifts completed.

GP Trainee Payscales 2016-2017

gptraining-pay-2016

If you are entering GP training from another training post, you should start on the paypoint with basic pay that is closest to your current basic pay. E.g. if your current basic is £29,500, you will move onto the StR Min scale, with a basic pay of £30,302 and so on. You will move onto the next point on the scale on the anniversary of your increment date (this should be on your last payslip). If you are entering training from a non training post, then you may be entitled to pay protection if you are in a nationally recognised career grade post (e.g. consultant, specialty doctor, staff grade). Career grade doctors moving from a local grade (e.g. trust grade, trust registrar, clinical fellow) do not get pay protection.

When you are on paypoint StR3 or higher (shown in cream above), you are entitled to an extra 5 days of annual leave – so you will get 30 days instead of 25 in addition to bank holidays. Please note that StR3 is NOT the same as being in your ST3 year. The paypoint is based on past NHS experience, NOT your year of training. For example, a doctor entering GP training straight from Foundation Year 2 will go onto the StrMin payscale during their ST1 year, then StR1 in their ST2 year, and StR2 in their ST3 year. They will have 25 days annual leave in all 3 years of the rotation. A doctor entering GP training having already completed 2 years of core medical training would start on the StR2 payscale (while in the ST1 year). They would have 25 days leave in this year. In the ST2 year, they would be on the StR3 payscale and get an additional 5 days leave, and so on.

GP Registrar Salary – Net Monthly Pay

Most GP rotations now have 16-18 months in general practice. As there are a lot of costs during the latter part of your GP training, we thought it would be helpful to look at estimated NET pay (i.e. take home pay after Tax and National insurance). This might help you plan and budget so you can meet the costs of sitting the MRCGP AKT Exam and MRCGP CSA Exam (about £2,100 together) as well as other final year costs such as CCT, indemnity etc.

gp-registrar-pay2016*These figures are estimated monthly take home pay net of income tax and national insurance. They have been rounded down to the nearest pound, and are based on a standard tax code.  As your pay may change during the tax year, the actual amount may differ.  You can get an accurate monthly calculation here (external link).  These figures do not include deductions for the NHS pension – although you can put pension into the calculator to get an accurate amount. If you are paying into the NHS scheme, expect a take home pay around £200 a month lower than the figures above.

GP Registrar’s medical indemnity will be reimbursed less the amount they would have paid for a hospital job.

10 tips to help you pass the MRCGP AKT exam

Dr Mahibur RahmanMRCGP AKT Courses The MRCGP AKT exam is a challenging exam, testing applied knowledge relevant to UK general practice. In this article, Dr Mahibur Rahman discusses some key tips to help you prepare for and pass the exam.

  1. Understand the basics

The exam lasts 3 hours and 10 minutes, and consists of 200 questions. 80% of the questions relate to clinical medicine, 10% to evidence based practice, and 10% the organisational domain. The exam is computerised, and there is now access to a basic on-screen calculator if needed. The majority of questions are single best answer and extended matching questions. Other formats include algorithm questions, short answer (you type the correct answer into a box), video questions, and picture based questions.

  1. Fail to prepare, prepare to fail

Allow enough time to revise all material in the exam – most candidates need 3 or 4 months to be able to cover everything sufficiently well to pass the exam. We help a lot of candidates prepare when they are resitting the exam – a common finding amongst candidates that failed the exam is that they had not realised how long it would take to prepare, and did not have enough time to complete their revision. The curriculum is large and covers a broad range of topics – try to have a systematic approach to allow you to cover all the important topics adequately. The RCGP has produced an AKT topic review which details the key areas and subjects covered in the exam.  The MPS has produced a more concise checklist of key topics that frequently feature in the exam as part of their free MRCGP Study Guide.

  1. Focus on the clinical domain

Aim to spend the majority of your revision focusing on the clinical domain – this makes up 80% of the marks and questions (160 questions). Someone who scored very poorly in this area (under 60%) would usually fail the exam – even with 100% in the other domains. Overall, a poor score in this domain is the most common cause of failure in the AKT exam. This domain also takes the longest amount of time to cover as the bulk of the curriculum is focused on clinical topics. Questions from the clinical domain can include those relating to making a diagnosis, ordering and interpreting tests, disease factors and risks, and management. It is important to have a good knowledge of key guidelines – NICE, SIGN, BTS etc. for common and important disease areas as they are frequently tested.

  1. Revise core statistics and evidence based practice

10% of the exam is evidence based medicine, including basic statistics, graphs and charts and types of study. These offer easy marks if you make sure you have a good grasp of the basic concepts and can interpret common charts and graphs. Make sure you can calculate averages (mean, mode, median), numbers needed to treat, sensitivity and specificity as well as understanding absolute and relative risk, odds ratios, p values, 95% confidence intervals and standard deviation. You should be able to interpret scatter plots, L’Abbe plots, Forest plots, funnel plots as well as Cates plots. Finally, you should be able to understand the usage of common study types including cross sectional surveys, case control studies, cohort studies and randomised controlled trials.

  1. Don’t forget the organisational domain

This makes up another 10% of the exam, and is the area that candidates tend to do worst on. These areas can be dull to read, but learning about practice management, QOF, certification, DVLA guidelines and legal duties of doctors will not only get you easy marks, it will be useful when you qualify.

