1. Vocational Training & Certification


	VOCATIONAL TRAINING became established throughout the United Kingdom in the 1970s. It became mandatory with the implementation in 1981 of the NHS (Vocational Training) Regulations. Training has to date consisted of 24 months in approved hospital posts and 12 months in General Practice. There will be more opportunities, in the future, to spend 18 months in the general practice component as a result of new legislation in the NHS (Primary Care) Act 1997. Training which follows the standard format is called Prescribed Experience. There are time limits for completion of prescribed experience and where training does not conform to the requirements but the doctor feels it is equivalent experience, then they may apply for a certificate of Equivalent Experience. Both certificates are equally valid for the purposes of entry into general practice. Vocational training is organised regionally in the UK. Directors of Postgraduate General Practice Education have responsibility for provision and organisation of training within their region. Training can be by means of a formal three-year vocational training scheme or a self-constructed scheme. Posts must have approval for GP training to be recognised. As yet there is no national database of posts approved for training although the RCGP is planning to set one up. On completion of training, doctors can apply to Joint Committee on Postgraduate Training for General Practice (JCPTGP) for a certificate of prescribed or equivalent experience. This is in essence a licence to practise as an unsupervised GP in the NHS. Since September 1996 the JCPTGP has expected all doctors completing training to demonstrate that they have achieved a minimum level of competence to practise independently. This requirement has meant that there has been a professional expectation that all doctors completing training will have passed Summative Assessment. (See chapter on Summative Assessment). From January 30th 1998 it became a legal requirement. It is hoped that the JCPTGP will soon enable a pass in the MRCGP to exempt registrars from Summative Assessment (and therefore having to sit two assessments). The MRCGP is the standard of excellence in general practice taken by the majority of registrars at the end of their training. Joint Committee on Postgraduate Training for General Practice (the JCPTGP) The Joint Committee on Postgraduate Training for General Practice is an independent body, set up in 1976, to be responsible for setting the standards of general practice training and monitoring the performance of regions who are responsible for providing training programmes. In 1981 the Joint Committee was appointed by the Secretary of State to administer the NHS (Vocational Training) Regulations and to issue Certificates of Prescribed and Equivalent Experience. It consists of the two main representative bodies in general practice; the GMSC and the RCGP and has representation from other bodies (see below). It aims to ensure the highest standards of training, education and support for training GPs. The committee’s main responsibilities are to set the standards of training and it has produced guidance on its expectations for Accreditation of Regions and Vocational Training Schemes which includes the selection of training practices and hospital posts. The Joint Committee monitors the extent to which its guidance is followed during inspection visits to regions and schemes. The committee has an honorary chairman and two joint honorary secretaries, all of whom are GPs. It now also includes representatives from: United Kingdom Conference of Postgraduate Advisers in General Practice Association of University Departments of General Practice Association of Course Organisers Joint Consultants Committee National Association of Clinical Tutors United Kingdom Conference of Postgraduate Medical Deans Armed Services General Practice Approval Board The committee has registrar representatives elected by the GMSC Registrar Sub-Committee and by the RCGP. JCPTGP booklets on Accreditation of Regions and Schemes for Vocational Training in General Practice and Training for General Practice are available from the secretariat. Regulations NHS (Vocational Training) Regulations 1979 came into force on 16th February 1980. These made vocational training mandatory for doctors entering the profession as principals after 15th February 1981. The regulations were amended by European law which facilitated the free movement of doctors and mutual recognition of their qualifications and training. The amended regulations (Vocational Training for General Practice (European Requirements) Regulations 1994) came into force on 1st January 1995. Until these 1994 amendments locums and assistants could practise simply on the basis of their full registration with the GMC. Only for those who wished to work as principals was vocational training mandatory. From the 1st January 1995 all doctors working in general practice in the NHS (other than GP registrars) must have a certificate of prescribed or equivalent experience from the JCPTGP or have a certificate issued by another equivalent authority in another European Member State or be exempt (see later) or have an acquired right (see later). Without such certificates, exemption or acquired rights doctors cannot legally work in general practice. Prescribed experience For training to be eligible for a certificate of prescribed experience doctors should: Undertake training in the UK in posts specifically approved for GP training totalling not less than 36 months whole time employment; Complete training within seven years immediately preceding application for a certificate; Include at least 12 months whole time employment within the NHS as a trainee general practitioner (GP Registrar); Include training in hospital or community medical posts, specifically approved for GP training, including not less than six months whole time employment in each of two of the following listed specialities: general medicine, geriatric medicine, paediatrics, psychiatry, accident and emergency or general surgery, obstetrics and/or gynaecology. Training in specialities not listed but relevant to general practice is normally acceptable as contributing up to six months of the total training period. Equivalent experience Doctors who have not completed a formal vocational training programme or whose programme includes posts held more than seven years from the time of application may present particulars of their experience to the Joint Committee for assessment of its equivalent value. Certificates of equivalent experience are normally given if the experience is acquired within the ten years immediately preceding the date of application and if applicants have shown continuity of clinical contact/activity throughout the ten-year period. Part time training