It has become apparent that some 'generic' safety netting by candidates such as 'phone 999' or 'go straight to A&E' can confuse and even upset patients.

The feedback statements and descriptors around safety netting will be changed to include the words 'appropriate' and 'realistic' safety netting Hence, clinical examination will no longer be a mandatory criterion in the RCA, but clinical examination skills will continue to be assessed in Workplace Based Assessment. In trying to explain to patients what examinations will be carried out in the proposed subsequent face to face consultation, candidates appear to feel that they are required to talk to the examiner rather than the patient. Clinical examination will no longer be a mandatory criterion There have also been many submissions of male breast lumps. We have found that breast lumps score poorly as the management is a straightforward (but appropriate) referral to a fast-track clinic of a breast surgeon with no other management skills that align with the original intention of the criterion. The mandatory criterion was in place to ensure that candidates have the clinical skills to manage obstetrics and gynaecology. The changes have been developed in partnership with the Committee of GP Education Directors (COGPED) representatives and are supported by the GMC: Breast lumps (apart from those associated with the postnatal period) will no longer be considered for the mandatory criteria of maternal and reproductive health It is important to note that these changes cannot be applied retrospectively, and therefore there are no grounds for appeal from candidates who were previously unsuccessful in the RCA. These will apply from the September 2021 diet, the submission deadline for which is 30 September 2021. In response to this feedback, and the valuable input from MRCGP Examiners (themselves practising GPs) based on their observations of submitted consultations, we are making some changes to the RCA. We have listened to feedback from candidates, GP trainers, the wider training community and other stakeholders. The RCA will remain in place to allow for sufficient time for development of the new MRCGP performance assessment module. Changes for the RCA to take effect from the September 2021 diet

Doctors in training workbook