  1. Learn from other people’s mistakes

Read through the examiners’ feedback reports to see which topics caused trainees problems, as they are usually retested in the next few exams. Having analysed every feedback report published so far, it is interesting to note that the same subjects get featured repeatedly! In the last feedback report, there was not a single topic that had not already featured as an area of poor performance in a previous report.

  1. Make the most of your revision time

Effective revision should combine reading with practising questions. Try to practise questions to time, as time pressure is a big issue with this exam – you have about 57 seconds for each question! If you get a question wrong, try to read more broadly about the subject to gain a deeper understanding. By relating it to a question you have just answered, you are more likely to retain the information. Concentration drops dramatically after an hour, so try to revise in chunks of no more than an hour at a time. Take a short break – even 10 minutes to make a hot drink, or get some fresh air is often enough to refresh you and improve concentration for the next burst of revision.

  1. Learn the subject, not the question

Some candidates approach AKT revision by picking an online revision service and then go through all the questions multiple times. This can lead to a false sense of security and ultimately failure in the exam. Repeating the SAME questions multiple times provides very little additional benefit. Often complex questions such as data interpretation are answered the second time by remembering the pattern rather than understanding the subject. In the exam, you will not get the same question, but a different one testing knowledge of the subject. While your mark will improve with each repeated attempt at the same questions, your knowledge may have only improved marginally (having seen the correct answers the first time, it is not surprising that you get most of them correct the next time). A better approach is to read up on the subjects and explanations after doing a set of questions, and then once you complete all the questions, move on to a different set of questions from a different service or book. This will give you a better idea of how well you have understood the topic and retained the knowledge.

  1. Read the question carefully

Many candidates that have a good knowledge base still fail the AKT by a few marks. This can be owing to poor exam technique. It is really important to read the question carefully to prevent losing marks for silly mistakes. This can relate to the instructions – some questions ask you to drag the right answer into a certain part of the screen. Clicking the right answer instead of dragging it will gain no marks. It is important to watch out for and to understand certain keywords – if the question asks for a characteristic feature, it means it is there in almost every case (90% or more) – whereas if it asks for a feature that is commonly seen in a condition, it only needs to be there in around 60% or more of cases. Some questions are negatively framed – “which of the following is not part of the Rome III criteria for diagnosing irritable bowel syndrome?” – candidates that fail to spot the “not” in this question could easily select the wrong answer despite knowing the Rome III criteria.

  1. Keep to time

To complete the entire paper, you have just 57 seconds per question. Try to be disciplined – if you are not entirely sure of the best answer, it is better to put down your best guess after about 55 seconds and move on. You can flag questions for review, so you could try to come back if you finish a little early to look at those are unsure of. By being strict with your time, you will at least pick up all the easy marks for topics that you have covered in your revision. Candidates that spend 2-3 minutes struggling with a few really challenging questions often end up unable to complete the paper. They may have missed easy marks from questions at the end of the paper that they did not see. It is useful to have some pace checkpoints – try to finish 33 questions every 30 minutes. At this pace, you will have completed 66 questions after 1 hour, 99 at 1.5 hours, and complete the whole paper with just under 10 minutes left to go over any questions flagged earlier.

Summary The MRCGP AKT is a challenging exam with a significant failure rate – over 1 in 4 candidates fail each exam, with the long term mean pass rate around 73%. It covers a large curriculum, so it is important to allow enough time and to have a plan to enable you to prepare in a systematic way. A lot of the knowledge gained from preparing will help you not only in everyday practice, but also for the MRCGP CSA examination. By mixing reading with practice questions, you should have both the knowledge and the exam technique to allow you to pass well.

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He has been the medical director of Emedica since 2005 and has taught over 20,000 delegates preparing for GP entry exams, MRCGP and on GP careers. He teaches an intensive 1 day MRCGP AKT preparation course in London, Birmingham and Manchester that covers all 3 domains. The course includes key theory and high yield topics, exam technique as well as mock exams in timed conditions. You can get a £25 discount by using the code passmrcgp

Details of the course are available at http://courses.emedica.co.uk/acatalog/nMRCGP_AKT_Preparation.html

MRCGP AKT Course

MRCGP AKT Exam Revision – High Yield Topics from the January 2015 AKT Exam

MRCGP AKT Exam – High Yield Topics from the January 2015 AKT Exam

Dr Mahibur Rahman153080449

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be preparing for the April or October MRCGP AKT Exam at the moment, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the January 2015 MRCGP AKT exam:

The top score was 97.5%
The mean score was 76.9% (this is higher than usual)
The lowest score was 45%
The pass mark was 71.5% (this is the highest it has ever been so far)
The pass rate was 75.8% (higher than average sittings)

Scores by domain:

Clinical medicine – 77.1%
Evidence interpretation – 77.2%
Organisational – 74.8%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Sickness certification
  • National screening programmes
  • Immunisation
  • Emergencies – including anaphylaxis, CPR
  • Antibiotic prescribing
  • Serious but rare conditions – adults and children
  • Childhood asthma management
  • Contraception – including “quick start”
  • Headaches

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Our AKT course offers comprehensive coverage of all 3 domains, and is updated after every exam to take account of high yield topics from the examiners’ feedback reports.

Further reading:
Complete Examiners’ report – January 2015 MRCGP AKT Exam