Training can be full or part time but time must not be less than 60% of whole time and both the hospital and general practice complement of training must include one period of full time employment lasting at least one week. In working 60% of whole time, trainees have to spend 40 months in hospitals and 20 months in general practice. Part time training should be discussed with the Director of Postgraduate GP Education to ensure it complies with the regulatory requirements. Further guidelines are available from the Joint Committee. Documentation Completion of each period of training is demonstrated by the completion of statutory forms. Form VTR1 is used for the general practice component and Form VTR2 is used for the hospital components (one for each post). The forms are available from departments of medical personnel for hospital posts and from regional directors’ offices or health authorities (and boards) and are signed by the trainer. Completed forms have to be endorsed by the Director of Postgraduate General Practice Education. Trainees are strongly advised to obtain VTR forms at the end of each appointment. Leaving collecting forms to the end of training can cause a delay in the issue of a certificate and therefore the ability to work unsupervised in general practice. Only original certificates can be submitted. From 4/9/96 doctors applying for a certificate of prescribed or equivalent experience will also be expected to provide evidence that they have passed summative assessment. The seven year rule All the training you wish to put forward must be contained within the seven years immediately preceding the date of application for a certificate of prescribed experience. So if you were applying for a certificate in 1997, the first of your SHO or GP registrar jobs should have been completed in 1990 or later. You don't have to start all over again, if say, you started your training in 1988; the JCPTGP would automatically consider it for equivalent experience but you would need to provide details of ‘clinical continuity’ up to 1997. Training outside the United Kingdom but within Europe If doctors have trained within Europe and they hold a certificate of vocational training or acquired rights issued by another member state, they are exempt from GP training in the UK. If not, they can submit evidence of their posts held abroad for consideration towards a certificate of equivalent experience. Special forms are available for hospital posts held in Europe. Training outside the United Kingdom and outside the EC Doctors who have trained overseas need to apply for equivalent experience for these posts and complete form OSF/R for hospital posts. This should be done as early as possible and preferably long before the general practice component of their training. Enquiries overseas can take weeks. Enquiries about whether a post is approved for training should be addressed to the local director of postgraduate general practice education. Enquiries on partially completed training and the additional need for certification should be addressed to the Joint Committee. Nationals of EEA countries should contact the GMC who will issue advice to the doctor and the JCPTGP. Application for certificates of prescribed experience There is no fee Prescribed experience certificates take about two weeks to be processed; GP registrars can apply during the last four weeks of their final training post; Certificates should be sent with a covering letter stating your full name, GMC number and address for the certificate to be returned (by recorded delivery); Current GMC certificate and original VTR forms must be sent; Confirmation from the local DPGPE of a pass in summative assessment. Applicants for certificates of equivalent experience Certificates should be sent with a specific application form (OSF forms for overseas hospital posts); Provide an address for the certificate to be returned (by recorded delivery); Current GMC certificate and original VTR forms must be sent; References and job descriptions from such posts may help the application. Exemptions Exemptions from the requirement to hold a certificate apply if: You were a principal in NHS general practice on or after 15 February 1981 (or were working in Defence Medical Services in a capacity equivalent to that of an NHS principal); You were a principal in NHS general practice before 15 February 1981 and re-entered a medical list before 15 February 1990; If you have a recognised primary medical qualification from an EEA member state (other than the UK) and were established in the UK on 31 December 1994 as a fully registered medical practitioner by virtue of that recognised qualification; If you provided limited general medical services and were included in the medical list of a health authority or health board as providing such services on 31 December 1994; If you hold a certificate/diploma of completion of training for general practice or a certificate of acquired rights issued outside the United Kingdom but within the EEA. Acquired rights This is the term used in the European Directive which enables EU States to grant certain doctors the right to practise as GPs without the need for a certificate. In the UK, the doctors this includes are: Those practising as principals in general practice in the NHS on 31 December 1994; All who are eligible to become principals under NHS (Vocational Training) Regulations by virtue of the fact that they were principals in general practice on or after 15 February 1981 or were employed in the Armed Services and have a statement of exemption from the Director General of Medical Services; All doctors who worked as an assistant (including retainees) or deputies (including locums) in NHS general practice on either 10 separate days in the four years or 40 separate days in the 10 years ending 31 December 1994 hold an acquired right to work in either of those capacities but not as a principal. Doctors who hold a recognised primary medical qualification awarded in an EEA State other than the UK and, were established in the United Kingdom on 31 December 1994 as a fully registered medical practitioner by virtue of that qualification, which is recognised by virtue of the Medical Directives. Much of the detail of these pages has been taken from the JCPTGP’s booklet ‘Guide To Certification’. I am grateful to Kate Farbey, Certification Officer, for her help with this summary. Doctors still unsure of their position can obtain a copy of the booklet from the secretariat. It is recommended that detailed enquiries are sent in by letter as the secretariat is not likely to be in a position to give full answers without careful consideration of the individual’s circumstances. Joint Committee on Postgraduate Training for General Practice, 14, Princes Gate, Hyde Park, London, SW7 1PU Telephone: 0171 581 3232 Fax: 0171 589 5047